Episodes

2d ago

If you've been wondering whether your "anxiety" might actually be ADHD (or both), this episode helps you sort through the overlap by focusing on the driver behind your symptoms—so you can get clarity, support, and the right tools.

Dec 10

In this episode, Kimberley breaks down why OCD themes shift so quickly and teaches you how to generalize your ERP skills so you can respond effectively—no matter what obsession shows up.

Dec 4

In this episode, Kimberley breaks down why holiday anxiety feels so overwhelming and teaches you compassionate, practical strategies to help you move through the season with more ease, clarity, and self-kindness.

Nov 24

This episode breaks down how OCD can quietly strain relationships and teaches partners practical, compassionate strategies to communicate better, set healthy boundaries, and reconnect as a team.

Nov 17

In this episode, we share how to stop "white-knuckling" your anxiety and instead use compassion, mindfulness, and gentle allowing to find lasting calm and confidence.

Nov 10

This episode unpacks how OCD shows up from conception through postpartum—and shares compassionate, evidence-based tools (especially ERP) to help you move from fear to values-based parenting.

Nov 3

In this episode, Kimberley Quinlan shares compassionate, practical tools to help you manage anxiety around "toxic" or triggering people—without losing your peace, your confidence, or your values.

Oct 27

This episode turns climate anxiety from paralyzing doom into doable, feel-good action by blending nervous-system care, compassionate mindset shifts, and practical, community-centered steps.

Oct 20

Kimberley Quinlan exposes the three lies depression tells (hopelessness, helplessness, worthlessness) and shares simple, science-backed steps—thought witnessing, compassionate reframes, and opposite action—to break the cycle and rebuild momentum.

Oct 13

Oct 6

This episode dives into the crucial differences between suicidal OCD and suicidal ideation—how to spot them, how to respond, and how to support yourself or a loved one with skill, compassion, and evidence-based care.

Sep 29

Kimberley Quinlan and Chris Trondsen break down how to tell BDD apart from body image concerns, OCD, eating disorders, gender dysphoria, BFRBs, and more—plus the right treatment moves for each.

Sep 24

BDD expert Chris Tronsden joins Kimberley to unpack how distorted perception and compulsive rituals drive Body Dysmorphic Disorder—and the evidence-based skills (perceptual retraining, BDD-specific ERP, CBT/ACT, and thoughtful medication) that actually help people reclaim connection and quality of life.

Sep 15

This episode breaks down what effective, child-friendly OCD treatment looks like—showing parents and clinicians how to build bravery, reduce accommodation, and tailor ERP to a child's developmental stage.

Sep 8

Learn why your brain fixates on the worst-case—and the simple, science-backed practices that help you rebalance attention, reduce compulsions, and live from your values instead of fear.

Sep 1

Discover 12 science-backed statements to stop self-blame, ease anxiety, and build self-compassion for lasting recovery.

Aug 25

Former Navy SEAL Rich Diviney joins Kimberley Quinlan to share practical tools for managing anxiety, reducing fear, and thriving in uncertainty. What You'll Learn in This Episode: The simple equation that explains fear—and how to break it down How to use the "moving horizons" technique to stay focused in chaos Practical ways to lower anxiety and get your decision-making brain back online Why stress and fear can be powerful allies instead of enemies The key attributes that help you adapt and perform under pressure

Aug 18

OCD can feel overwhelming, especially when therapy feels inaccessible—whether due to cost, availability, or burnout. The question remains: is it possible to recover from OCD without professional therapy? Kimberley Quinlan and OCD specialist Nathan Peterson dive deep into this very question, offering hope, insights, and strategies to help you move forward in your recovery journey.

Aug 11

In this episode, Kimberley Quinlan dives into the rising rates of depression, its underlying causes, and shares practical, evidence-based strategies to help you feel like yourself again.

Aug 4

In this episode of Your Anxiety Toolkit , Kimberley Quinlan shares powerful tools to help you stop treating every thought and feeling like a fact—so you can break free from anxiety's grip and start living in alignment with your values.

Jul 28

In this episode, Kimberley Quinlan breaks down the subtle but crucial differences between OCD, ARFID, orthorexia, and eating disorders—and how understanding these distinctions can lead to more effective, compassionate treatment. What you'll learn in this episode: Why the function behind food-related anxiety matters more than the behavior itself How OCD, ARFID, and orthorexia can look similar—but require very different treatment approaches What exposure therapy looks like for each condition (and why it must be values-led) The unique role disgust plays in ARFID and how to gently work through it How to involve family members in the recovery process without reinforcing avoidance Why healing doesn't mean perfection—and how to measure progress with compassion

Jul 21

In this episode, Kimberley Quinlan explores the hidden emotional, physical, and psychological costs of high functioning anxiety—and offers powerful, practical tools to help you break free from the pressure to constantly perform.

Jul 14

In this episode, Kimberley Quinlan breaks down the most common misconceptions about intrusive thoughts and shares powerful, compassionate strategies to help you respond in a way that reduces anxiety and stops the OCD cycle.

Jul 7

Struggling with social anxiety? In this episode, Kimberley Quinlan shares the six sneaky ways it keeps you stuck — and the powerful mindset shifts that will help you break free.

Jul 1

In this episode of Your Anxiety Toolkit , Kimberley Quinlan explores how shifting from hating anxiety to gently befriending it can radically reduce your suffering and help you live more in alignment with your values. What you'll learn in this episode: Why resisting anxiety may be keeping you stuck in a cycle of fear How to respond to anxiety without fueling it or making it worse A simple shift from "good vs. bad" to neutral observation The power of willingness and how to soften your approach to discomfort A visualization strategy Kimberley uses to stay aligned with her values A calming guided meditation to help you practice non-hatred in real time

Jun 23

In this episode of Your Anxiety Toolkit , Kimberley Quinlan breaks down the real reasons behind flying anxiety and offers practical, compassionate tools to help you board that plane with more confidence and calm.

Jun 16

In this episode, Kimberley Quinlan shares a compassionate 3-minute morning script designed to help you gently shift your mindset, speak to yourself with kindness, and take brave steps forward—even when anxiety feels overwhelming.

Jun 9

In this inspiring episode, Lydia Davies shares her powerful OCD recovery story—including how she faced fears around somatic OCD, scrupulosity, and intrusive thoughts with bravery, self-compassion, and evidence-based strategies.

Jun 2

Feeling overwhelmed by your to-do list? In this episode, anxiety specialist Kimberley Quinlan reveals six sneaky schedule habits that may be fueling your anxiety—and exactly how to shift toward calm, clarity, and confidence in your daily routine.

May 26

In this episode, Kimberley Quinlan and Dr. Giulia Suro unpack the overlapping features of OCD and eating disorders, helping you understand how to tell them apart, how they interact, and how to treat them effectively.

May 19

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

May 12

In this eye-opening episode, Kimberley Quinlan and neuroscientist Dr. Uma Chatterjee explore the fascinating science behind OCD, offering powerful insights into why OCD feels so real—and how understanding your brain can be a key to recovery.

May 5

In this episode, Kimberley Quinlan and Dr. Jon Abramowitz explore the current state of OCD treatment in 2025, highlighting what's working, what challenges remain, and how the future of personalized, evidence-based care is evolving.

Apr 28

In this heartfelt episode, Kimberley Quinlan and relationship therapist Elizabeth Shaw explore how to manage the anxiety, grief, and pressure that often come with dating and the fear of never finding love.

Apr 21

In this episode of Your Anxiety Toolkit , Kimberley Quinlan shares why we spiral after social situations and gives you a 4-step strategy to break the overthinking cycle with self-compassion and intention.

Apr 14

In this episode, Kimberley Quinlan and Dr. Russ Harris explore how to build real, lasting confidence—not by eliminating fear, but by learning to take action alongside it.

Apr 7

In this episode, Kimberley Quinlan shares practical tools to help you stop fearing judgment and start living more freely, even when anxiety is along for the ride.

Mar 31

If you're feeling mentally, emotionally, or physically overwhelmed, this episode offers compassionate, science-based strategies to help you reset your nervous system and gently take back control.

Mar 24

Not sure if you're struggling with Generalized Anxiety Disorder (GAD) or Obsessive Compulsive Disorder (OCD)? In this episode, Kimberley shares her personal journey with both and breaks down how to tell the difference—so you can get the right support and start healing.

Mar 17

Anticipatory anxiety tricks your brain into believing the worst-case scenario is already happening, but in this episode, Dr. Sally Winston shares powerful mindset shifts to help you break free from the cycle of worry.

Mar 10

Struggling with Generalized Anxiety Disorder (GAD)? Learn how to identify GAD, manage symptoms, and break the cycle with proven, science-backed strategies

Mar 3

In this episode, we explore three powerful attitude shifts that can transform your relationship with anxiety, helping you navigate life's challenges with confidence and resilience.

Feb 24

In this episode, we explore how to break free from frustration and self-judgment by shifting from stress to self-compassion using the powerful practice of loving-kindness.

Feb 17

In this episode, Kimberly Quinlan shares practical strategies to help you cultivate optimism even when the world feels overwhelming, offering tools to shift your perspective and find hope. What to Expect in This Episode: Learn how acknowledging your struggles can be the first step toward optimism. Discover the power of connecting with others who are working to make a positive difference. Find out how focusing on what you can control can shift your mindset. Hear a personal story about how taking responsibility in relationships transformed Kimberly's outlook. Get practical tips for spotting acts of kindness and beauty in your everyday life. Understand why optimism is a practice and how you can start cultivating it today.

Feb 10

In this deeply personal episode, Kimberley shares her journey through OCD and PTSD recovery, revealing the struggles, breakthroughs, and the powerful strategies that helped her make this her bravest year yet.

Feb 3

In this episode, Danielle and Andrew Cohen share their personal and professional insights on perfectionism OCD, how it impacts relationships, and the key strategies that have helped them navigate anxiety, communication, and growth together.

Jan 27

In this episode, we dive into practical, compassionate strategies to navigate panic attacks, offering tools to help you regain control and find calm amidst the storm.

Jan 13

In this episode, Kimberley Quinlan and Sue Chuddy dive into practical strategies for managing OCD and anxiety-related sleep disturbances, offering actionable tools to help you reclaim restful nights.

Dec 30, 2024

In this insightful episode of Your Anxiety Toolkit, Kimberley Quinlan chats with Andrew and Danielle Cohen about navigating the challenges of Relationship OCD (ROCD) through lived experience, clinical expertise, and actionable strategies for thriving in relationships.

Dec 23, 2024

In this episode, Kimberley Quinlan shares the six powerful rules that guided her eating disorder recovery and continue to help her clients find freedom and healing.

Dec 16, 2024

In this episode, Kimberley Quinlan shares practical strategies for navigating holiday-related depression, from setting boundaries to finding small moments of joy, so you can create a season that prioritizes your mental health.

Dec 9, 2024

In this episode, Kimberly Quinlan shares the transformative anxiety recovery skill of embracing all emotions and offers practical strategies to help you reduce fear and build emotional resilience.

Dec 2, 2024

Ever wonder, 'Why do I keep pulling my hair out?' In this episode, we break down the reasons behind Trichotillomania, including stress, boredom, genetics, and more. We also cover strategies like Cognitive-Behavioral Therapy (CBT) and Habit Reversal Training (HRT) to help you manage hair-pulling urges and stop the cycle.

Nov 25, 2024

In this podcast episode, Kimberley Quinlan dives into how to manage OCD urges effectively, breaking down why they feel so real and sharing actionable strategies to resist compulsions and regain control.

Nov 18, 2024

In this episode, Kimberley Quinlan shares practical tools and mindset shifts to help you stop worrying about being judged and embrace authenticity.

Nov 8, 2024

In this episode, holistic nutritionist Heather Lilico shares practical insights on how food choices can help manage anxiety, support mental well-being, and create a balanced approach to nutrition.

Nov 4, 2024

In this episode of Your Anxiety Toolkit , Kimberley Quinlan guides listeners through practical strategies for managing the fear of medical procedures, such as needle and blood phobias. Drawing from both professional expertise and personal experience, she shares actionable tips to help listeners confront their fears with compassion and resilience. Learn how to turn anxiety into a manageable experience and feel empowered through the process.

Oct 28, 2024

Oct 21, 2024

Oct 15, 2024

Oct 8, 2024

Sep 27, 2024

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Jul 26, 2024

Jul 19, 2024

Finding Your Perfect Rest-to-Productivity Ratio The Burnout Dilemma Ever felt like you're constantly running on empty, juggling a never-ending to-do list, and battling that nagging voice that tells you you're not doing enough? You're not alone. In a world that glorifies hustle and productivity, finding the right balance between rest and work can feel impossible. But what if I told you that striking this balance is not only achievable but essential for your well-being? Today, let's dive into the concept of the rest-to-productivity ratio—a game-changing approach to ensure you're resting enough to fuel your productivity and thrive without burning out.

Jul 6, 2024

In today's discussion, we're delving into the seven mistakes some OCD therapists are making in 2024. While the title might seem provocative, the goal is to highlight concerning trends in OCD treatment and provide insights that could enhance therapeutic approaches. Remember, this is my opinion based on what I've observed in various forums. I don't claim to have all the answers, but I hope to spark a constructive conversation. Mistake #1: Insufficient Initial Education Importance of Education at the Start of Treatment Many clients report feeling thrown into exposure and response prevention (ERP) without adequate preparation. Therapists must take the time to educate clients about OCD, their obsessions, and compulsions, and what to expect from treatment. This foundational knowledge empowers clients, giving them a sense of control and a clearer understanding of their journey. Mistake #2: Failing to Instill Hope and Confidence The Power of Hope in Treatment Therapists must remind clients that they have the potential to succeed. Treatment for OCD can be highly effective, and it's crucial to communicate this. While maintaining a realistic perspective, therapists should focus on the positive aspects of available treatments and instill a sense of hope and confidence in clients. Mistake #3: Neglecting Evidence-Based Modalities Therapists should prioritize evidence-based treatments, particularly ERP. While it's important to integrate supplementary approaches like ACT, mindfulness, and self-compassion, the core of OCD treatment should be grounded in proven methodologies. Clinicians need to stay informed and ensure their clients understand the rationale behind chosen treatments. Mistake #4: Misconceptions About ERP Being Traumatic ERP: Not Abusive When Properly Delivered Concerns about ERP being traumatic often stem from poor delivery rather than the method itself. Proper education and a strong therapist-client rapport can mitigate these fears. It's vital to ensure clients understand why they're facing their fears and to provide a supportive environment throughout the process. Mistake #5: Rigid ERP Plans Flexibility in Treatment While structured plans are important, rigid adherence can be detrimental. Treatment should be flexible and tailored to the client's evolving needs. Engaging clients in the planning process and adapting as necessary ensures that the therapy remains client-centered and effective. Mistake #6: Overlooking Barriers to Progress Exploring Underlying Issues When clients struggle with certain exposures, therapists should explore the underlying barriers. Understanding the client's fears, trust issues, or other relational dynamics can provide insights that help adjust the treatment plan accordingly. This approach prevents avoidance behaviors from taking hold. Mistake #7: Not Assigning Homework The Role of Homework in OCD Treatment Homework is a critical component of OCD treatment. Without it, progress can be significantly hindered. Therapists should find creative ways to ensure clients complete their assignments, offering support and accountability measures. This empowers clients to practice skills outside sessions, enhancing overall treatment efficacy. Conclusion These seven mistakes highlight areas where OCD treatment can improve. It's essential for therapists to remain flexible, informed, and supportive, tailoring their approaches to each client's unique needs. Open communication and a collaborative mindset can help address these common pitfalls, ultimately leading to more effective and compassionate care. Remember, this discussion aims to foster growth and improvement. If you're a client, don't hesitate to discuss these points with your therapist. Together, we can create a more effective and empathetic therapeutic environment. Transcript Today we're talking about the seven mistakes some OCD therapists are making in 2024 . Now, I know the title sounds spicy, but in no way am I trying to be spicy. What my goal is today is to talk to you about some of the things I've heard, whether that be on social media, on podcasts, on blogs, or at conferences, when people are talking about the treatment of OCD that deeply concern me. Now, let me first say, in no way do I consider myself the moral police on OCD treatment. In no way do I believe that I am the knower of all things. In no way do I think that I know more than other people, my way or the highway. That is absolutely not what I'm saying here today. However, I am going to give you my opinion on some of the things that I hear that deeply concern me. I'm just here to share what I think is helpful. I hope, if anything, it's here to really reassure clinicians that they're on the right track because there are some amazing, amazing OCD specialists out there. If not, if this is something that you may find is calling you out a little, please, I'm here to hopefully bring some goodness into the world. Let's talk about the seven mistakes some OCD therapists are making in 2024. As I said, this is all about my opinion. Again, in no way am I the moral police, but let's talk about it. My guess is you're probably going to agree with everything I say. If not, I'm totally okay with being disagreed with. Mistake #1: Not spending enough time at the beginning of treatment educating their client about the research and the science-backed treatment approaches that are here ready for us to use for OCD So often, I hear clients saying in my office that they had this experience of ERP exposure and response prevention where they were just thrown into it, and they were like, "Let's just go." I get that. I love an eager therapist. I love a therapist that's not going to waste people's time, but we have to spend a lot of time in the beginning educating them about the condition of OCD, helping them to understand their obsessions and their compulsions and how we get stuck in them and how they can be so seductive and how they can trick us, and also talking about what's coming, what treatment's going to look like, and what you can expect. We have to spend a lot of time talking about that as well so that the person who's engaging in this treatment feels a sense of mastery over what's about to happen. They feel like they can make decisions as they go because they've got a plan. They can see them crossing the finish line. They can keep that. They know what that's going to look like, and they can use that to inform their decisions and how they connect and communicate with the clinician. Mistake #2: Not instilling hope and confidence in the client We have to remind our clients that they have everything that they need, that the treatment can be very, very successful, and that it's an experiment. We don't have to get it perfect the first time. This is a collaborative experience. There's a lot of hope here that by us collaborating and by us talking through what's working and what's not working and having them understand that this is actually a really good thing to have in terms of there are many conditions that the treatment sucks, the treatment isn't that effective. The treatment doesn't help as much as it does with OCD. I never want to do the toxic positive thing with clients, but I also want them to acknowledge the conditions. This is one that we actually have some good research on. We have some good treatment options. We have these great supplement modalities that can help us along the way. We want to infuse them with hope. We want to infuse them with confidence in this process. I do often see particularly younger therapists not spending enough time really bringing a sense of hope to treatment because it's so scary. They're already in so much pain. They've probably been through treatment that sucked in the past. What we want to do is really focus on that hope, because hope is often what motivates us to take those first baby steps. Mistake #3: Not engaging in evidence-based modalities This is a huge one. I could spend a whole podcast episode or a week on this topic. There is so much misinformation about treatment and what is considered evidence-based. Now again, I'm not here to tell anybody what their treatment should look like. That's a personal decision, and every client gets to make that decision. Who am I to judge? People need to come and know that they have agency over their lives and the decisions they make. But clinicians should be educated, and they should educate their clients on the options for evidence-based treatment modalities. Now, I am a huge supporter of exposure and response prevention . I have been trained in it. I have been doing it for 14 years. I have seen it succeed over and over and over and over again. As I've been public in saying, I see no reason to abandon that. Now, that's not to say that I haven't introduced modalities that supplement ERP. I love the use of ACT. I love the use of mindfulness-based cognitive therapies. I love the application of self-compassion. In many cases, I have applied dialectical behavioral health therapy to clients who are struggling with emotional regulation. Maybe they're having self-harm or suicidal ideation. Absolutely. As time continues, we're seeing newer approaches and modalities come up. But I see it in my job as a clinician to educate my clients on the treatment, what has worked, and what I'm skilled at doing too. The other thing is there is some research on other treatment modalities besides ERP. I think that's wonderful. I mean, my hope is that one day we have something that is a sure thing, 100%, and we can absolutely promise that we've got guaranteed results. This is going to be something that I continue to learn and educate myself on, but my opinion is that I'm sticking with ERP. I love it. I find it so helpful and empowering. It lines up with everything and my treatment that has helped me. For those who are wondering, I am a committed ERP therapist. Mistake #4: Saying that ERP is traumatic or abusive Now, in fact, this concerns me so much that I did an entire episode with Amy Mariaskin. It's Episode 365. We talk specifically about this very sensitive and important topic, "Is ERP abusive?" What came from that episode, which is very similar to this one, is I don't actually feel like ERP is an abusive treatment modality. I think that sometimes how it's delivered can be concerning, but that's the truth for any treatment modality. You could say the same about cognitive behavioral therapy. We could say the same about any medical treatment in terms of how the delivery can determine whether it harms people who are vulnerable. One thing that I will be very clear, and I believe this in my heart, is the narrative that exposures, that facing your fears is mean, is a traumatic experience. I agree that if you're having someone face their fear without giving them the education that they need and not explaining to them why they're doing it -- believe me, guys, let me also disclose here. I've made a lot of these mistakes myself as a clinician. Let's just be open. I have been in this particular situation. Actually, if I'm going to be really honest with you, number one, that mistake of not educating your clients, I learned that by a client telling me, "Kimberly, I do not understand why you're having me do what you're doing. I'm someone who needs to know what I'm doing, or I'm not going to trust you. Slow down and tell me what this looks like." Again, no judgment over here. I've made a lot of these mistakes myself. But I think that throwing people too fast and too hard can feel very overwhelming, very activating. Again, these are things we learn as we get better. Every clinician makes mistakes. That's what makes them good clinicians. In no way do I want clinicians to feel blamed or judged here. We're human beings. We're doing the best we can, and every client is different. Sometimes we also need to build a rapport with clients so that they can share with us. We talked about that in the episode with Amy. The most important piece here is having a rapport and a connection of trust and respect so that the client knows that they can tell us that this doesn't feel right, that this crosses my values, my limits, and my boundaries. This doesn't feel like it's something that lines up with my values. We can have a conversation about that and be respectful about, "This is what works for me in this relationship, and this is what's not," or "Here are my concerns about ERP. Could you help me to work through this, or could we consider having a conversation before we move forward?" I think that's what also helps this from being experienced as a trauma as well. But if this is something that is a hot topic for you, go and listen to that because it's such an important, compassionate, respectful episode. Amy did a beautiful job of going deeper into this specific topic. Mistake #5: Following an ERP plan that has zero flexibility I get it. When I first started as an OCD therapist, I was trained to use a very structured exposure and response prevention plan. There were modules and systems, and you had to follow the manual. I loved my training. My training literally set me up. It was some of the best OCD training I think anyone could ask for. But there were times when I stuck to the plan so diligently that I missed the client. I missed their needs. I missed hearing from the client on what they think the next step is. Now, what I have found to be so beneficial is to talk to the client. What would you like to do next? This is our plan that we originally made together because we talked about it at the beginning of treatment. Do you feel like you're ready to take this next step? What's getting in the way of you taking this next step? Let's discuss. Is this the right step based on what we thought we knew, or are we going to shift it up now? I think that the flexibility in treatment helps teach clients how to be flexible in their daily lives as well. We don't want to follow a rigid plan unless there's some clinical reason to do so. I think we also have to understand here that some intensive treatment programs require really rigid plans because of the severity of the disorder. Absolutely, I completely get that. But I think where we're really going with that is it has to be individualized. We have to understand the client's needs in order to make a plan. And then from there, we can decide what's best. But we have to stay away from rigidity. I also don't love any treatment modality that has modules that make the clients go through modules because, again, I think it misses the client, where they're at, what their needs are, and what else is going on in their life. Again, every clinician delivers it differently. I respect every clinician to know what's best for their clients, but it's something that we can look out for. Mistake #6: Moving on without exploring what was getting in the way Let's say you had a treatment plan and the client said, "Ah, that doesn't work for me." And then you just say, "Okay, fine," and you move on without slowing down and getting curious. Tell me about that. What's getting in the way of you being able to do this exposure? Is there an obsession I'm not aware of? Is there something else happening that's happening relationally, or is there a trust issue or rapport issue between you and I that might be getting in the way of us not completing that part of the treatment plan that we had originally agreed would be helpful for you? It's really important, and I've seen this with my own staff, with my own consultation with other clinicians. Moving on too quickly can allow OCD to get sneaky and help them engage in avoidant compulsions. We have to be really careful about not engaging in compulsions with our clients. Sometimes our client's OCD can be very convincing in getting us to not address certain issues because of an avoidant compulsion. Again, complete transparency. I've been there a million times, so absolutely no judgment here. These are all things we just have to keep an eye out for and do the best that we can. Consult as much as we can. Do a little check-in with ourselves. I try to do a check-in every week. How is each client going? How are they doing? Where am I stuck? Where are they stuck? Am I having any blind spots here for this client? And this could be one where there's a real big blind spot. Mistake #7: Not assigning homework to clients This one is so hard. Again, I've been there. Often, when clients are in a lot of distress and they have a busy life, a family, or a job, we might assign homework, and they might show up on Tuesday at nine o'clock and say, "I'm so sorry, I didn't do my homework." You say, "Not a problem. Let's try and get it done this week." Send them home with the homework. Next Tuesday at nine o'clock, they show up and still haven't done their homework. Sometimes, I see this a lot, therapists go, "Okay, they're not someone who does their homework. I'll pivot, and I'll make sure we're doing extra exposures in session." That's a really great pivot. But I would usually stop there and have a conversation with the client and really help them understand, not from a place of judgment or shame, but that their success in treatment goes way down when they stop engaging in their homework assignments. We have to really stress to clients that one hour a week is not enough and that we have to find creative ways and motivation tools to help them make sure they're engaging in their assigned homework. I have allowed clients to send me the thumbs-up emoji in an email to show me that they've done it, or maybe they've called into my voicemail to confirm that they've completed their homework. Again, I don't make them do this, but I always offer them, what can I do? What service can I offer you that will help you stay accountable for your homework? Because for every minute of homework you do, you have massively pushed the needle in the success of your treatment. I often see a lot of clinicians just disregard homework and say, "It'd be great if they did it, but they won't." I would stop and pause there and really explore with the client and make sure they understood that treatment won't be that super successful if they're not engaging in homework. Again, we want to get creative. We want to collaborate with them as much as we can. What can we do to help get that homework done? Can we set more realistic goals? Can we stack it onto another routine that you do? Can we help with accountability? Can we bring in a loved one or someone who can support you? What can we do to help increase the chances of you getting better? Because I always say to my patients, my hope for this treatment is to teach you everything I know so that you can be your own therapist. Not to say that I don't want to treat you, and I think you shouldn't need a therapist. I just want you to be trained to think about it so that when you're at home and you're struggling or maybe you're in recovery, but you have a little lapse, you can recall, "Oh, I remember the steps. I remember what I need to do. I feel empowered. I know this works. I'm going to get to it and trial that first." There are the seven mistakes some OCD therapists are making in 2024. Please know, there is zero judgment here. Please also know, this is just my opinion. I fully respect that every clinician is going to come from a different perspective. I fully believe that every clinician comes and sees their client and has the ability to really meet them where they are. I just wanted to bring this up because these are topics I'm discussing with my staff, and I think that it's something that maybe would help you today. I'm going to send you off with a big, loving hug and remind you that today is a beautiful day to do hard things. If you're a client and your therapist is engaging in some of these behaviors, don't be afraid to bring it up. We're a collaborative team here. I always tell my patients, I want to hear your honest feedback. I want to hear if something's not working for you because that helps you, and I'm in the business of helping. Have a wonderful day. I'll see you next week.

Jun 28, 2024

9 Ways to Stop Picking Your Skin This Summer As summer approaches and the weather gets hotter, many of us are eager to wear shorter sleeves and enjoy the sun. However, this often leads to increased skin exposure and, unfortunately, a greater temptation to pick at our skin. In today's article, we'll explore nine strategies to help you stop picking your skin this summer. These tips have been helpful to many of my clients, and I hope they will be just as beneficial for you. Understanding Skin Picking Before we dive into the strategies, it's important to understand what skin picking is. Clinically known as dermatillomania , skin picking is a type of body-focused repetitive behavior (BFRB). People with this condition may pick at their skin, arms, lips, scalp, nails, and even more sensitive areas like the pubic region. It's similar to trichotillomania, which involves hair pulling. It's crucial to note that skin picking and hair pulling are not forms of self-harm. People who pick their skin are not trying to hurt themselves or seek attention. They often do it because they are either understimulated (bored) or overstimulated (anxious or overwhelmed). Understanding this can provide insight into the strategies we'll discuss. Strategy #1: Awareness Logs Awareness logs are a powerful tool in any stage of recovery. By logging every time you have the urge to pick, noting how much you picked, where, and for how long, you gain a better understanding of how this condition impacts your life. Many people find that having to document their behavior reduces the frequency of picking. Awareness logs are a key component of habit reversal training, a cognitive-behavioral therapy technique specifically designed for BFRBs. For more information about BFRB School, our online course for skin picking and hair pulling, CLICK HERE Strategy #2: Keep Your Hands Busy Engaging in a competing response can help divert your urge to pick. Competing responses might include using fidget toys, holding a stone, or playing with soothing textures. You can find many affordable fidgets online or at dollar stores. Create a basket of tactile items that you can use to keep your hands busy. Place these items around your house, in your car, and at work to ensure they are easily accessible when you need them. Strategy #3: Create a Skincare Routine A good skincare routine can help prevent irritation and dryness that might tempt you to pick. However, it's important not to overdo it, as too much attention to your skin can also trigger picking. Consult with your doctor to develop a routine that keeps your skin healthy without exacerbating your condition. Strategy #4: Use Physical Barriers Using physical barriers ( called habit blockers ) like gloves, band-aids, or long sleeves can prevent you from touching and picking at your skin. Some people find that keeping their nails short or wearing fake nails can reduce the tactile satisfaction of picking. Identify what works best for you and use these barriers consistently. Strategy #5: Self-Compassion Practicing self-compassion is vital. Beating yourself up for picking only increases negative emotions like shame and guilt, which can lead to more picking. Instead, practice radical acceptance and reduce self-criticism. This approach can help you feel more motivated and improve your overall well-being. Strategy #6: Manage Stress and Anxiety Managing stress and anxiety is crucial, as many people pick their skin to cope with these feelings. Cognitive-behavioral skills can help address faulty cognitions and behaviors that exacerbate stress. Consider taking an online course, like Overcoming Anxiety and Panic, to learn effective stress management techniques. Strategy #7: Establish a Support System Having a support system can make a significant difference. Whether it's family, friends, or online support groups like those at BFRB.org , having people to check in with can help you feel less alone and more accountable. Some people find it helpful to text or call a support person when they feel the urge to pick. Strategy #8: Stay Hydrated and Healthy Good nutrition and hydration can impact your skin's health. Speak with your doctor about how to maintain healthy skin through diet and hydration. Additionally, consider looking into over-the-counter medications like N-acetylcysteine, which has been shown to help with skin picking. Always consult with your doctor before starting any new supplement. Strategy #9: Set Realistic Goals and Track Progress Set achievable goals and track your progress. Instead of aiming to completely stop picking, focus on gradually reducing the behavior by a small percentage each week. Tracking your progress helps you see improvement and identify what strategies are working. Remember, small steps lead to significant changes. Conclusion These nine strategies can help you stop picking your skin this summer. Whether you use awareness logs, keep your hands busy with fidgets, or establish a support system, each step you take brings you closer to managing this behavior. Remember to practice self-compassion and set realistic goals. If you need additional support, consider enrolling in courses like BFRB School or Overcoming Anxiety and Panic . Transcript Today we're going to cover nine strategies to stop picking your skin this summer. It's getting hotter. You want to start wearing shorter sleeves or have your skin exposed to the sun more often, which means you're more likely to start picking at your skin. Let's talk about nine strategies that you can use right away. Hopefully, you find them as helpful as my clients have. Welcome back. I am so excited to talk with you about nine strategies and skills that you can use to stop picking your skin this summer. But before we do that, let's just first do a little deep dive into what skin picking is. Clinically, we call it " dermatillomania, " and it's a kind of body-focused repetitive behavior. Often, people with skin picking will pick out their skin, their arms, their lips, their scalp, and their nails. There's really no limit to where someone can pick their skin. Some people even pick pubic areas under their arms or around their genitals. There is, as I said, no off-topic area that people will pick. It's completely normal for people to pick in one or all of these areas. It's similar to a condition called trichotillomania, which is hair pulling. Again, hair pulling is another type of body-focused repetitive behavior, and people may pick at any area where there is skin on their body. It is important for us to first highlight that skin picking and hair pulling are not self-harm. People who pick their skin aren't trying to hurt themselves. They're also not trying to just get attention. They do not want to be damaging their skin or giving their skin abrasions and such. It's just a part of a condition, and we have a little bit of insight as to why they're doing it. Often, people with skin picking, or dermatillomania, are skin picking either because they're understimulated, they're bored, or we know they may be overstimulated. Maybe they're very anxious, they're feeling hyper-reactive to feeling overwhelmed with either emotions, stimulation, or thoughts. We do know that people who engage in this skin-picking behavior are more likely to pick either when they're overstimulated or understimulated. That's something to think about, and there is a clue there into some of the strategies that we're going to use today. Let's get to it. Let's start talking about some of the strategies that you can use to stop picking your skin this summer. Strategy #1: Awareness Logs Awareness logs can be so helpful at any stage of recovery. An awareness log is either a piece of paper or a document on your computer or on your phone, where you log every time you have the urge to pick your skin, how much you picked your skin, where you picked your skin, and how long you engaged in skin picking. What this does is, number one, it helps us really understand to what degree this condition is impacting your life. Secondly, people often report that when they have to document it, they're less likely to engage in the behavior because nobody wants to have to spend all their time logging it as something they don't want to deal with. Awareness logs can be a very helpful skill for us in understanding our own condition and our own symptoms, and in addition, they can help us with motivation to slowly reduce this behavior. Awareness logs are something we use in a very well-known and researched way of using cognitive behavioral therapy, and the type of therapy is called habit reversal training. It's the specific modality that we use for skin picking and hair pulling, and it is a key component of that cognitive and awareness work. Strategy #2: Keep Your Hands Busy Now again, when we're using habit reversal training, we engage in something called a competing response. A competing response is a behavior that competes with the feeling of picking our skin. Now, a competing response might be fiddles or fidget toys. It could be holding a stone or maybe stroking a feather. It could be playing with other fidgets that we have. The cool news is that you can get so many fidgets online these days for a really low price, or you could easily go to your dollar store and look around for textures that feel beautiful to you, feel soothing to you, or help you with either the understimulation or overstimulation. What we want to look for here is, what are the specific tactile experiences that you can use to keep your hands busy? We actually have an online course called BFRB School, which is a specific course for people with hair pulling and skin picking, using skills like habit reversal training and cognitive behavioral therapy. We talk all about the core importance of using competing responses. I often tell my patients and my students to always have a bucket or a basket in the house of different tactile experiences, different tactile things that you can play with objects, so that at that moment, if you've identified in your awareness log that you're feeling bored, you can engage in something that stimulates your creativity, stimulates your awareness. However, if you're the opposite and you're feeling overstimulated, you might dig into the basket and find something that's quite soothing. Maybe it's more like a silly putty, a gel, or something else that's more soothing for you. These competing responses are going to be so important for you in getting very clear on what you need at that moment and having it readily available. I often say to my patients and my students, don't just have it in one area of the house because, in that moment, you're still going to want to just pick your skin. What we prefer to do is to have little pieces over the house, in your car, or in your office so that they're easily accessible. Some people have it on their key rings, some people have it in their purses—whatever works for you. Again, that awareness log will help us identify specifically where you are when you're having these urges to pick your skin. And then we can put in competing responses to compete with the skin-picking behavior. Strategy #3: Create a Skincare Routine That Helps You This is a little bit of a fine line, though, because we don't want to engage in a skin routine that has you putting too much attention on your skin because, again, too much attention on your skin is going to mean that you're more likely to pick your skin. However, we also want to make sure that we are not ignoring your skin, letting it get really dry, especially in the summer. Maybe you've had a sunburn or such, and you've got some wind chafing or something. Again, if you have any irritation on your skin that isn't taken care of with a skin routine, you are more likely to pick at that skin, especially if there's already an open wound or a scab. If you already have an open wound that you've scratched or maybe you bumped into something and you've got a little scab there, we want to make sure that we're engaging in a really healthy skin routine to help that heal and repair so that you're less likely to go and pick that. I would encourage you to speak with your medical professional about skincare and what would be best for you. Maybe you have a skin condition. Very commonly, people with skin picking do. Speak with your doctor about a skincare routine that will help your skin picking but not be so extensive that it actually makes it worse. I would trust that your doctor will be able to help you in that area. Strategy #4: Use Physical Barriers Again, going back to the gold standard treatment for skin picking, which is habit reversal training, we use what we call a habit blocker. This is something that blocks you from the habit of picking, and this can involve anything that stops you from being able to touch your skin. A lot of patients and students I have had have used things like gloves or band-aids to cover an area that they're likely to pick. Maybe in the summer, they may wear longer sleeves even though it's very hot because that actually stops them from getting to the area that they feel an urge to pick. You may also want to keep your nails really thin or cover your nails. Some people keep nails on, like actual fake nails, as a barrier to being able to touch the skin. Maybe it doesn't give them that same tactile feeling of picking when their nails are medium-length. What we want to do here is identify for yourself the specific barriers that are helpful. The thing to remember here about skin picking is that everyone is different. Not one strategy that I've used for one client is going to be the strategy we use for another client. It's going to be very much dependent on those awareness logs that you logged out of in that first strategy. Getting clear on specifically what are the triggers that cause you to pick your skin and what specific behaviors and habit blockers are helpful to reduce the skin picking that you feel the urge to engage in. Strategy #5: Self-Compassion We have to engage in not beating yourself up, not judging yourself, not punishing yourself if, in fact, you have picked or recently picked despite all of these strategies. Beating yourself up actually does not motivate you to stop picking. In fact, it usually brings up more emotions such as shame, guilt, sadness, anger, and humiliation. Those emotions can send us into overstimulation, making us want to pick again. Again, we want to engage in a practice of self-compassion. We want to engage in a sense of radical acceptance of ourselves, whether we pick or not. This is so important because we want to reduce our suffering, not make our suffering higher. We do find that people who practice self-compassion tend to have higher levels of motivation, decreased levels of procrastination. They tend to feel better about themselves and have higher self-esteem. They're more likely to get out there and do the things that they love. Every moment that you're engaging in in your life is a moment you're less likely to be picking. It's very, very important that you practice a self-compassion routine, even if it's once a day. Anything is better than nothing to reduce that self-criticism where you can. Strategy #6: Manage Stress and Anxiety I cannot stress this enough. It is so important when it comes to skin picking that we manage our stress. Again, a lot of people pick their skin because it is a way in which they can manage their stress. A lot of people with skin picking say once they start picking, they can exit out of reality and go into a trance-like mode where everything disappears and they feel relaxed and in the zone, and it takes away all of the stress. We can now understand why there is actually an urge and a pull towards picking and pulling, because who really wants to stay in stress and anxiety? Of course, it makes total sense. The more we can manage our stress using strategies, skills, and other tools like cognitive behavioral therapy, the less likely we are to use skin picking as a coping strategy. When it comes to managing stress, again, the most important thing we're going to do here is what we call cognitive behavioral skills. It's going to be taking a lot of our cognitions that might be faulty, leading us to have more anxiety, and also looking at our behaviors and the things that we do that may be actually exacerbating the stress and anxiety that we experience. If you're someone who struggles with anxiety and stress, I strongly encourage you to check out our online course called Overcoming Anxiety and Panic. We go through all of these steps. You can do it from home, and it may help you to get an idea of what might be some of the things that are triggering your stress response, triggering your anxiety response so that you can manage that, so that then you can move on to manage your skin picking as well. Strategy #7: Establish a Support System We want to have a community of people who can support us as we go through these steps. It's not an easy thing to overcome skin picking, so I really want to encourage you to find a support system, whether that be family or friends, or you can go to BFRB.org. They have a whole array of online support groups that you might be interested in looking at to get support, so you feel like you're not alone and that you have the support that you need. Another option here is to also look for accountability bodies. Somebody who mightn't even have skin picking. They might be a loved one, a friend, a parent, or a sibling—someone who you can check in with when your urge is really high. A lot of my students have said that it's been very helpful when they have the urge to text somebody and say, "I have a strong urge. I'm texting you to let you know." They may have already set up a plan on what to do. Maybe they jump on a phone call together, they might text each other throughout it to help the person ride that wave of the urge. Or maybe that person might encourage them to say, "Hey, you told me to remind you of this one thing if you have this urge." Really, the importance of a support group can help you, or a support person can help you not only with feeling less alone, not only with beating yourself up, but also with putting these strategies into action, especially if you let them know about the strategies. Strategy #8: Stay Hydrated and Healthy Now again, I'm going to encourage you to speak with your medical doctor about this, but I just wanted to mention because I try to look at you as a holistic, full person, someone who's not just your skin picking, but also, we want to have a look at things like your health. Take a look at your nutrition. Take a look at your hydration levels. Again, these things can impact our skin. If, let's say, you're having a lot of nutrition that's causing a lot of breakouts and you're someone who's prone to skin picking, those two things together could become a disaster. You want to speak with your doctor or a professional in that area about specific nutrition, things you may want to avoid eating, and how hydrated you need to stay to keep your skin healthy, to reduce the chances of you wanting to pick and pull. A lot of patients I see, and a lot of students that have come through BFRB School, our online course for skin picking, have reported having skin conditions, acne, or certain things that have impacted how much their skin is irritated, how many pimples they're having. Now, I'm not assuming that nutrition and hydration are the solution to all of that, but I would encourage you to speak with a doctor and just inquire about what you could do to make sure we're addressing those skin conditions. Another thing to know here, and this is like an inside scoop, is that there are specific over-the-counter medications you can get that have been proven to help with skin picking. I'll leave a link in the show notes for you to take a look, but there is a vitamin that's called N-acetylcysteine. It is an over-the-counter medication that has very few side effects and has been shown to help people with skin picking. Now again, I'm not a doctor. I would strongly encourage you to speak with your doctor about that, but again, I'm trying to give you as many resources today as we can to help you get to the goal that you want. These are all things that you can take a look at and speak to your doctor about. Strategy #9: Set Realistic Goals and Make Sure You Track Your Progress We want to set realistic goals. I always tell my patients at the beginning of treatment that the goal isn't to completely stop skin picking, even though most people are coming for that goal. Because what I have found is, when you set that huge goal, it sets you up to fail. It makes you feel so bad if you slip. It makes you feel so much pressure. It's such a scarier experience than if you say, "Hey, I'm just going to reduce this by 3 to 5 percent each week," or month or day, whatever is right for you. We want to set realistic goals—goals that can help keep you motivated and goals that make you feel like they're achievable. We also want to track progress. One of the most important parts of treatment, once we've done that first awareness log—and we do this in BFRB School, I do it with my patients as well—is that once we're off and running, we then track how well we're doing. How well did you use your tools? What tools didn't work? How long did you pick for? Where were you? What went wrong? We are not doing this to beat you up or to scrutinize you; we are doing it from a place of experimenting, gathering information to know specifically what's getting in the way of your recovery and what your progress looks like. Some people may say, "I'm not making any progress," but when we actually look at their logs, we're starting to see progress in these small ways. Remember, small steps lead to medium-sized steps. Medium-sized steps lead to huge changes. The last strategy is probably the most important. I could have spent a whole podcast episode talking about that. It's about setting realistic goals and tracking your progress. Again, if you are struggling with this and you want to take BFRBSchool.com, head on over to CBTSchool.com. You'll get access to it there. It will take you through all of these steps. We also have modules on self-compassion, mindfulness, and healthy lifestyles that can really help you with this recovery as well. I'd strongly encourage you to consider that as a hopeful strategy as well. All right, guys, thank you so much. These have been the nine strategies to help you stop skin-picking this summer. I hope you found it helpful, and I'll see you next week.

Jun 21, 2024

Today, we're diving into a topic on how to become more self-confident, especially if you struggle with anxiety. Self-confidence is a quality we all desire, but for those of us with anxiety, it can seem particularly elusive. Let's explore how to cultivate self-confidence, even when anxiety is a persistent part of your life. Understanding Self-Confidence First, let's clarify what self-confidence actually is. Many people mistake it for arrogance or an inflated sense of self. True self-confidence, however, is a deep trust in your own abilities, strengths, and judgment, even when faced with adversity. Anxiety can often undermine this trust, making us feel uncertain and vulnerable. But self-confidence is not something you're born with—it's something you develop over time. Debunking Myths About Self-Confidence Myth 1: Self-confidence is Innate One common misconception is that self-confidence is an inherent trait. This couldn't be further from the truth. Self-confidence is a skill that can be nurtured and grown with practice and perseverance. Myth 2: Success Equals Confidence Another myth is that self-confidence only comes after achieving certain milestones or successes. While accomplishments can boost confidence, they are not the sole source. True confidence is built through the process, not just the outcomes. Myth 3: Confident People Don't Have Anxiety It's a widespread belief that confident people are free from anxiety . In reality, confident individuals often face anxiety just like anyone else. The difference lies in their willingness to face their fears and grow through the experience. Building Self-Confidence: Practical Steps Embrace Challenges Self-confidence grows from facing and overcoming difficult situations. Initially, the thought of tackling a tough challenge can be overwhelming, but each experience strengthens your trust in your ability to handle adversity. Practice Feeling Your Emotions Confidence isn't about the absence of fear but rather the ability to feel and manage your emotions effectively. By practicing feeling emotions like fear, inadequacy, or shame, you become more comfortable and resilient in facing them. Identify Specific Scenarios Pinpoint the situations where you feel least confident. Reflect on what emotions these scenarios evoke and work on becoming more comfortable with those feelings. For example, if public speaking makes you anxious, practice feeling that anxiety in smaller, controlled settings until it becomes more manageable. Cognitive and Behavioral Strategies Cognitive Restructuring Changing your thoughts can significantly impact your confidence. Instead of telling yourself, "I'm going to fail," try affirmations like, "I'm prepared and capable." This shift in mindset can reduce anxiety and boost your self-assurance. Behavioral Exposure Facing your fears head-on through repeated exposure can be incredibly effective. For example, if public speaking terrifies you, join a group like Toastmasters, or practice in front of friends and family. Repetition helps desensitize you to the fear and builds confidence in your abilities. Reflect and Learn After facing a fear, take time to reflect on the experience. Ask yourself, "What did I learn?" This reflection helps you identify areas for improvement and reinforces your ability to handle challenging situations. Embrace Failure as a Learning Tool Failure is an inevitable part of growth. Instead of viewing failure as a negative outcome, see it as an opportunity to learn and improve. The more you fail and learn from those failures, the more confident you become in your abilities. Conclusion Self-confidence is a journey, not a destination. It involves embracing challenges, feeling your emotions, and learning from both successes and failures. Remember, today is a beautiful day to do the hard thing. Face your fears, practice self-compassion, and celebrate your progress along the way. Have a great day, everyone, and keep building that self-confidence! TRANSCRIPTION: Hello and welcome back. I'm so happy you're here. Today we are talking about how to become more self-confident, especially if you're someone who has anxiety. Self-confidence is something that a lot of people talk about. It's something we all want more of. But if you are someone who has anxiety, you might actually find that being self-confident is really, really hard. So I'm here today to talk with you about how you can become more self-confident even if anxiety is here. Let's do it. First of all, what is this thing called self-confidence? Some people think that it's like thinking really highly of yourself and that you think you're the coolest—sort of arrogance—but that is not the definition of self-confidence. Self-confidence is a deep trust in your own abilities, your own strengths, your own capabilities, and your own judgment in the face of adversity. I get it. When we have anxiety, it's very hard to feel that sense of trust. In fact, I think anxiety can sometimes make us feel like we can't trust anything. We're in a heightened state of fight, flight, freeze, and fawn. What we want to do today is take a look at how we can improve self-confidence in the face of anxiety. Now, in order to do that, we first have to look at some of the myths about self-confidence. A lot of people think that self-confidence is just something that you're born with, and that could not be further from the truth. Self-confidence is something we grow over time. Other people believe that self-confidence is something you get once you've achieved something, like you've achieved some success, or you've lost enough weight. That was me when I had an eating disorder. When I've finished a course, then I can feel confident. Or, when I've done enough practice, then I can feel confident. I understand that. However, that if-then statement creates a lot of opportunities for us to feel out of control and like it's something that we can't create on our own. I actually want to really take that idea away and lean towards another strategy. Another common myth about self-confidence is that some people have it and some people don't, and that it's like an inherent piece of who we are—also not true. Anyone can work toward being confident. We have a lot of evidence. You probably know someone who's really, really confident, and you don't even think that they are warranted to have that much confidence—again, proof that we can grow self-confidence. It's something that you can have that doesn't require a certain accolade or level of success. It's something that we can take on. Again, we are not using it in a way to hurt other people or to make other people feel bad. That's actually not self-confidence. That's usually coming from a place of insecurity. Another myth is that confident people don't have anxiety—also not true. Confident people are as afraid, if not maybe even more afraid, than the average person on the street. I don't want us to believe that confident people don't bring anxiety to the table, and we are going to take a look at how we can work with that. Let's now talk about how you can become more confident. Here's the thing. As I have gone through some very difficult things, at the beginning of going through those difficult things, I too was overwhelmed with thoughts like, 'I can't handle it.' 'I don't have what it takes.' 'This is going to destroy me.' 'This is going to ruin me.' It's like I'm just going to implode with this degree of suffering. But what I found was that once I had been through that difficult season, I felt more confident. It wasn't that I succeeded in it, though. It's not that I conquered all during that difficult turbulence season. There was a different shift towards, again, trusting that I could handle hard things. Often we go into hard, scary things, saying, "If I only had been through this before, well, then I would feel confident." But that's actually not true. A lot of self-confidence is your ability to feel the feelings you will have to feel when you do that hard thing, not the actual doing of the hard thing. The more we practice feelings of fear, threat, inadequacy, shame, or whatever it might be, the more we're comfortable, open, and caring in feeling those feelings. That's how we begin to feel self-confident in any situation, whether we've been through it before or not. I had a friend who once told me that a very, very dear loved one, actually a child, had been through cancer. I had said to her, "How are you doing?" She said, "Oh, I've been through cancer. Nothing can take me down." But what she meant by that is that it's not that everything was in comparison to cancer; it's that she had mastered feeling her feelings as she navigated something really, really difficult. She could go through something completely different. But because she's already committed and gone through the willingness to have some really uncomfortable feelings, she had a sense of self-confidence, like, 'I could handle anything at all.' What I want you to think about here is, what are the things that you don't feel confident about? What specifically are the situations, the scenarios, and the times in your life where you don't feel confident? And then I want to ask you, what would you have to be willing to feel, and what would you have to build comfortability feeling in order to feel confident doing that thing? It's just a question. Sometimes it's like, "Oh, to be confident doing my exposure, I'd have to be confident feeling uncertainty." "Oh, to go through seeing my child struggle, I'd have to be confident feeling maybe guilt or maybe sadness." "Maybe to handle my parents' aging, I'd have to be able to confidently and willingly feel grief." Ask yourself these questions because they can help us identify the emotion that we need to practice feeling on purpose. Now, when it comes to creating self-confidence, there are two ways we can target it. I talk to my clients about this all the time. We can create self-confidence by changing our thoughts, or we can create self-confidence by changing our behaviors. Let's talk about creating or changing our thoughts. Let's say you have something you need to do that's creating a lot of anxiety. Maybe you have to do a public speaking event. You have a lot of anxiety. You could do some cognitive restructuring by changing your thoughts. Instead of saying, "You're going to fail and this is going to be terrible," you could practice saying, "It's going to go great," or "I feel like I know my stuff, I'll be able to do it." These are great strategies. We could use that. Another strategy would be, if you have a fear of public speaking, go and do lots of public speaking, Maybe you would join Toastmasters. Maybe you would rehearse it in front of your family, your neighbors, or your colleagues. You would practice doing this behavior over and over and over again with repetition. These are two very good ways to help with confidence building. However, let's compare and contrast them. Let's say that before this public speaking event, you spent a lot of time doing cognitive restructuring. "I'm going to do great. I'm going to do great. Nothing's going to go wrong," which we don't actually know is true. But the thing is, when you walk up onto that stage, you don't have a lot of proof that it is going to go well. You don't have a lot of proof. If it doesn't go well, you mightn't leave there with a ton of confidence. However, if you're somebody who instead practices facing that fear over and over and over and over again, as you go to walk onto that stage because you've changed your behavior repeatedly and you've practiced, you actually have trust in your ability. You have trust in your capability to feel fear. You know what fear feels like, you've practiced feeling it, and therefore you're a little bit desensitized, or you're a little bit feeling a sense of mastery over that feeling, and you are able to walk up onto that stage. My advice is that the better way, the more superior way to build self-confidence, is to practice facing that emotion as much as you can. In exposure and response prevention, which we use as the gold standard treatment for OCD and many other anxiety disorders, we've practiced facing fears over and over. What clients often tell me is, "I actually start to feel confident doing that thing. I start to feel confident taking flights. I'm starting to feel confident going to the post office. I'm starting to feel confident driving my car by actually doing the thing." The real moral of the story here is that confidence comes from repeatedly facing the thing that is hard for you. Identifying the specific emotion that makes it more difficult and practicing being willing to have that feeling. Now, here is where, going back to that cognitive changing of your thoughts, it might be very, very beneficial, particularly at the end of when you faced your fear. Meaning, after you faced your fear, you can actually stop and go, "What did I learn? What did I learn about facing my fear?" Let's say the public speaking example. You go up in front of your partner, your mom, or your dog, and you present your presentation. You might say, "I learned that I don't know the script well enough," or "I learned that I'm still anxious, but I can handle the anxiety." "I learned that when I have anxiety, I beat myself up." Oh, interesting. So we have an opportunity to make another tweak in behaviors because if beating yourself up doesn't work—PS, it never does—then we might want to change our behavior in that area. The next time we're going to go and do that presentation, we're going to work at not beating ourselves up this time. What else did we learn? "I learned that my body didn't explode when I gave the presentation to my dog and then to my mom and then to my neighbor." We're starting to learn things, and we're starting to change the way we think because we changed our behavior. This is a really great strategy for anyone. There's, again, an important cognitive era that we have that gets in our way of building self-confidence, and it's this: "I'm a failure if it doesn't go well." This belief and this thought could create so much suffering. If I can leave you with one core thing to keep in your back pocket as you practice this, it's that we need to fail a lot of times to get confident. We need to fail a lot of times to be good at something. That doesn't mean there's something wrong with us. I create these podcasts and these YouTube videos all the time. I sucked at them when I first started, but I didn't stop, and I didn't say, "That's because I'm terrible at it." It basically meant I had some learning to do. I had some practice to do, and it's okay to suck at things until you get better. The only way I got better was by doing it over and over and over again. I got a little more comfortable and a little more confident in myself as I strategized how I could tweak it a little bit to be better and not be like, "When I'm better, I'll feel good about this." Again, that's a myth. Self-confident people still have anxiety. They just bring it with them, and they know in their hearts that there's no emotion I'm not willing to feel. Again, as we get better at this, we can start to have a sense of mastery over the emotions that we have to feel. Another thing I want you to think about here is if, as you do these scary things, you feel guilt, self-criticism, and shame. What we want to do is soften around that emotion, not add to it and be like, "Oh yeah, you're right. I am the worst. I'm terrible. This is the worst thing ever. I'm bad and I shouldn't be doing this and all the things." Instead, we want to soften into it and change our belief around failure and learning and say, "It's okay. I'm not bad at this. It's okay that I'm not perfect at this." Everyone starts at zero. The people with a million followers on Instagram originally started with zero followers. The people who win Olympic awards in races were once not the fastest runner. They were once in their school and maybe getting beaten by people in their elementary school, high school, or college. We all start somewhere at the beginning, so give yourself permission to start at the beginning. Don't let yourself give up trying a couple of times, and expect yourself to feel confident. Confidence comes from the repetition of doing the thing and practicing having the emotion that is uncomfortable in relation to that task or activity. That is where I want you to change the way you think of self-confidence. It's how I want you to change the way you lean into a task and an emotion as you do that task. I also want to remind you that today is a beautiful day to do the hard thing. This is why I say it on almost every episode. Today is a beautiful day for you to do the hard thing. I want you to go on after that thing that you want to do and practice this. Let the anxiety come, let whatever emotion come. I'm so impressed and proud of you for trying. Have a great day, everyone.

Jun 14, 2024

Health anxiety is a common yet often misunderstood condition that can significantly impact one's quality of life. Whether it's worrying excessively about potential illnesses or constantly seeking reassurance about your health, the effects can be overwhelming. Understanding the nature of health anxiety and learning effective strategies to manage it can make a world of difference. In this article, we explore five essential things you need to know about health anxiety and offer practical tips for recovery, with expert insights from Michael Steer. 1. UNDERSTANDING HEALTH ANXIETY: WHAT IT IS AND WHAT IT ISN'T Health anxiety is a term often misunderstood by many. It's not just about being overly concerned with your health or frequently looking up symptoms on Google. Health anxiety can be categorized into two main disorders: Illness Anxiety Disorder and Somatic Symptom Disorder. Illness Anxiety Disorder involves a preoccupation with health despite not having significant physical symptoms. On the other hand, Somatic Symptom Disorder includes severe and persistent physical symptoms that cause substantial distress. It's essential to understand these distinctions to recognize that health anxiety isn't simply a matter of being overly cautious or paranoid about one's health. Moreover, health anxiety can often intertwine with Obsessive-Compulsive Disorder (OCD), involving obsessive thoughts and compulsive behaviors centered around health concerns. 2. NAVIGATING THE MEDICAL SYSTEM WITH HEALTH ANXIETY Dealing with health anxiety within the medical system can be particularly challenging. One of the critical aspects to remember is the importance of finding a healthcare provider who listens and validates your concerns. If you feel dismissed or unheard, it is perfectly acceptable to seek a second opinion or switch providers. Additionally, distinguishing between different types of symptoms can help manage health anxiety more effectively. Medical symptoms require immediate attention, such as severe chest pain or sudden numbness. Physical symptoms, like a sore back from yard work, are often benign and manageable with self-care. Psychological symptoms stem from anxiety and can include manifestations like tightness in the chest or dizziness. Understanding these differences can help reduce unnecessary panic and improve communication with healthcare providers. 3. TRUSTING THE RELIABILITY OF YOUR THOUGHTS A common challenge with health anxiety is differentiating between real medical issues and anxiety-driven thoughts. Think of your anxious thoughts as spam emails—they're real, but their content isn't always reliable. Health anxiety often triggers false alarms that feel urgent and terrifying. Learning to question these thoughts and not take them at face value is crucial. Techniques like cognitive diffusion can help change your relationship with these thoughts. For instance, if you've convinced yourself numerous times that you're having a stroke and it hasn't happened, the likelihood that your current fear is another false alarm is high. Questioning the reliability of these thoughts can help manage the overwhelming fear they generate. 4. THE ROLE OF COMPULSIONS AND SAFETY BEHAVIORS Health Anxiety Compulsions and safety behaviors , such as constantly checking symptoms or seeking reassurance, often exacerbate health anxiety. One significant trap is becoming inwardly focused, constantly monitoring your body for signs of illness. This behavior leads to a vicious cycle where anxiety increases symptoms, which in turn heightens anxiety. Shifting your focus outward and engaging in meaningful activities can help break this cycle. It's essential to become more outwardly focused, enjoying life and participating in activities that bring you joy and fulfillment. This shift can reduce the power of health anxiety over your life. 5. EMBRACING LIFE DESPITE HEALTH ANXIETY Health anxiety often steals the very things we're afraid to lose—time, relationships, and enjoyment of life. The constant preoccupation with health can make us miss out on living fully. Therefore, the goal isn't just to reduce anxiety but to reclaim your life. Engage in activities you love and focus on adding value to your life. This shift in focus is incredibly powerful and can help you live a more fulfilling life despite health anxiety. It's not just about feeling less anxious; it's about living more fully and enjoying the moments that matter most. CONCLUSION Health anxiety can be overwhelming, but with the right strategies, it's possible to regain control and live a fulfilling life. Michael Steer's book, "The Complete Guide to Overcoming Health Anxiety," is a fantastic resource for those seeking further support and information. Additionally, his website, overcominghealthanxiety.com, offers a wealth of resources, including a free virtual support group. Remember, while health anxiety can take a toll on your life, effective strategies and a focus on meaningful activities can help you reclaim your joy and well-being. TRANSCRIPT: Kimberley: [00:00:00] Welcome back, everybody. Today I have Michael Steer here talking about the five things you need to know about health anxiety and how to recover from it. So welcome, Michael. Michael: Thanks for me. I'm really excited to be here and talk a little bit about health Kimberley: Yes. It's actually a very, very requested topic. It there's always questions about it. So I think this is really, really wonderful that we're doing it. Okay. So first of all, what is health anxiety? Let's just do a little bit of a, you know, intro, uh, tell me what it is and then tell me what it isn't. Cause that's point number one. Michael: Absolutely. Yeah. So we'll jump into point number one, which is I kind of was breaking down if I could have people know five things about health anxiety, what would I want them to know? Or people that support people with health anxiety. And number one point that you're going to bring it up is the first thing that I would want [00:01:00] people to know is exactly what health anxiety is. I feel like health anxiety is one of those things where, you know, you see somebody on their phone looking up symptoms and everybody kind of knows, right? They're like, Oh, I've been there before, right? We all kind of know what health anxiety is, but sometimes we don't know exactly like what it looks like or even more so that there's actually treatment that people can get that actually works. Not medical treatment, but maybe psychological treatment. So, um, I break down health anxiety in a couple of different ways, which is one is that. if you actually have a medical condition, so if you were diagnosed with cancer or, you know, whatever that might be. Um, there can still be anxiety around those types of things, but that's not exactly what we would be calling health anxiety. Uh, you know, kind of in a professional community, that would be an adjustment, Kimberley: Yeah. Michael: a massive adjustment, right? It's like you get this scary diagnosis, you're trying to go undergo treatment, those types of things. So that's kind of one category. And then, We also have this other category, maybe [00:02:00] what we would love them to call health anxiety, which actually is kind of awkward, too, because there's really no such thing as health anxiety , like, oops. Um, but there are some categories under health anxiety that we would say, these are actually what we're talking about. One of them is what we call illness anxiety disorder. Um, the other one is what we call somatic symptom disorder. And, uh, these are kind of the two things that we would call health anxiety. Now, Illness Anxiety Disorder is really a very basic way to break that down, is a preoccupation with your health, but you don't have a lot of symptoms that go along with it. I mean, you might have some here or there, and it's like, Oh, one day, like maybe my vision is a little bit more blurry, or I got a kind of weird pain over here. But the, usually the symptoms kind of come and go pretty, pretty quickly. Um, now, Somatic Symptom Disorder is still the preoccupation with your health. But the one big difference that people run into is usually the symptoms are pretty severe. They're [00:03:00] pretty significant, and they're usually a little bit long lasting. So, you know, maybe people are dealing with, you know, chronic stomach pain or pains in their stomach that they really become preoccupied about, but those symptoms are pretty significant where it's like impacting life, those types of things. Um, and then the other category that we can just throw in there real quick is also OCD. Um, and what we'll talk about here and, uh, maybe towards the end of this part is a lot of times I put health anxiety and OCD kind of as hand in hand. Uh, they're not the same thing, but they share so many of the similarities and how they work. And, um, if you ever look through some of the OCD literature. OCD can have health themes and so those would be times where we can be very, become very, you know, have the obsession and compulsion cycle go around health. So that's, that's really what health anxiety is, is usually one of those three things, which is either you don't really have many symptoms and you really worry [00:04:00] about it. You're actually having a lot of symptoms. you're worrying about it, or it may be a bigger dynamic of OCD, where maybe you have other obsessions and compulsions, and then maybe one of them is also just the obsessions and compulsions around your health. Kimberley: Amazing. Michael: yeah. Kimberley: What about hypochondria? Do we, where would you put that? Michael: So that's an older term. Kimberley: Yeah. Michael: So we've kind of, you know, and a lot of times, um, I feel like I'm kind of glad that that term has kind of shifted as just kind of like, you know, illness, anxiety, and somatic symptom. Um, just because there's a lot of judgment and a lot of negativity also around kind of, you know, as soon as somebody is like hypochondria, right? And it's kind of like, it comes with this like really negative experience and like, Oh, you know, they're, they just worry about their health all the Kimberley: Right. Michael: it kind of gets dismissed pretty quickly. So, um, that's just, if you ever see hypochondria, um, it's just an older term or sometimes it's still used in the medical community. [00:05:00] I think it's, even when you look up in some of the, um, Um, things to, uh, you know, for some of the coding, it still comes up as hypochondriasis. Um, however, it's just, it's the same, it's a different terminology just for what we would now call illness, anxiety disorder and somatic symptom disorder. Kimberley Quinlan, Thank you for sharing that too. Cause I think Googling, because that term has been used for decades, that is often what people are looking for. And I think, as you said, people get dismissed like, Oh, you're being such a hypochondriac about it. You know, that. I think is, I'm glad that you, you shared that. Okay. So that was number one. Number two, um, what is the second thing we need to know about health anxiety? Michael: So number two is kind of going right off of what you're saying is a lot of times, you know, what I would really want people to know is to, a lot of times people do get this mess. and even clients that I'm working with, because I work with a lot of health anxiety clients are still trying to navigate [00:06:00] that relationship between, they probably really do have some anxiety around their health, but they're also trying to work with the medical community. and that makes it quite challenging, um, because you know, there can, um, there can be some times where it can be challenging. People can get written kind of off of like, well, this person, you know, they've, they've been anxious about their health before, and then they've sort of become. Um, what could be an obsessive worry but also could be a very realistic worry of I go back into my doctor and they kind of know that I deal with anxiety around my health, they going to take me seriously? Michael: know, if I come in and I say, wow, I've been really having a pain here or here, are they really going to be listening to me? Like really take me seriously and investigating this or are they just kind of writing it off You know, this is, you know, awful, you know, this person has been anxious about a lot of those different things. So the one thing I, I think that we, um, that I think, I think is really important for people to know [00:07:00] is you're working with a medical provider and you don't feel like they're listening to you, they're not validating some of your concerns, they're, they're, you don't feel like they're really invested in some of these things. Um, it's always okay to go find somebody Kimberley: Mm hmm. Michael: That is totally okay to do. You can take it from me. Hell, like, you know, what I would, I don't know if there's no delineation of a health anxiety specialist, but I think there can be some of those times where things are not taken serious. So Kimberley: Yep. Michael: do feel like that is a relationship that you're having with a health provider, find somebody new. Go find somebody that really does listen to you, right? Now if you're also working with somebody that you feel like you really trust, you feel like They feel like they got your back, like they're, they're, you know, but maybe you're kind of running to the end of the road of like, I, don't know really what else we could test for. That's something different, right? Because at least there's that level of trust. So the second thing that we like when it goes into this piece of, you know, like Val or validating people's [00:08:00] symptoms is we also have to realize that there is a difference between physical symptoms, medical symptoms and then also psychological symptoms. And so here's how I break these things down. Medical symptoms is usually the ones we're really afraid of. medical symptom could be like if I have chest pain. And a medical symptom would be I need to go to the hospital because I'm having a heart attack. That is an explanation, a medical explanation of a symptom that I'm Kimberley: Mm hmm. Mm hmm. Mm. Mm. Mm. Mm. Michael: ER, those types of things. one category or one bucket that sometimes we put those in. A second bucket is what we call physical symptoms. And a physical symptom is something that's actually really happening in our body, probably don't need to run to the ER or the urgent care because of that. So like, for instance, if I went and did a bunch of yard work over the weekend, and my back really hurts, um, arguably because I'm getting [00:09:00] older or because I've done a lot of yard work, who knows? Um, Um, I don't, that's a real physical symptom that a lot of times our mind could try to catastrophize, but it's probably not something that I need to go and run to the doctor about. I probably need to take it easy, put a little bit of ice on my back, et cetera, et cetera. So we have medical symptoms, we have physical symptoms, but then also we have psychological symptoms and this is the way that our mental health can also affect our physical body. So for instance, if we're becoming anxious, I'm sure that, you know, if anybody has ever been anxious before, which I'm going to assume everyone has, If we become anxious, sometimes our chest gets tight. That's a real physical symptom. That's a real symptom that we have. But the origins of the conclusions of that is from a psychological standpoint. Now, here's why I think these buckets are important, why I want people to know about them. Surprise, surprise, health anxiety always usually goes to one bucket. Medical symptoms, right? It's like, Lower back pain, medical. You know, my chest is tight, medical. This weird kind of [00:10:00] feeling in the back of my head, medical. You know, all of those different types of things. And one of the things is being able to have this context of if I could start to separate some of these symptoms out to maybe there are some symptoms that I could have that are medical, but maybe there's also physical symptoms that are just happening. There's a great article that I always like to give all my clients The Noisy Body by, uh, Abramowitz, that's just a wonderful handout, a wonderful article. And it just speaks to the nature of like, well, we get signs and symptoms and weird feelings and burps and farts and all these things all the time. The hard thing is, is when our mind gets really preoccupied and starts to put them into the category of, oh no, what if, could this be this really negative thing? So I'd like to, that's the second point that I would really want people to know is. We have to realize that even though there is always this scary explanation of symptoms, it's important to have this perspective of noticing that there could be, there could [00:11:00] be medical symptoms that I need to really do something about, physical symptoms that I need to do to some TLC, and then also psychological symptoms. And then one last thing I just throw in there real quick before we can go on to the third one is, um, the most important part about this is regardless of what bucket you put this in, all of them are valid and real symptoms. that's the other piece that we get into this kind of like stigma or negativity, that sometimes people will talk about a real symptom that they're having, and then they'll be like, Oh, well, that's just your anxiety as almost as if the symptom is not happening. And so I think what I would really want people to know with health anxiety is regardless of what bucket it's coming from, it's always real. You're always valid and feeling it. The one question that we have to just ask, which is going to lead us into number three at some point is. Or can we trust that the explanation for the symptom that our brain has brought us really the explanation of what's happening? Kimberley: Mm. [00:12:00] So, I have a question, which you might answer it in, you can even use this for the, for an example. So, a lot of my followers know that I, in, um, in 2018 was diagnosed with Postural Orthostatic Tachycardic Syndrome. Michael: Mm. Mm Kimberley: one of the main symptoms of that is that you faint and a lot of, I'm very well in recovery of this right now, but one of the things was me without using this terminology, which you've beautifully put out. And I actually learned this terminology from you is it was about passing out, passing, like not, not, not passing out, like, uh, differentiating, sorry, my accent got it, differentiating. Um, is this dizziness from my anxiety? Is this dizziness evidence that I'm going to pass out, like faint? Um, Michael: hmm. Kimberley: because a lot of [00:13:00] having this condition is tolerating dizziness 24 seven of the day. Like it's a symptom of the condition. Um, so in that case, just as that as an example, how would you, which bucket would you put this in? Michael: For sure. Good. Great question. And this is where, like, health anxiety, I think that's why it's really important to, to really notice the stickiness of Kimberley: Mm. Michael: Because, you know, as an, also as an OCD specialist, a lot of times when we deal with OCD themes, not often having people, like, deal with, uh, you know, harm obsession. And also undergoing evaluations to see if they're a Kimberley: Yes. Yes. Michael: Uh, that doesn't really make sense. health anxiety starts to become this kind of interesting dynamic of, well, what happens if we have anxiety around medical Kimberley: Yeah. Michael: And also we have to like, go get evaluations and other things that are actually Kimberley: Yep.[00:14:00] Michael: that's a great point. And it's like, okay, so what if the, um, Um, you know, the symptoms that I'm feeling could be an explanation of a medical condition that's happening, or it also could be, you know, from the place of, um, you know, from my anxiety. Um, think the answer comes down to, um, is going to this, what I usually like try to call a pretty, a best guess. Which is, now, when we're thinking about passing out, the one thing I think is always important. as a person that works on a lot of needle phobias and blood phobias is that if you feel like you're going to pass out, get yourself in a safe place, right? Like sit down, make sure you don't hit your head. You know, Kimberley: Yep. Yep. Yep. Michael: But also there's this kind of conclusion that we can come through with our experience that says, know, um, if I, if I think about the symptoms that I'm having right now, where would I put my best guess on those, right? And if we're putting this, that medical side, then we could say, okay, well, [00:15:00] Um, I need to do whatever the doctor has recommended that I do in those situations because that's just what's most helpful. If I'm feeling like it's more on the anxiety side, that's maybe where I could use some of my tools that we learned in therapy to be able to manage that. Now is it a perfect system? No it's not, right? Because there's always this little piece of uncertainty and the unknown there Kimberley: hmm. Mm hmm. Mm hmm. Mm hmm. Mm hmm. Mm hmm. Michael: that's, I think that's what's also really important about being able to kind of discuss those things either with your doctor or a therapist to be able to really walk those muddy lines. Um, I have quite a few clients that we try to walk that line all the time where, I've had clients where thought that maybe this was or maybe it was assessed as like, Oh, this is just something anxiety related. That's why you're having symptoms. And then it's like, months later, surprise, I'm allergic to this, right? And so, that's why we don't always know the answers to all of [00:16:00] those things. Um, but as we kind of go, we can kind of walk that line to say, could I make my best guess about what this is at this current period of time? And if that was the case, what would I do in that Kimberley: Yeah. Michael: You know, and so do I need to go a medical route? Do I need to go to a psychological Kimberley: Yeah. Which I think takes us to next step number three so beautifully. So go ahead and share what is the third thing we need to know. Michael: Absolutely. So number three talks about. Um, a lot of times our brain can bring us to a lot of different conclusions and we just talked about the conclusions that a lot of times our brain Kimberley: Yeah. Michael: into in terms of medical, physical, psychological. And a lot of times we just take those conclusions as the truth. go with them because they're terrifying, they're scary, right? And they feel really threatening. And so one of the things that I think is important for people to recognize is I like to use the example of a spam email. is I'm sure we've all gotten spam emails. And if you haven't gotten a spam email, please let me know your trick because that would be I could clear out like [00:17:00] 75 percent of my email box. So but a spam email to me is kind of walking this line between is a spam email real? Oh, of course, we all get them in our email box, right? Like they actually come through to us. They have a time stamp, et cetera, et cetera, right? But the one question that we have to start to kind of wrestle with with health anxiety is. is the conclusion or email that I'm getting a reliable source of information. so if you get an email from tomjones1973 at AOL. com that claims to be from the FBI, why would the FBI be sending you from AOL? That doesn't make Kimberley: No. Michael: Now, is that email real? You betcha. However, if we can question its reliability to say, can, you know, do I trust this email to be what I think it is? Kimberley: Mm hmm. Michael: Then that can really start to dictate some of the actions that we take. So when we think about health anxiety, right, is your brain can give you a lot of really scary a lot of really unknown possibilities that could be going on with you. And [00:18:00] so, you know, one of the things that I think we have to really kind of start to become curious about is, do I just go with them? You know, am I there just responding to all of my spam emails in my email box? And if you do, we probably need to help like. Credit monitoring and all those Kimberley: Yeah. Michael: besides, from that point, do we get ourselves into a lot of actions that could be very unhelpful when we take these emails as as reliable? So, like, for instance, if you, you know, you have the dizziness, right? And you're, you're, you know, the initial evaluation or conclusion that your brain comes up with, aka what we could also call an obsession, right? Is like this could be an aneurysm, right? Or maybe you have a stroke or all these different types of really scary things. If we take that as a reliable piece of information, it starts to make Kimberley: Mm hmm. Michael: that we would be like, well, I need to figure that out. I need to be like, look up some symptoms of online or I need to go to the urgent care, whatever those things are, right? but if we get a, oh, by the way, I should have included this earlier, but [00:19:00] that's okay. We'll include it Michael: This is all on the premise that we have a relatively good answer. if you don't. If you're getting dizzy for no reason, and you have no idea why, I don't want you practicing anxiety Kimberley: Yes. Michael: Go to the doctor, right? Like, explore those things, figure those things out, try to get a pretty good answer. However, if we get a pretty good answer about something, and we are going to say it's like, I think this is because of my anxiety, but my brain wants to really convince me of all these other conclusions. can we use some of those tools in terms of, you know, Becoming curious about, can I really trust my brain sending me right Kimberley: Mm hmm. Mm Michael: if this is like the 937th time that I'm convinced that I've had a stroke, what's the chances the 938th time is going to be it? Probably not. so, I could go look on things online, or probably got a lot of other things to do, too, that I could go and get involved with as well. So, that's it. One of those tools is, is really being [00:20:00] curious about, yeah, your brain's going to give you a lot of really scary medical possibilities. If we can ask that question of not if it's real or not, because those things are totally real, but can I trust the message that I'm being sent? It can start that process. Now, the other tool that I really like to use with people is diffusion. Um, and, and to kind of give it a quick breakdown of cognitive fusion, even though some people may be like some of the listeners may know, is just being able to like what kind of relationship that we have with some of our scary thoughts. so sometimes I kind of describe as like, well, it's not really necessarily getting away from them. It's just about changing our perspective towards them. So like, I kind of think about this example. It's like if you go out into like a really busy highway, you set up a lawn chair right in the middle of a busy highway and you have cars whizzing by you, you can see the traffic, but man, oh man, is it overwhelming. And so if we can use some diffusion skills and those would all be the great things, like, you know. Uh, just repeating or thanking our mind or my favorite is always just [00:21:00] singing, like, you know, the tune to happy birthday, Kimberley: Yep, Michael: be right is sometimes those start to kind of be able to take us from this position of, could you just take your chair and put it on the side of the highway? And if we can do that, we can still see the traffic that's out in front of us, but it's much less overwhelming at that point because you don't have cars whizzing by Kimberley: all right Michael: these cognitive interventions, I think, can be really helpful. Um, because a lot of times our brain is leading us to all of these conclusions, giving us these really scary ideas, and it might really start to go against the information that we have at that time, at least medically. Kimberley: Amazing. And I, the reason I love this is that was a big piece of it for me, just to sort of give a real example of me having health anxiety and a chronic illness when you are you're dizzy. My brain was like, this is it. You're going down, you're going down. And I had to get used to just having the thought like, yeah, you're dizzy. It could be it. But we know the symptoms of when you are, and you're just, you know, again, like you [00:22:00] often say, like, it's about being uncertain and being able to just to have the thoughts whenever they show up. So would you add anything to that or, Michael: Know it. And I think what's important with that is, there's a piece of uncertainty Kimberley: um, Michael: but we can also act within a reasonable Kimberley: yes, Michael: right? It is like, you know, we can, we can always make those, you know, I always love delay in these situations Kimberley: um, Michael: is if I start to become dizzy and I'm concerned that like this is going to be, this is me passing out, right? And if you just like, if you're dizzy and you remain dizzy and you remain dizzy, you know, those types of things and it, you know, you're just kind of like working through it and it's like, okay, maybe that's one thing if you're dizzy and then the wall start closing in, right? And you start to get tunnel Kimberley: yeah, Michael: Well, that's what you can always make a different, Kimberley: yes, yes, um, Michael: I think the lay, but. nothing about health anxiety that likes delay, right? Because whenever these [00:23:00] symptoms come up, it's always going to be about you need to do this Kimberley urgent, Michael: to the E. R. Currently, like right Kimberley: yeah, Michael: wait, Kimberley: yeah, yeah, Michael: if even if we're able to kind of like practice some type of delay, right? We'll be like, okay, this is what this feels like now. I understand the concerns my brain has, like not quite sure if I can trust it. I don't know. It's giving me some bad advice before. I But could I just wait that out and kind of see how that Kimberley yeah, Michael: And, you know, if it continues to get worse or you start to get tunnel vision, go take care of it. There's probably something going on. But if those experiences, you know, I think what happens a lot of times for people is they, they try to move themselves on to something else, right? They get back to dinner or whatever it might be. And then they kind of have that reflection point or like later of being like, Oh yeah, I was like dizzy Kimberley: um, Michael: earlier. And it's like, Oh, Kimberley: um. Michael: to that? Right? So I think delay can be a really helpful Kimberley: Fantastic. Quickly, just because I have a couple of people in mind, and I know what their questions would be here, is in regards to [00:24:00] the, the point number two, where we were talking about the difference between medical, physical, and psychological. Let's say somebody. Um, has just intrusive thoughts about like, what if, actually maybe no, let's say they have a headache, a physical symptom and their brain is just constantly telling them like, this is a brain aneurysm, or this is a brain tumor, like this is cancer and it doesn't quit, um, Um, and the person also experiences this sort of intuition that this is what it is. What, how would you, what, what bucket would you put that in and would you use the same skills? Michael: So, yeah, so the, the questions that I would have for that situation, which is number one, have you been to the doctor? You know, have you gotten it checked out? Have you like evaluated some of these, you know, headaches that you've been Kimberley: Mm. Michael: Now if they say, uh, no, I've never been to the doctor about that. I'm, I'm not a doctor. I'm going to say would be [00:25:00] kind of silly of me at that point to be like, you're Kimberley: Yeah. Michael: You know, that's Kimberley: Just tolerate the uncertainty. Michael: Yeah, that'd be good, right? We're like, that's probably not great. So because nobody would do Kimberley: No. Michael: Like we, well, hopefully most people would not do that because if there is, so that's the first question I would always Kimberley: Mm. Michael: is if you're having a physical symptom that's different, that's changed, that's more significant, whatever it might be, question needs to always be, have you gotten this Kimberley: Mm. Mm. Michael: part that it's, I really wish there was a better answer to this. but there's not the least that I found, which is like how much is too much, you know? So if you're like, okay, so let's say the answer is yes, I have gotten it looked at and they can't find anything. Um, sometimes the conversation starts to become, well, how much, like, should I go for a second opinion or third or fourth or fifth or sixth? Um, and what's really difficult about that [00:26:00] is no one really knows that answer. Okay. And, um, what I try to really do to level with people, too, is that, you know, if you were having that headache and you're like, I don't know, Mike, like, this is like, I've seen like four doctors, still feel like there's something, like the intuition Kimberley: Mm hmm. Michael: feel like there's something wrong. There's something going on. I can't, I can't fight you on that and being like, no, you shouldn't, right? Because I, the fifth time might actually be the time where it's like something comes back and you're like, oh my goodness, like, I'm so glad they found that. So. always this kind of difficult time that I get these questions where people would say like, what, what, what is too much now getting like a fourth or fifth or sixth opinion, whatever that might be, could just be reassurance Kimberley: Mm hmm. Mm hmm. Michael: you know, getting another clear scan or whatever that might be. And it just kind of gives us that temporary relief of like, okay, goodness, like nothing's going on. But I think it's reasonable for us to know it's like it's not a very clear cut kimberley-_1_06-04-2024_101032: Mm hmm. Michael: Of saying, like, [00:27:00] everybody's in their right to go get another opinion. you know, to, you know, however much you want to pursue that. We have to be on board and somewhat of being like, okay, like, go do that. But the other thing that I would always throw in there, too, that I like to try to work with people is, there's going to be productive ways that we can pursue that, there's going to be unproductive Kimberley: Mm. Michael: you're having those headaches, and you're, and you're like, I've seen three people, I kind of want to go see four, I would say, I can't fight you on that. You should go see that fourth person, see what they say, but that's a productive method of trying to figure something out, right? Like, cause you could possibly, they could give you some scan, right? And be like, Oh my goodness, like right here, we found something, right? also other unproductive behaviors that sometimes people get into, um, that like your brain at 3 a. in the morning while you're ruminating about if there could be something going on in your brain or not, right? have no access to scans, like you're not gonna figure anything [00:28:00] out. You're not gonna come to some revelation of like, Oh, now that I can see inside my brain, I can see what the problem is, right? So, there's, there's kind of an encouragement that I try to give to people, too, is if you really feel like there's something wrong, and even though you've gotten a lot of things that have said maybe nothing is wrong, if you want, if you feel like it's necessary to continue to pursue those productive ways, set an appointment with a doctor. Go to that appointment when it's the time, right? Great, go do those. But some of these other things when we're thinking about like, but are we like ruminating about this for hours on end during the day? never going to become anything Kimberley: Mm. Michael: not going to come to some insight of like, ah, I see everything clearly now, I see what's wrong. And so we try to practice those tools in those situations of saying, you know, if that's kind of an unhelpful thing to do, could I find something better to do? Uh, to do with my time than just endlessly going over this in my Kimberley: Yeah. Amazing. Which [00:29:00] ties us right into the thing number four. Um, tell us. Michael: four, the four, I almost held up five, so that's good. Number four is, now, when we think of like, like, you know, for some of the viewers who might be a little bit more familiar with OCD, a lot of times I just use the terminology of TOs Kimberley: Mm. Michael: triggers, obsessions, and Kimberley: Mm. Michael: you might be saying, it's like, well, I didn't think health anxiety was really OCD. It's not. But. The functionality of these things kind of operate in the exact same way. So number four is talking about compulsions, or if you just wanted to view it as safety behaviors, that's cool, too. They kind of do the same thing, which is there's going to be physical or behavioral compulsions that we could do or mental. and one of the things that we really have to account for is just their ability to not really be able to give us an answer that we really want. and how sometimes it actually, especially with health anxiety, one of the things that I'll point with health anxiety. Usually makes things [00:30:00] worse. So there's always like pretty classic different mental or behavioral compulsions, you know, googling or, you know, going on Web and D and clicking on the little body right and being like, you know, we get the huge list, you know, you put in fatigue and it's like, gives you all these terrible things, right? It's like, Oh, maybe I don't Kimberley: There's like cancer at the bottom of every single Urban D article. Michael: Yeah. Yeah, it's just like this. Just put it on the Kimberley: Yeah. Michael: you know, it'll be there. Um, the one thing I think is really important to consider specifically with health anxiety is the tendency for us to become really inwardly focused. And I think this makes it really difficult people to be able to have any chance of being able to move on from any of their health worries. a lot of times what we all want to do is the one thing that we want to monitor is the thing that's wrong. And so for instance, if you go back to your dizziness, right, we might continue to check in on that being like, well, my dizzy now or my dizzy now. How about now? [00:31:00] But the problem is, is that now you're like now you're swapping buckets, Because we have the medical that we have the physical and we have the psychological bucket. But what's a, um, I don't know. You feel dizzy because you drank a little bit too much coffee this morning. You're kind of feeling a little whoa, right? That's a physical symptom. not medical. You don't need to go to the doctor and be like, I've drank too much coffee and be like, great, just go run around for a little bit. Work it off. Right. Um, but the hard part about that is like, so that's a physical symptom. However, then we could start to get that conclusion that we talked about of like, Oh, my goodness, like, what does this mean? And maybe the conclusion is medical. You know, it's like, Oh, maybe I'm gonna pass out. but then the result of that is psychological. We start to get anxious about it. We're like, Oh my goodness, like this could be really bad and like, I don't want this to happen. However, now the byproduct of anxiety a lot of times is lightheadedness, right? And so we work into this catch 22. The [00:32:00] hard part about it is we keep checking in on those and there's a lot of body monitoring with health anxiety that really gets people stuck, um, paying attention to feelings and sensations and symptoms. And the hard part is it keeps going back and forth between these two things of we get really concerned about a symptom. It makes us feel anxious, which increases symptoms, which we notice more. And when we notice more, it makes us feel more anxious. And when we get more anxious, and so we just keep getting into the step ladder. So one of the things that I think is important when we think about this Catch 22 that starts to happen, is I try to really encourage people to think about, If often you get, start to get stuck within your body, your, your focus is inward thinking about how do I feel, what do I notice all of these different things? biggest goal that we can do with any of these things is how do we become more outwardly focused? That doesn't mean that you have to like [00:33:00] pretend that you're not feeling some of these things. Um, I'm a huge fan of dialectics in terms of using and Kimberley: Yes. Michael: which is noticing like I'm feeling dizzy right now. And also I could try to be as best of my ability really involved in whatever is going on around me. Um, and so think it is, like there's a lot of different compulsions and things that we could talk about, but the biggest one I would want to bring up, at least for people to be aware of. it's becoming more inwardly focused, gets us stuck Kimberley: Yeah. Michael: And, and it's, and understandably it's scary. to direct ourselves away from those, right? Because then it starts to feel terrifying of like, oh my goodness, if there's something that's really going wrong with me and I'm not paying attention to it? And that's where we start to get to the feared consequence, Kimberley: Yeah. Tell Michael: some of the work starts to become, which is if I can recognize I have a pretty good answer about [00:34:00] this, maybe my brain isn't being all that reliable. I think this is just a psychological symptom. Um, maybe I'm willing to take the risk that maybe it could be something bigger, better. Um, but in service of being able to get back to my life do the things that I would like to be able to do, maybe that's a risk I'd be willing to take. Kimberley: me about number five. Michael: That leads into number five. realize whenever I wrote these out, these were going to blend so well, but Kimberley: It's like we're flowing. We're in, we're jiving today. Michael: I know, right? The number five just goes back to this piece of The hardest thing about health anxiety is that one of the things it's not always about death because that sometimes that's what people always think is like, Oh, you're just afraid to die. Um, Kimberley: Mmm. Michael: people's faces whenever I always had the pre face, know, we always like to ask that question of like, what would be the worst thing about that? And health anxiety is always the really like, [00:35:00] uh, interesting one where it's like, well, I'd probably die and be like, what would be the worst thing about that? And people look at me and they're like, Kimberley: I'd be dead. Michael: that'd be dead. And I'd be like, yeah, I know, but what would be the worst? And so for some people it is, Kimberley: Yeah. Michael: death. But there's a variety of different, um, feared consequences that I think it's important for people to wrestle with too, which is some people it's around Kimberley: Mmm. Michael: Some people it's about just the struggle. It's about treatment. It's about just how miserable it'd Kimberley: Mm. squadcaster-48hd_1_06-04-2024_121032: You know, uh, it would be about, you know, the whole process around, you know, getting treated and. You know, saying goodbye to people. For some people, it's not just about death, but it's also about, um, like, the impact that they would see a huge increase in health anxiety when people usually have, like, big life events. Uh, not just in terms of stress, but like, they get married, and now it's kind of like, it's up the ante of their health anxiety. It's like, well, now it would be kind of bad if you Kimberley: Yeah. Michael: But it would be even [00:36:00] worse because now you'd leave like your spouse behind or even worse like Kimberley: Yeah. Michael: kids search into the picture, right? And it's like, Oh my goodness. And so I think it's really important to kind of start to look at is a lot of things that we could really fear to lose. The dirty trick that health anxiety plays it kind of makes us lose those things before we've even lost Kimberley: Yeah. Michael: And what I mean by that is that sometimes we become so preoccupied with our health. Going to the ER, you know, running to the doctor again or, uh, just ruminating her mind or, you know, the family's around or you're having dinner and you're on your phone, right? Like looking up symptoms, right? things that we're afraid to lose might already be Kimberley: Yeah. Michael: they're there in front of you to be able to engage in. the really hard thing is, is we're afraid that those would go away, but they've already gone Kimberley: Yeah. Umm. Michael: other process. So. think the one thing we have to kind of really wrestle with is [00:37:00] it's not just about trying to get rid of anxiety. I mean, that's part of the picture. Um, I'm sure for anybody that's ever in the helping profession, they'll always have somebody come in and saying, I really want, you know, this to go away, to be less pain, to feel less anxious, to feel less sad, whatever that might be. And those are cool goals. Like I'm on board with those, right? Like, I don't want people to feel more anxious. Um, I want people to feel less anxious. But if that's the extent of our goals for ourselves is just to, like, worry about my health less, I mean, that's kind of good, but we're missing a big part of the picture here, which is really, what can we add? You know, because health anxiety wants to steal all these things away from you in your life, The things that we're so scared to lose in the first place. And so a big part of number five, I think, is important for people to really recognize, is that Health anxiety is going to want to take those things away from you. And I wouldn't want people to work just like feel less anxious about their Kimberley: Yeah. Michael: I would want them [00:38:00] to work in what are the things that you're really afraid to lose. I want you doing more of Kimberley: Yeah. Michael: Right. And that is going to get to the point of having to work to give up some of the things that often would make us feel like we need to do to be able to keep ourselves safe. And that's hard. That is, that's the Kimberley: Yeah. Michael: Is being able to lean into those things. But, the work also becomes, also gets with the reward, which is, we're actually being able to live life and be able to do those really meaningful and valuable things that we really are afraid to lose in the first Kimberley: Yeah. And when you start living your life, you tend to be focused less inward on all the symptoms as well. So it's sort of like a reverse snowball effect. Michael: That one of the, absolutely. Good, I'm glad you bring up that point, right? Because that's what happens, Kimberley: Yeah. Michael: we get involved in something else, we start having fun, and then it's that tendency for our mind to want to go back to be like, well, how does this[00:39:00] Kimberley: Yes. Michael: How does this feel? And so my encouragement for anybody is that about trying to get away from those. I try to draw a quick, line between distraction and redirection, which is a distraction is like an escape, right? Be like, I can't think about this. I got to get away from it. You know, like, let me focus on this movie, Kimberley: Mm hmm. Michael: Where a redirection is really just trying to make a place for that of just noting of like, yeah, I am feeling this way. I noticed my brain is like yelling at me to be like, look this up on Google right Kimberley: Yes. Michael: I could notice that. And also, I know it's going to be more helpful for me to make a place for that. Get back to the movie. Really try to get into that. Pay attention to it. that gives us a chance to do, just like what you said, is now we're focusing outside Kimberley: Yeah. Michael: Instead of all the things that could be going on in our body, which some of them could possibly be serious, but most of them are probably just our bodies being Kimberley: and I think that's cool too is like our bodies will be bodies there, especially as we [00:40:00] age. I see a lot of people's health anxiety go up as aging. You said aches and pains, sleep issues, like it's so common. Yes. Yes. Okay. Yeah. Michael: and it's like sleeping on like something like really uncomfortable floor and And then like, I'm like, oh, I slept really good. And then like me, as I got older and there was like a sock in your bed that you slept on and you're like, oh my goodness. Like, and, and age is gonna Kimberley: Yeah. squadcaster-48hd_1_06-04-2024_121032: had to remember as, as age goes up, health kimberley-_1_06-04-2024_101032: Yes. Yeah. Yeah. Michael: you know, the question real quick, I'd just like to add with this is a lot of times I do get the question of like, well, what if you've had cancer in the past? Right? Like, is that still health anxiety? And it's like, well, you know, if you're in remission you're doing all the things that you need to do, you know, you're probably getting more frequent scans, all those different types of things. We can still become preoccupied with the [00:41:00] possibility of like, what if this new thing, whatever we're feeling is cancer again, right? And that's, I think we have to walk that, that piece of like, that's an incredibly understandable place. And also we go back to number three. which is, is like, are we getting information from our brain that's reliable? And if all the other information that we have in the current period of time, working with an oncologist, whatever it might be, is saying, Hey, your markers look good. Blood work looks good. Your scans look great. Then that's maybe what we challenge ourselves to say, maybe I need to get back the things that are most important. Kimberley: I love this so much. Thank you so much for sharing these points and bringing so many applicable skills and tools as well. Tell us where people can hear about you. Tell us about your book. All the things. Michael: Yeah, absolutely. So, um, A couple different things with that. One is we did release a book in the mid December. Um, [00:42:00] it's right here. The Complete Guide to Overcoming Health Anxiety. Uh, How to Live Life to the Fullest Because You're Not Dead Yet. Kimberley: Punchy little yes. Michael: Still here. So, um, there is a book out on Amazon. You can get it, uh, soft cover or you can get a Kindle version. It's written, wanted to write it. Uh, so the, my coauthor. Uh, Josh Kimberley: Yes. Michael: and I wrote it, um, and we really wanted to write a book that didn't feel too clinical, didn't feel too like, um, you know, that, you know, like you're reading like a, an academic book or something like that. So I think if you appreciate maybe a little bit of a lighter approach, at sometimes funny, some points, uh, cringy, maybe not cringy, I'll just blame it on Josh. Maybe that was all his cringy points. I, I did all the good jokes. Uh, just kidding, Josh. I love you. Um, uh, it is, it's just written in a little bit of a different way that I hope that, you know, some of the feedback [00:43:00] is for people have said that like it's written differently, but it's just written and they feel like they can connect Kimberley: Yeah. Kimberley: make sense. Um, but that's also very back to, you know, number three that we talked about in terms of cognitive interventions is that you know, it's really important to start to change our relationship with those. So the book is out there, but also we, we also started a website, um, overcoming health anxiety. com. Um, and it has a ton of different resources. We just redid it and try to add a bunch of different other stuff. So we have a health anxiety one on one section. We have treatment resources. have videos, you know, different podcasts. Um, we have a link to our free virtual support group that meets every Thursday of the month. Michael: So, um, uh, so, uh, we have a link to there. Because we really just want to be able to try to reach out. And like I said when we first started [00:44:00] is, a lot of people know that this is a thing, right? Because they, they know and there's even the term cyberchondria out there, right? Like people know about health anxiety. But very people do know that you can actually like get Michael: this not necessarily just through a doctor in terms of like, Oh, here's your medical treatment, but there's psychological tools that you can use that with that. So, yeah, those are our resources. We got that website. We got the book. Um, and, um, we're just trying to connect with health anxiety sufferers to show them that there's some hope to feel better. Kimberley: So good. Thank you. So many wonderful resources and amazing book. Thank you so much for coming on. Um, those folks are the five things you need to know about health anxiety. Thank you so much, Mike, for being here with us today. Michael: Thanks for having me. I appreciate it.

Jun 7, 2024

Today, we're going to go through the six reasons you procrastinate so that you can make a plan and hopefully end that procrastination so you can get back to doing the things you want to do. Recognizing the reasons why you procrastinate is so important. I want to make sure I cover one key point before we get into the six reasons, and that is: you're not lazy, and you're not faulty. It's not a bad personality trait that you procrastinate. I want to dispel that myth right out of the gate so that we can beat the self-criticism, the self-judgment, and the self-punishment that you may be doing or have done in the past. The fact that you procrastinate does not mean that there's anything wrong with you. You're not broken. We engage in these patterns and safety behaviors to manage distress in our bodies. Procrastination is an avoidant behavior to avoid having to be uncomfortable and to work through the deep stuff that's going on in our brain, mind, and body. First, I wanted to review that this is not your fault. You're not bad because you do this. I'm even going to reframe a couple of those things here. A PERSPECTIVE SHIFT ON PROCRASTINATION As we talk about why you procrastinate, I want to tell you a story that changed my thoughts about procrastination. As an intern, I had a supervisor when I first became a therapist who supervised us and all our cases. A lot of the interns were talking about how we were so behind on all of our research and our study. We had all these tests, we had all these assignments, and we had to see clients. She questioned us by saying, "Procrastination isn't necessarily a problem. First, you've got to look at the function of procrastination ." She said that if procrastination is working for you and it means you get the work done, you complete it in time, and you're happy with the product you've created, procrastination isn't a problem. In our society, we tell ourselves that we should be organized and calm when handing in the assignment instead of pressing the button right at the very last minute or sliding into work right as we should start. Now, she said, if it's working for you, go ahead and keep doing it. But so many of you, particularly those with anxiety, say, "No, Kimberley, that's not the case. It is not working for me." If that's the case for you, let's first look at the effects of procrastination. Suppose you are somebody who has an extreme amount of anxiety when you procrastinate, and it's coming from a place of anxiety. In that case, it increases your panic and stress at the last minute, and you melt down. Then, this is why we want to explore the causes and why you procrastinate so that we can come up with a solution and a strategy that does help you. The Six Reasons We Procrastinate Fear of Failure This is true for many people because we fear making mistakes. Our society has become allergic to making mistakes and failures. So we create such a story in our heads about how it's going to be so bad if we fail, and it's going to be so bad if it doesn't go right, and how we are going to look stupid and how we are going to feel terrible. But much of that comes from this entrenched belief that we are not supposed to fail. I took a whole year and practiced failing for an entire year. I tried to fail a hundred times, which completely changed my thinking about failure in everything I do. I got good at things because I failed repeatedly and changed how I looked at failure. Now, I understand that we are expected to perform at such a high level in today's society. But what I want to have you do is act from the place of a B-. What I mean by that is, instead of going for an A+ all the time, try a B-. You will find that if you just drop the bar and let it be imperfect, you'll have so much less anxiety. It is much easier to practice being gentle and kind to yourself when you mess up or fail. I've had so many patients and students tell me, "Failing is not the problem; it's the beat-up I give myself when I fail that I do not want to do and do not want to experience. That's why I avoid it. I don't want to beat myself up if I fail." We want to make sure we change the way we look at failure. Not Wanting to Be Uncomfortable This could cover all of these categories because all of the reasons we procrastinate are ultimately just trying to avoid discomfort. So often, I procrastinate while recording this episode of Your Anxiety Toolkit, or I avoid and procrastinate while working out. It's not because I don't want to do those things. I love making these videos and exercising, but what I do is avoid the uncomfortable feeling that I have. Ultimately, I'm avoiding the hard work stage of any product or anything we do. So many positive things in our lives that fulfill us require hard work. Nobody likes hard work. It's not that fun. It's uncomfortable. As a human species, or any species, we love to avoid discomfort. We do what we can to cut corners, and procrastination is one of those things. Often, we're scrolling on Instagram or checking our email to avoid having to propel ourselves into doing the hard thing. The tip is to break things down into small, manageable, tiny, doable steps and open up our willingness to allow for some discomfort. Willingness is a mindfulness skill that will help you so much in your anxiety recovery. I talk about it a lot here on Your Anxiety Toolkit because it is crucial for the management of anxiety. The more we're willing to lean in, be open, and release the tension we hold from feeling discomfort, the more we get to embrace that discomfort, overcome that discomfort, and, in many cases, recover from anxiety. Willingness will be necessary regarding the discomfort we feel from doing the hard, scary thing. Perfectionism Perfectionism is so similar to the fear of failure. Perfectionism is all through our society. We are told that we have to be perfect, that we have to do it perfectly, and that we can't make those mistakes. I want to offer you here that if you struggle with perfectionism, we want to adopt the B- mentality. We want to adopt kindness. We also want to pause and acknowledge how our society has created this because the truth is human beings are inherently imperfect. It is impossible to be perfect, yet we're striving for it. We're so committed to it as if it's a reality, and it's not. We won't be perfect. Even if you achieve a perfect score on a test, you'll still have to look in the eye for imperfections three minutes later. We will have to see the other things we're not perfect at. It's essential to see that. If your goal is perfection, you're chaining yourself to having consistent anxiety. When I was suffering from an eating disorder, I was constantly going for perfection with my body, with my diet, and with my exercise. That kept me stuck, and even when I did get to this "perfect goal," I had anxiety about maintaining the perfect goal. Even once I achieved it, anxiety was still there. Anxiety was still running the show, and I was in panic mode all the time, either trying to be perfect or fearing that I'd lose this idea of perfection, which I never had anyway. But again, it's all something like a construct in our brain that keeps us stuck and anxious. It's essential to understand how that impacts us and the fact that we will never be perfect. Thank God, I love imperfect people. I find it hard to befriend these "close to perfect" people. I don't relate to them, and I don't feel safe with them. I actually sometimes feel uncomfortable around them. You probably think the same way, but I feel so much better when I'm with real people who are comfortable or willing to admit their imperfections, share their imperfections, and connect with our humanness together when we settle into that imperfection. Feelings of Overwhelm If you have anxiety, yes, overwhelm is a thing. I think of being overwhelmed like there are papers, things, and phones swirling around in my head. All I want in that moment is just a moment of inner peace and outer peace, where I want everything to slow down and stop so I can catch up in my mind. However, that's probably not going to happen. There often needs to be a physical way to get everything clear when we have a deadline or something we must do. The only thing I have found helpful with this is to simply write down the steps I need to take and how I will do them. That is the only thing. But at the end of the day, similar to the discomforts, a lot of the work we have to do with overwhelm is to be willing to feel it, slow down, and identify catastrophization. When we catastrophize, we increase our feelings of overwhelm, and that's a cognitive error we engage in. If you catastrophize a lot, you'll probably feel overwhelmed frequently. That's just the way that it goes, unfortunately. We want to create a system where you have something to do that you can break down into small steps. I'm visual, so I like to draw, write circles around it, and put numbers one and two. If you've been following me here on Your Anxiety Toolkit, I want a step-by-step process. I like the five reasons for this so that I can comprehend it in my mind. If you need that, lean into it and use it to help you create small baby steps. Another thing to do here is to breathe. When we're overwhelmed, we often stop breathing. When overwhelmed, we often clench and hold all this tension in our brain and body. Our main goal here is to slow it down. You're still going to be uncomfortable. You're still going to be anxious. You will still be overwhelmed. But can you reduce the problematic response to that? Remember, we can't control our experience and how it shows up, but we can control how we respond to it. We can control how we react to it. We don't want to clench as much as we can. Again, we're going to move slowly into the activity over time. Set some time limits. Maybe you do it for 10 minutes. There are so many Pomodoro apps that you can set a timer for three minutes and say, "I'm just going to do this for three minutes, then I'm going to take a break." Do some breathing. But you're moving in small, baby steps. Lack of Motivation If you're someone who suffers from depression or you're just not very motivated today, that's another reason it's difficult to launch yourself into something. An essential tool to remember when it comes to motivation is that we often rely on motivation to get us started, and that's fine. That's actually helpful if we have it. However, we want to flip the script on motivation. If you lack motivation, the only thing that's going to generate motivation is to get moving. I know what you're thinking. You're probably thinking, 'Yeah, but if I had motivation, I could get going. So I just need motivation to get going." But I'm here to say no. Sometimes, you just need to go back to creating small baby steps. Once you start, you start having positive feelings about yourself. You begin to have positive feelings about what you've generated. And that is what creates motivation. Again, tiny baby steps. That is a very encouraging mindset. Try to be your inner bestie. Encourage yourself. "You've got this. You can do it." "I believe in you. Just a little more." "Just get started. I know you can." You'll feel so much better when you do. Just keep talking to yourself, coaching yourself, and embracing yourself with that motivational best friend voice that encourages you. That can be very beneficial, as you're doing this daunting thing that you really don't want to do. Poor Time Management This is one of the most important, especially if you have something that has a deadline. If you don't have time management skills and aren't good at really understanding how long the activity will take, you're probably going to procrastinate and miss the deadline. We talk all about this in our online course called Time Management for Optimum Mental Health . We actually sit down and, step by step, plan your day. Not compulsively, but what we do is actually plan pleasure first. That's the first thing we put on the schedule. One of the main reasons people procrastinate is that they want pleasure. We want to feel good. We want to have great, fun things in our lives. So we spend a lot of time going back and forth, "I have to do this assignment, but I want to relax. But I have to do this assignment." Because we haven't planned our time and scheduled pleasure, we end up negotiating and spending a lot of our time going back and forth. You plan and schedule your pleasure first so that you know you've given yourself what you need. And then you're so much more likely to do the hard thing because you've already promised yourself and followed through that you would do the pleasurable thing so that you can get that more challenging thing done. In addition, you might want to be someone who schedules pleasure, hard, pleasure, hard, pleasure, hard, and gives yourself lots of breaks where you have lots of pleasure and things that bring you fulfillment and joy as you do this hard thing. I often do this with household chores. As I'm doing the hard thing, I'm listening to a podcast that I like. I've planned that. For example, I know that there's a podcast that comes out on Friday, Your Anxiety Toolkit. On Saturday morning, when I know I have to do the laundry and fold the laundry, which I hate doing and often procrastinate with, I go, "Okay, Saturday morning when I want to listen to that podcast, I'm going to marry the positive and that difficult together." Time management is so important. If you're interested in taking the Time Management course, it is a deal. It is reasonably priced for something that will help you run your week and your day much more easily. You can go to CBT School or click the link in the show notes to get access to that course. Those are the six reasons we procrastinate. I hope that this has helped you identify where you're getting into trouble so that you can make changes and get your life going so that you don't have to panic and be stuck in that absolute last-minute frantic panic. You can just schedule your time, break it into small steps, be as gentle and kind and motivating and encouraging as you can, and get the things you want done so that you can go and live your life. Don't forget, as I always say, today is a beautiful day to do hard things. I want you to remember that none of this is easy breezy. I never want to make it sound like it's easy breezy. It's hard work, but we must remind ourselves that hard work is a part of being human. It is a beautiful day to do hard things. I don't want you to buy into society's idea that life should be easy. "This should be easy for you. What's wrong with you?" Nothing's wrong with you. It's hard. No one wants to do hard things, but you can do those hard things. I hope you have a wonderful day. I'll see you in the next episode.

May 31, 2024

I have a new best friend just for you. I know that might sound a little strange, so hang with me here because this was mind-blowing to me, and I hope it is for you as well. Let's talk about best friends. What does a good best friend look like? It will be different for everybody, but generally, the way I see a best friend is that they're fun to be with. They're interested in fun things or things that you're interested in. They are there for you. They show up for you. They celebrate your birthday. They want to know how you're doing. They have a genuine interest in you. They're willing to pour into you. But in addition to that, they are also there for you when things get crappy. It's so important because sometimes we feel vulnerable when sharing with people. But when we do share and are vulnerable, we can be held, and some space is created. There's this beautiful relationship where you share how you're doing, and they hold space for that. They encourage you. They ask how they can support you. Maybe they can give you some helpful advice. They're there for you when things are really hard. When you start to be hard on yourself, they pull you up. THE BENEFITS OF BEST FRIENDS Best friends can also be brutally honest but in the most beautiful way. I have two best friends. One is my husband, and one is a friend who lives quite a distance away. It's all via technology—voice chat, FaceTime, phone calls, and so forth. My best friends, not only do they support me, not only are they kind and lovely, but they also do call me out on my crap. They often say, "I don't think you've thought about this one well enough," or "Kimberley, I think you're going a little too urgent here. I think that your anxiety might be getting in the way." Or "Kimberley, have you taken care of yourself today? I'm noticing you mentioned you haven't been getting a lot of sleep. Could that be why this is hard for you?" Best friends aren't just all flowers and roses. They are honest and real. They're there for you when things aren't going well, but they champion you too. They believe in you like nobody else. When you're at your lowest, best friends will be like, "You could do totally that." Or if you're beating yourself up for not being good enough, they're like, "Oh my god, are you kidding me? Look at all the things that you've done." They're so ready to celebrate you, and they see you for way more than you can see yourself. That is what I want for you so I will introduce you to your new best friend, and it's you. Your new best friend is you. I want you to think about this because you haven't developed a relationship with YOU enough to be your own best friend. It's something you're going to have to invest in. Your new best friend is YOU, whom I'd like you to meet. Hello friend. This new bestie that you're creating is going to be the person who is there for you no matter what. AN INNER BESTIE VS. THE KIND COACH Let me tell you why I've been thinking about it this way. I wrote a book called The Self-Compassion Workbook for OCD , and I talked about the Kind Coach concept. The kind coach is this warm voice inside you that coaches you through hard things. If you were to think about the mean coach you probably had in high school, he's like, "Get down and give me 20," or "Get going, you loser. Run faster." He or she motivates you through criticism and harsh comments and uses a very aggressive voice. We don't want that because we know,, based on the research,, that it decreases motivation, increases procrastination, increases punishment, and wreaks havoc on the nervous system and the immune system. We don't want that. Instead, we use this Kind Coach. The Kind Coach encourages us. They know our strengths, and they encourage us based on our strengths. They know our weaknesses, and they don't use our weaknesses to get you moving forward. The kind coach is constantly there, encouraging you to keep going. I love this concept. But as I recently went through a difficult time, I was using this tool,, and I kept thinking, 'Something isn't landing here. This feels a little too professional.' I didn't want it at that time. While the kind coach has helped me through so many things, I didn't want a coach around when things fell apart for me. What I needed was a bestie, a best friend. I needed somebody who was more like a pal, someone who could be in my pocket. Someone who I felt a little sassier with, someone who I could use my humor with because I needed humor to get through this hard thing. THE INNER BESTIE: THE UNCONDITIONAL FRIEND I was thinking, 'What is it that I need?' This is the golden self-compassion question that you should be asking yourself all the time. What do I need? When I checked in, I was like, "I do. I really need my best friends around." But sometimes my best friends weren't around. My husband would be at work, and my best friend lives far away in a different time zone. They weren't even awake at the time that I needed them. Who do I go to when my best friends aren't there? Some people would say, "It's fine; just go to the next best person." But I needed to be there for myself. I giggle as I say this to you because practicing leaning on my inner bestie or my inner mate has been so powerful because there's a playfulness to this where you get to goof off with them a little. You get to make fun of it. I really do. I make fun of myself quite regularly, but not in a critical way—in a way where I'm like, "It's really cute and goofy that I do that." Often,, when I think of things that I'm not super proud of, I go, "I love that I am a little goofy." My family always makes fun of me because I love taking bites out of things, like everything. There's often something like a banana that's got a little piece cut off, or if we get a box of chocolates, I take a bite out of every single one and put it back in there because I just want to taste all of them. I'm okay to giggle at that. I want to be able to giggle with my best friends about how that's my little quirky thing. A best friend is someone who is always there for you. They're okay to giggle. They're okay to warm, be warm, and connect. They're okay to be firm and redirect you when you're totally off track. Over the last few months, I've befriended this friend so much. I call this friend 'babe,' and babe and I have conversations together. As I'm getting ready, I'll be like, "Okay, babe, it's cool. We're doing this together. It's going to be a hard day. You've got this, this, and this to go through. What do you need, babe?" We have a conversation, and it's me. It's not anybody else. It's not the voice of a coach; it's me—my inner bestie, the one who's always going to be there for myself. THE VOICE OF THE INNER BESTIE As I've gone through these challenging times, I think this voice feels so grounding. I trust her more than I've ever trusted the kind coach. I'm not saying there's no place for the kind coach, but this is the next level for me. Here's what I want you to do: I want you to find a piece of paper, and I want you to either draw and/or write what this inner bestie is for you and what they look like. They're you, but how they sound, how they look. What do they say to you? How do they say it? What's their body language? How do you talk to it? For me, it's a different way of relating to myself. Now I'm talking to myself like, "Hey, babe, I got you." It's a little more conversational, a little bit more interactive. But that's what best friends are. Let's also think about how we treat our best friends. One thing I have learned mostly through therapy is how to be a good wife. When I say good wife, I mean, just for me, how to stand next to my husband and encourage him. Even if I'm slightly annoyed, how can I pour into him? How can I show him how much I appreciate him? Even if that doesn't come naturally in the season that I'm in, how can I encourage him? How can I check in with him? I have to think about that consciously. What I want you to do is think about how you can relate to your new best friend—you, your inner bestie—and also how you can pour into your best friend this inner bestie. Can you check in with it more often? Can you send it love more often? Can you ask how we can be in a relationship? What does it need? I want you to practice having a daily check-in. You can't just have a best friend and take the benefits but ignore them and their needs as well. This is what I want you to journal down. I am also fine if you want to give it a name. I call mine 'babe,' as I said before. "Hey babe, how are you doing? What do you need?" It calls me babe, and we talk to each other that way. In fact, that's how I talk to most of my friends. I call them babe. Then, I want you to check in with them as much as you can. I want you to start having conversations. When I was struggling, I started recording myself talking to Babe on my phone and saving it. As I'm getting ready, I'm saying, "Hey babe, you've got a hard day." This is babe talking to me; I'm talking to it. "You've got a hard day. I'm so sorry you're going through this. That sucks. This is just so much. I'm proud of how you got up today. Even though you didn't sleep very well, I'm proud that you didn't lose it on that one person who ran into you at the supermarket because you're so overwhelmed and you have so much going on. That was pretty impressive." Or, "Hey babe, it is so cool how you regulated your emotions at that moment. That was impressive." "Hey babe, I know you didn't do so well at that moment, but I love how you're coming to me and aligning again. you've come back to me. that's cool." Some days I might go, "Hey babe, anxiety's here today. Alright, we know what to do. We should have expected it, but it's all good. we're going to go with anxiety. it's going to come along with it. what do you need?" This conversation that we're having back and forth doesn't make you crazy. It doesn't mean anything's wrong. What it means is that you are starting to talk to yourself in a way that you deserve, that you need to be respected, and that you deserve to have that person. This is what we want to do. The cool thing is, if you follow me on Instagram or YouTube , I'm starting to do way more videos where I talk to myself through the lens of my inner bestie. I'm having those conversations. I'm brushing my hair as I talk to myself. I am brushing my teeth. I'm doing the dishes. I'm writing checks if I have to be writing checks. I'm practicing it in all the little places, and I'm trying to show you how to do it so you can go follow me there and see for yourself. But I want you to think about this. The new best friend is here, and you get out what you pour into it. Give it a try. I really, really believe in this. If this is a bit awkward for you, that's okay. There's no problem with the awkwardness. Let it be awkward. If it feels a little wrong or weird, that's okay too. Let it be weird and awkward and strange and uncomfortable. There's nothing wrong with getting used to these feelings. You might even say, "Hey, babe, it's weird to talk to you. This feels odd. I'm not so sure about this." Then you might even listen and be like, "Yeah, it's okay that it's uncomfortable." You might even have your babe in my accent, and that's fine as well. What we are really trying to do is get an inner dialogue that is kind, that's got a little sass to it, and that's got a little punk to it, whatever you like. That is exactly what you need, because what I need in a best friend might be different from what you need. Sometimes your best friend needs to be total sassy, like doesn't take crap from anybody and stands up for you no matter what. If that's what you need your babe to be, go ahead. Let your babe be that. Take what you need. Leave the rest. Play around with this. But I would say give it a full 30 days. Practice having an inner bestie, connecting with and pouring into that inner bestie for 30 days, and you'll be shocked at how your inner narrative changes. Have fun with your best friends. I cannot wait to hear how this aligns with you and how it's helping with any struggles that you're having. Please let me know on social media if you have any questions. You can catch me on Your Anxiety Toolkit on Instagram or YouTube. Have a great day, everybody, and it's a beautiful day to do hard things.

May 24, 2024

Imagine being able to walk into a crowded room without feeling your heart pound out of your chest. Envision yourself confidently striking up conversations with strangers or going about your day without being overwhelmed with the fear of being judged by others. If social anxiety has been holding you back from enjoying life, it's time to take on an exposure challenge and learn how to feel more confident in your skin when you are in public. In this episode of Your Anxiety Toolkit, we will explore one of the most well-known, science-based, and effective strategies for overcoming social anxiety. From gradual exposure to uncomfortable social situations to building a support network, you'll discover practical steps to overcome the grip of social anxiety . Recently, I overheard a therapist (of all people) say that letting our clients experience distress is harmful. When I heard this, I gasped. This idea and this narrative concerned me so much. We have become so fixated on never feeling distressed that we fuel our anxiety and emotions. Now, I get it. I am not in the business of being a therapist to make people feel terrible. Quite the opposite. However, one of the most powerful messages I give my clients is that we can learn to compassionately and effectively navigate distress because distress is a natural part of being a human. If we have anxiety and we are committed to not feeling it, it will control every aspect of our lives. If you have social anxiety and you are committed to never being uncomfortable, social anxiety will take everything you love from you, including your future. Today, we are focusing on pushing yourself outside of your comfort zone and facing your fears. What you will learn is that you'll gradually build your confidence and become more at ease in social settings. With each small success, you'll grow more robust and more resilient, expanding your social circle and embracing new opportunities. My hope is that you don't let social anxiety hold you back any longer. Today, I am going to give you a 30-day Social Anxiety Challenge. I have seen this work for my clients repeatedly, and I am confident it will change your life, too. Before we get started, let's first make sure you have a good understanding of social anxiety. UNDERSTANDING SOCIAL ANXIETY Social anxiety, also known as social phobia, is a common mental health condition characterized by an intense fear and anxiety in social situations. It goes beyond mere shyness and can significantly impact an individual's daily life. People with social anxiety often experience excessive worry about being judged, embarrassed, or humiliated in social settings. This fear can be so overwhelming that it leads to avoidance of social situations altogether. One thing I always share with my students and clients is that while Social anxiety is considered an anxiety disorder, I agree with Christopher Germer, a well-known psychologist who has been on the show ( episode 199 ), that social anxiety is as much a shame disorder as it is an anxiety disorder. From my experience, people with Social anxiety struggle immensely with shame, and this powerfully painful emotion can disrupt so much of someone's life. It can increase the incidence of depression and even suicidal ideation. Having social anxiety can leave you feeling like a fool, awkward, and alone. Commonly, people with social anxiety withdraw and isolate, only making themselves feel more alone, defective, and often more depressed. Social anxiety can have a profound impact on various aspects of a person's life. It can hinder their ability to form and maintain relationships, limit their career prospects, and diminish their overall quality of life. Simple tasks such as making a phone call, attending social gatherings, or speaking in public can elicit intense anxiety, leading to avoidance behaviors and missed opportunities. The constant fear of being evaluated negatively by others can create a cycle of self-doubt and isolation. But today, we will put our entire attention to turning this around for you. Today, I am going to give you a 30-day Social Anxiety Exposure challenge where you face your fears and take your life back from social anxiety. The 30-day Social Anxiety Exposure Challenge: What is it and how does it work The exposure challenge is a science-based therapeutic technique widely used in the treatment of social anxiety. It involves deliberately facing feared social situations in a gradual and controlled manner. The goal is to help you habituate to your anxiety-provoking situations and develop a sense of mastery and confidence. Exposure can be done in real-life situations or through imaginal exposure, where you vividly imagine yourself in anxiety-inducing scenarios. Today, we are going to focus on real-life situations because I wholeheartedly believe that is where the money is. I have seen it work with hundreds of my clients. Exposure works by activating the fear response and allowing you to experience the anxiety you feel. Over time, repeated exposure to the feared situations helps retrain your brain, reducing the anxiety response and building resilience and confidence. It is important to note that exposure should always be done at a pace that feels manageable for you, and seeking professional guidance can be beneficial in designing an exposure plan tailored to your specific needs. What are the Benefits of doing a 30-day social anxiety exposure challenge? Facing your social anxiety through exposure can have numerous benefits. Firstly, it allows you to confront and challenge your irrational beliefs about social situations. By repeatedly exposing yourself to feared situations, you'll begin to gather evidence that contradicts your negative thoughts (such as "everyone hates me," "They will think I am an idiot," or "I will make a fool out of myself"), gradually reshaping your perception of social interactions. This process can lead to increased self-confidence and a more positive self-image. Exposure also provides an opportunity for skill-building and learning. As you face your fears and navigate social situations, you'll develop new coping strategies and important social skills. These skills will help you manage anxiety and enhance your ability to connect with others and build meaningful relationships in ways that feel authentic to you. The more you expose yourself to different social scenarios, the more adaptable and resilient you become in handling various social challenges. THE 30-DAY SOCIAL ANXIETY EXPOSURE CHALLENGE RULES Okay, before we get started, please know that you can either do these in the exact order or you can put them in the order of easiest to hardest. My only tip is to make sure you do at least one of these exposures per day. You get extra points if you do them many many times, as this is how you will really learn the most. Tracking your progress and celebrating small victories is essential for maintaining motivation and building confidence. Keep a record of your exposure activities, noting the level of anxiety experienced and any positive outcomes or insights gained. Reflecting on your progress can help you see how far you've come and provide a sense of accomplishment. Celebrate each small victory, no matter how insignificant it may seem. Recognize that every step forward is a step closer to overcoming s ocial anxiety and living a fulfilling life. Other tips: Plan ahead. Some of these exposures will require some planning and arranging. Do not let fear stop you or make too many excuses. You will only get out what you put in. Do these exposures with kindness ONLY. The biggest goal is to not criticize yourself at all. Do the best you can. Catch yourself when you are going down the self-loathing rabbit hole. Challenge your negative thoughts about yourself and be your biggest cheerleader. Once the exposure is over, you are not allowed to think about what happened. Try not to ruminate about it. Celebrate your wins. Set up a reward for completing the challenge. Or several rewards throughout hte 30 days. If you find one of them easy, try to double up and add something challenge to the challenge. THE 30 DAY SOCIAL ANXIETY CHALLENGE PLAN Day 1: Take a walk in public and give eye contact to 5 people. Day 2: Take a walk in public and give eye contact and a smile to 5 people. Day 3: Take a walk in public, make eye contact, smile, and greet five people. Day 4: Go to the mall or a store and make small talk with a cashier. Day 5: Ask a stranger for directions. Day 6: Order food at a restaurant without rehearsing. Day 7: Compliment 5 strangers. One Week Check-in: What thoughts are you having? Day 8: Attend a social event without a close friend. Day 9: Speak up in a meeting at work or school. Day 10: Join a club or group related to a hobby. Day 11: Make a phone call instead of sending a text or email. Day 12: Practice introducing yourself to 2 new people. Day 13: Start a conversation with someone in a waiting room. Day 14: Sit in the front row during a presentation or class or at the movies. Day 15: HALF WAY: Join a public speaking group, like Toastmasters . Day 16: Share a personal opinion in a group setting. Day 17: Attend a social gathering and stay for a set amount of time. Day 18: Initiate a conversation with someone you find intimidating. Day 19: Go to a party and introduce yourself to at least three new people. Day 20: Take a class in improv or acting. Day 21: Sing karaoke in front of others or sing as you walk down the street. Day 22: Ask someone for help in a store. Day 23: Participate in a team sport or group exercise class. Day 24: Initiate a conversation with someone sitting alone. Day 25: Practice saying "no" in various social situations. Day 26: Give a compliment to a coworker or classmate. Day 27: Ask someone to coffee or a casual outing. Day 28: Go to a new place and ask a stranger about the best things to do there. Day 29: Introduce yourself to your neighbors. Day 30: Share a positive personal achievement with others. There you go! There is your 30-day Social Anxiety Life after the Exposure Challenge. As you continue to face your fears and engage in exposure activities, you'll gradually notice a shift in your confidence and ability to navigate social situations. Embrace this newfound confidence and allow it to propel you forward in life. Your social world will expand with each successful exposure, and opportunities for personal and professional growth will arise. Remember that overcoming social anxiety is a journey, and setbacks may occur along the way. Be kind to yourself, celebrate your progress, and continue to challenge yourself to reach new heights of confidence and self-assurance. Don't let social anxiety hold you back any longer. Step out of your comfort zone, face your fears, and embrace the incredible potential that lies within you. I always say, "Today is a beautiful day to do hard thing." You deserve to live a life free from the shackles of social anxiety. Get going with this challenge as soon as you can. I promise that you will not regret it.

May 17, 2024

Behind every smile, there can be hidden struggles and pain. You might even be one of those people struggling so much but puts on a smiling face even though you feel like you are sinking. Smiling depression, a somewhat new term to describe people who are struggling with high-functioning depression, is a lonely battle that many individuals face. In today's episode, we dive into the topic of smiling depression, exploring what it is and how it affects those who suffer from it. IS SMILING DEPRESSION A DIAGNOSIS? First of all, let me be clear. Smiling Depression is not a specific mental health diagnosis. Instead, it is a presentation of depression. Unlike well-known symptoms of depression, those with smiling depression put on a facade of happiness. They may appear perfectly fine on the surface, leaving their inner turmoil hidden from the outside world. Unfortunately, this masks the severity of their emotional struggles, making it difficult for others to offer support or understanding. It is important to acknowledge the hidden struggles of smiling depression and offer compassion and support to those who are silently battling this condition. They are not lying or faking it to deceive you. Instead, they feel completely trapped. They often see no way but to keep going and keep pretending. They just keep smiling, even though they see an end in sight. They put a smile on their face, and they push through. Even just saying that makes me want to cry, as I have been in this situation too many times. I completely understand the pressure (often self-induced pressure) just to keep going and "not complain," "look at the bright side," or "be grateful for what I have," even though I was being crushed with hopelessness, helpfulness and worthlessness. My hope is by addressing this topic, we can create an environment where you feel safe to express your true emotions and seek help. You are not broken. You are not wrong for feeling this way. And asking for help does not make you weak or bad. You deserve to have support, love, compassion, and time to recover. SIGNS AND SYMPTOMS OF SMILING DEPRESSION Smiling depression can be difficult to identify, as those who experience it often mask their true emotions behind a smile. However, there are certain signs and symptoms that can help us recognize this hidden condition. One common characteristic of smiling depression is the apparent contradiction between a person's outward demeanor and their inner emotional state. While they may appear cheerful, happy, and successful, they may be struggling with feelings of hopelessness, helpfulness, worthlessness, emptiness, sadness, or even thoughts of self-harm or suicide. Another smiling depression symptom is the tendency to keep their struggles hidden from others. Individuals with smiling depression often feel the need to maintain a facade of happiness, fearing that opening up about their inner turmoil will burden or disappoint those around them. This can lead to a sense of isolation and loneliness, further exacerbating their emotional struggles. Furthermore, individuals with smiling depression often experience a lack of motivation and interest in activities they once enjoyed. They may withdraw socially, have difficulty concentrating, and experience changes in appetite and sleep patterns. These symptoms, when combined with the constant pressure to maintain a happy facade, can take a toll on their overall well-being. What I think is very interested is the overlap of Smiling depression and perfectly hidden depression. We previously did an episode with Margaret Rutherford about perfectly hidden depression which is a form of depression where people become hyper fixated on being perfect to mask their experience of depression. You can listen that episode on the show notes to learn more . THE HIDDEN STRUGGLES OF SMILING DEPRESSION Smiling depression is not simply a case of "putting on a brave face." It is a complex mental health condition that can have severe consequences if left untreated. While individuals with smiling depression may appear perfectly fine on the surface, they often battle with intense emotional pain behind closed doors. One of the hidden struggles of smiling depression is the constant pressure to maintain a happy facade. Society often expects individuals to be cheerful and optimistic, making it difficult for those with smiling depression to express their true feelings. This can lead to shame, guilt, and a sense of being misunderstood. Additionally, the internal conflict between the outward appearance of happiness and the inner turmoil can be mentally and emotionally exhausting. Individuals with smiling depression often feel like they are living a double life, constantly hiding their pain while wearing a smile. This internal struggle can affect their self-esteem and overall mental well-being. Furthermore, the lack of understanding and awareness surrounding smiling depression can make it difficult for individuals to seek help. Since they appear to function well in their daily lives, others often dismiss or overlook their struggles. This can further isolate them and prevent them from receiving their desperately needed support. THE RELATIONSHIP BETWEEN SOCIAL MEDIA AND SMILING DEPRESSION Social media has become an integral part of our lives in today's digital age. While it has its benefits, it can also contribute to the development and exacerbation of mental health conditions such as smiling depression. Social media platforms often present a distorted reality where everyone appears to be living their best lives. This constant exposure to curated and idealized versions of other people's lives can create a sense of inadequacy and comparison for individuals with smiling depression. They may feel like they are not living up to the standards set by others, further fueling their feelings of emptiness and sadness. Furthermore, the pressure to maintain a positive online presence can be overwhelming for those with smiling depression. They may feel compelled to post happy and upbeat content, even when struggling internally. This can perpetuate the cycle of hiding their emotions and feeling isolated from their online communities. If this is true for you, remember that social media is almost always fake . It is not the real life of the people you follow. I love seeing posts where people show pictures of themselves looking all glamorous and then show them crying just a few minutes later. Even though I hate that they are struggling, some people are showing what real life is like behind the scenes and I think we all need to remember that. COPING STRATEGIES FOR INDIVIDUALS WITH SMILING DEPRESSION While overcoming smiling depression can be a challenging journey, there are coping strategies that can help individuals navigate their inner struggles and find some relief. The first coping strategy is to practice self-care. This involves prioritizing your physical, emotional, and mental well-being. Engaging in activities that bring joy and relaxation, such as exercise, hobbies, or spending time in nature, can help alleviate symptoms of smiling depression. Building a routine with healthy habits, such as getting enough sleep and maintaining a balanced diet, can also contribute to overall well-being. If you want to learn more about health routines for depression, we covered that in a recent podcast episode called Living with Depression: Daily Routines for Mental Wellness . The link to that episode will be in the show notes. Seeking social support is another crucial coping strategy for individuals with smiling depression. Opening up to trusted friends, family members, or mental health professionals can provide a safe space to express emotions and receive support. Joining support groups or engaging in therapy sessions can also help individuals develop healthy coping mechanisms and learn from others who have faced similar challenges. In addition, practicing mindfulness and self-reflection can be beneficial for individuals with smiling depression. This involves being present in the moment, accepting one's emotions without judgment, and exploring the underlying causes of their struggles. Techniques such as meditation, journaling, or engaging in creative outlets can aid in self-discovery and promote emotional healing. It is important to note that coping strategies may vary from person to person, and what works for one individual may not work for another. The key is to explore different techniques and find a personalized approach that best suits one's needs and preferences. TREATMENT FOR SMILING DEPRESSION While coping strategies can be helpful, it is important to acknowledge that smiling depression is still simply a term to describe a serious mental health condition that often requires professional intervention. Seeking help from a mental health professional, such as a therapist or psychiatrist, can provide individuals with the necessary support and guidance to navigate their journey toward recovery. A mental health professional can help individuals with smiling depression by providing evidence-based treatments, such as cognitive-behavioral therapy (CBT) or medication. To start, the main treatment goal might be to offer a safe and non-judgmental space for individuals to express their emotions and come to terms with the fact that smiling through their pain is not working anymore. This can be painful and very scary. It is crucial to remember that seeking professional help is not a sign of weakness, but rather a courageous step towards healing. With the guidance and support of a mental health professional, individuals with smiling depression can find the strength to overcome their inner struggles and live a fulfilling life. CBT treatment will involve addressing any errors in their thinking and also addressing the behaviors that are contributing to their depression. The real goal of CBT is to compassionately help the person with smiling depression to find new and effective coping techniques, and kind, and move them towards long-term recovery and healing. If you are looking for help with depression and do not have access to professional mental health care, or if you are interested in learning new ways to manage your depression, you may want to consider our online course called OVERCOMING DEPRESSION. Overcoming depression is an on-demand online course that will walk you through the exact steps I take my clients through when they have depression. I will first help you fully understand the science behind why you have depression, and then I will teach you all about how to create a plan of attack to overcome your depression. Treatment for depression involves learning a lot about self-compassion and mindfulness. These skills will help you manage strong emotions and the depressive thoughts that you have. I will teach you how to correct the errors in your thinking, create a schedule that will help you reduce overwhelm and hopelessness, and increase your motivation to get the things that you need to get done I will give you printouts and video training to show you just how to do it all. If you are interested, go to www.cbtschool.com/depression . Just remember, it is not therapy. This is a home study course to show you the steps others have taken to overcome their depression. SUPPORT SYSTEMS FOR THOSE WITH SMILING DEPRESSION Building a strong support system is vital for individuals with smiling depression. Having a network of understanding and empathetic individuals can provide a sense of validation and belonging, helping to counteract the feelings of isolation that often accompany this condition. Support can come from various sources, including friends, family members, support groups, and online communities. It is important for individuals with smiling depression to reach out and connect with others who have similar experiences. This can provide a safe space for sharing emotions, exchanging coping strategies, and offering mutual support. Additionally, it is crucial for loved ones to educate themselves about smiling depression and understand the unique challenges faced by those who suffer from it. By learning about the condition, they can provide the necessary support and validation, helping individuals feel heard and understood. CONCLUSION AND ENCOURAGEMENT FOR THOSE WITH SMILING DEPRESSION Smiling depression is a hidden battle that many individuals face. Behind their smiles, they may be struggling with intense emotional pain and a sense of isolation. If you or someone you know is experiencing smiling depression, remember that you are not alone. Reach out to trusted friends, family members, or mental health professionals. Seek help and support, and remember that there is hope for recovery.

May 10, 2024

In today's fast-paced and demanding world, it's easy to forget to show ourselves the same compassion and empathy we extend to others. But what if I told you that embracing self-compassion could lead to a happier, more fulfilling life? It's true, and in this article, we will explore the power of self-compassion and how it can positively impact your overall well-being. Self-compassion is about treating ourselves with the same kindness, care, and understanding that we would show to a loved one. It involves acknowledging our imperfections and mistakes without judgment, and embracing our humanity. When we practice self-compassion, we cultivate a positive relationship with ourselves. We learn to be more understanding and forgiving, and that inner critic inside us gradually softens. We become more resilient in the face of challenges, and our self-esteem and self-worth improve. So how can we embrace self-compassion in our daily lives? We will delve into practical strategies and techniques that can help us cultivate self-compassion and create a more loving and compassionate relationship with ourselves. Join us on this journey of self-discovery and learn how to harness the power of self-compassion for a happier and more fulfilling life. Understanding Self-Compassion Self-compassion is about treating ourselves with the same kindness, care, and understanding that we would show to a loved one. It involves acknowledging our imperfections and mistakes without judgment, and embracing our humanity. When we practice self-compassion , we cultivate a positive relationship with ourselves. We learn to be more understanding and forgiving, and that inner critic inside us gradually softens. We become more resilient in the face of challenges, and our self-esteem and self-worth improve. Self-compassion is not about self-pity or self-indulgence. It is about recognizing our common humanity and understanding that we all make mistakes and face challenges. It is about being kind and supportive to ourselves, especially during difficult times. By embracing self-compassion, we can free ourselves from the constant pressure to be perfect and allow ourselves to be authentic and vulnerable. The Benefits of Practicing Self-Compassion The benefits of practicing self-compassion are numerous and far-reaching. Research has shown that individuals who regularly practice self-compassion experience higher levels of well-being and life satisfaction. They are more likely to engage in healthy behaviors, have better mental health, and experience lower levels of stress and anxiety. One of the key benefits of self-compassion is its role in fostering resilience. When we are kind and understanding towards ourselves, we are better able to bounce back from setbacks and failures. Instead of beating ourselves up over mistakes, we can learn from them and grow stronger. Self-compassion also plays a crucial role in our relationships with others. When we are compassionate towards ourselves, we are more likely to show compassion towards others. We become better listeners, more empathetic, and more understanding. This, in turn, leads to healthier and more fulfilling relationships. Self-Compassion vs. Self-Esteem While self-compassion and self-esteem are related, they are not the same thing. Self-esteem is about evaluating ourselves positively and feeling good about our worth and abilities. It is often based on external factors such as achievements, appearance, or social status. On the other hand, self-compassion is about being kind and understanding towards ourselves, regardless of our achievements or external circumstances. It is about accepting ourselves as flawed human beings and embracing our imperfections. Self-compassion is not contingent on success or meeting certain standards; it is a constant source of support and care. Research suggests that self-compassion may be a more stable and nurturing source of self-worth compared to self-esteem. While self-esteem can fluctuate depending on external factors, self-compassion provides a consistent and unconditional sense of acceptance and love. The Science Behind Self-Compassion The benefits of self-compassion have been extensively studied and documented in the field of psychology. Researchers have found that practicing self-compassion activates areas of the brain associated with positive emotions and well-being. It also reduces activity in the areas of the brain associated with self-criticism and negative emotions. Furthermore, studies have shown that self-compassion is linked to lower levels of stress hormones, such as cortisol. It has also been found to enhance the functioning of the immune system, improve cardiovascular health, and promote overall physical well-being. The scientific evidence supports the idea that self-compassion is not just a fluffy concept; it has real, tangible benefits for our physical and mental health. How to Cultivate Self-Compassion Cultivating self-compassion is a journey that requires practice and patience. Here are some practical strategies and techniques that can help you cultivate self-compassion in your daily life: Practice mindfulness : Mindfulness involves being present in the moment and non-judgmentally observing our thoughts and emotions. By practicing mindfulness, we can become aware of our self-critical thoughts and replace them with more compassionate and supportive ones. Challenge your inner critic : Notice when your inner critic is being harsh and judgmental towards yourself. Challenge those negative thoughts by asking yourself if you would say the same things to a loved one. Replace self-criticism with self-compassionate statements. Practice self-care : Take time to prioritize your physical, emotional, and mental well-being. Engage in activities that bring you joy and relaxation. Be kind to yourself by getting enough rest, eating nourishing foods, and engaging in self-care rituals. Cultivate gratitude : Develop a gratitude practice by regularly reflecting on the things you are grateful for. This can help shift your focus from self-criticism to appreciation and self-compassion. Seek support : Reach out to trusted friends, family, or professionals who can provide a compassionate ear and support. Sometimes, sharing our struggles with others can help us gain a fresh perspective and find solace in knowing we are not alone. Remember, cultivating self-compassion is an ongoing process. Be patient with yourself and embrace the journey of self-discovery and self-acceptance. Integrating Self-Compassion into Daily Life Integrating self-compassion into our daily lives requires conscious effort and intention. Here are some practical ways to incorporate self-compassion into your daily routine: Start your day with self-compassion : Set aside a few minutes each morning to practice self-compassion. This could be through meditation, journaling, or simply reminding yourself of your inherent worth and embracing the day with kindness and love. Practice self-compassion during challenging moments : When faced with difficulties or setbacks, pause and offer yourself words of encouragement and support. Remind yourself that mistakes and failures are a natural part of life, and treat yourself with the same kindness and understanding you would offer to a friend. Create a self-compassion mantra : Develop a mantra or affirmation that embodies self-compassion for you. Repeat it to yourself throughout the day as a reminder to be kind and gentle with yourself. Practice self-compassion in self-talk : Pay attention to your inner dialogue and notice when self-critical thoughts arise. Replace them with self-compassionate statements and affirmations. Be your own best friend and cheerleader. Engage in self-compassionate acts : Engage in acts of self-care and self-compassion regularly. This could be treating yourself to a relaxing bath, taking a walk in nature, or engaging in a hobby you love. Prioritize activities that nourish your soul and remind yourself that you deserve kindness and care. Remember, self-compassion is a skill that can be developed and strengthened over time. With practice, it becomes a natural and integral part of your daily life. The Role of Self-Compassion in Relationships Self-compassion not only benefits our relationship with ourselves but also has a profound impact on our relationships with others. When we are kind and compassionate towards ourselves, we are better able to extend that kindness and compassion to others. Self-compassion allows us to be more empathetic and understanding towards others. It helps us recognize that everyone has their own struggles and imperfections, just like we do. Instead of judging or criticizing others, we can approach them with empathy and kindness. Furthermore, self-compassion helps us set healthy boundaries in our relationships. We learn to prioritize our own well-being and recognize when we need to say no or take a step back. This allows us to maintain healthier and more balanced relationships. In romantic relationships, self-compassion plays a crucial role in fostering intimacy and connection. When we are kind and accepting towards ourselves, we are more likely to be vulnerable and open with our partners. This, in turn, creates a safe space for emotional intimacy and strengthens the bond between partners. Self-Compassion Exercises and Techniques There are numerous exercises and techniques that can help us cultivate self-compassion. Here are a few to get you started: Self-compassion meditation : Set aside a few minutes each day to practice self-compassion meditation. This involves directing kind and loving thoughts towards yourself, acknowledging your struggles, and offering yourself comfort and support. There are guided self-compassion meditations available online that can help you get started. Writing a self-compassion letter : Write a letter to yourself from a place of self-compassion. Acknowledge your struggles, validate your emotions, and offer yourself words of kindness and understanding. Read the letter whenever you need a reminder of your own self-worth and compassion. Body scan meditation : Practice a body scan meditation to cultivate self-compassion towards your body. Bring attention to each part of your body, noticing any tension or discomfort, and offering words of kindness and acceptance to each area. Self-compassion journaling : Start a self-compassion journal where you can write down your thoughts, emotions, and experiences with self-compassion. Use this journal as a safe space to explore your feelings and practice self-compassion towards yourself. Remember, these exercises are tools to help you develop and strengthen your self-compassion practice. Explore and experiment with different techniques to find what resonates with you. Self-Compassion Resources and Books If you're interested in delving deeper into the topic of self-compassion, here are some recommended resources and books: "Self-Compassion: The Proven Power of Being Kind to Yourself " by Dr. Kristin Neff : This book explores the science and practice of self-compassion, offering practical exercises and techniques to cultivate self-compassion in daily life. " The Gifts of Imperfection" by Brené Brown : Although not solely focused on self-compassion, this book emphasizes the importance of embracing our imperfections and cultivating self-compassion as a path to wholehearted living. "Radical Acceptance: Embracing Your Life With the Heart of a Buddha" by Tara Brach : This book explores the concept of radical acceptance and offers mindfulness and self-compassion practices to cultivate a deeper sense of self-acceptance and compassion. Online courses and workshops : Many mindfulness and self-compassion experts offer online courses and workshops on cultivating self-compassion. These resources can provide guidance and support as you embark on your self-compassion journey. Remember, self-compassion is a personal and individual experience. Explore different resources and find what resonates with you and supports your own self-compassion practice. Conclusion: Embracing Self-Compassion for a Happier and More Fulfilling Life In a world that often values achievement and perfection, it's easy to forget the importance of self-compassion. However, by embracing self-compassion, we can unlock the power to live a happier and more fulfilling life. Self-compassion allows us to be kind and understanding towards ourselves, even in the face of challenges and setbacks. It helps us develop resilience, improve our relationships, and enhance our overall well-being. Remember, self-compassion is not a destination; it is an ongoing journey. It requires practice, patience, and self-acceptance. Embrace the power of self-compassion and experience the transformative impact it can have on your life. Start today, and be kind and gentle with yourself every step of the way.

May 3, 2024

If you need an anxiety routine to help you get through the day, you're in the right place. My name is Kimberley Quinlan. I am an anxiety specialist. I'm an OCD therapist . I specialize in cognitive behavioral therapy, and I'm here to help you create an anxiety routine that keeps you functioning, keeps your day effective, and improves the quality of your life. Because if you're someone who has anxiety, you know it can take those things away. Now, it's so important to understand that generalized anxiety disorder impacts 6.8 million American adults every single day. That's about 3.1% of the population. And if that is you, you're probably going to agree that anxiety can hijack your day. It can take away the things that you love to do, it can impact your ability to get things done. And so, one of the tools we use—I mean myself as a clinician—is what we call activity scheduling. This is where we create a routine or a schedule or a set of sequences that can help you get the most out of your day and make it so that anxiety doesn't take over. So if you're interested, let's go do that. Again, if you have anxiety, you know that anxiety has a way of messing up your day. You had a plan. You had goals. You had things you wanted to achieve. And then along comes anxiety, and it can sometimes decimate that plan. AN ANXIETY SCHEDULE And so the first thing I want you to be thinking about as we go through putting together this schedule is to plan for anxiety to show up. Those of you who show up in the morning and think, "How can I not have anxiety impact my day?" Those are the folks who usually have it impact them the most. So we want to start by reframing how we look at our lives instead of planning, like, "Oh gosh, I hope it's not here. I hope it doesn't come." Instead, we want to focus on planning for anxiety to show up because it will. And our goal is to have a great plan of attack when it does. MORNING ROUTINE FOR ANXIETY First of all, what we want to look at is our morning routine for anxiety . We want to have an anxiety routine specifically for the morning. There will be folks who have more anxiety in the morning. There will be folks who have more anxiety in the evening. You can apply these skills to whatever is the most difficult for you. But for the morning routine, the first thing we need to do is the minute we wake up, we want to be prepared for negative thoughts. Thoughts like, "I can't handle this. I don't want to do this. The day will go bad." We want to be prepared for those and have a strategic plan of attack. COGNITIVE RESTRUCTURING Now, what we want to do instead of going down the rabbit hole of negative thinking is use what we call cognitive restructuring or reframing. During the day, at a time where you've scheduled, I would encourage my patients to sit down and create a planned response for how we're going to respond to these thoughts. So if your brain says, "You can't handle the day," your response will be, "I'll take one step at a time." If your brain says, "Bad things are going to happen," you have already planned to say, "Maybe, maybe not, but I'm not tending to that right now." Let's say your brain is going to tell you that this is going to be so painful and, "What's the point? Don't do it," absolutely not. I'm going to show up however I can in my lifetime. I'm not going to let those thoughts dictate how I show up. I'm going to dictate how I show up. So we want to be prepared and have a plan of attack for that negative thinking. MINDFULNESS PRACTICE The second thing we want to do is have a solid mindfulness for anxiety practice . Again, you're going to start today, and you'll start to see the benefits of this over the weeks and months, but a mindfulness practice will be where you are able to have a healthier relationship with the thoughts, the feelings, the sensations, the urges, the images that come along with anxiety. A big piece of mindfulness is learning how to stay present. As you are brushing your teeth in the morning, you're noticing the taste of the toothpaste, the feeling of it on your gums, the smell of the fluoride, and the toothpaste that you have. A solid mindfulness practice will help you move through each part of the day's routine that we're creating in a way that reduces the judgment, reduces the suffering, reduces the self-punishment, reduces the reactions that you would typically have. Now, one of the most helpful mindfulness skills I use and I tell my patients to use—we actually have a whole episode on this. It's Episode 3. It's really early on, but it's talking about being aware of the five senses. Again, as you're brushing your teeth, what do you smell? What do you see? What do you taste? What do you hear? What does it feel like? And you're going through systematically these different senses so that you can be as present as you can. And this will help you with panic attacks, anxiety attacks, or just general anxiety that you're feeling. If you're wanting to deep dive into mindfulness and have a mindful meditation practice, we have an entire vault of meditations that are guided by me that you can look into by going to CBTSchool.com, or I'll leave the link in the show notes. There is an entire vault specifically for people with anxiety of guided meditations to help you with different emotions, different sensations, different experiences, different struggles that you may be having. That's there for you. 4. GET SOME EXERCISE Now the next thing I want you to do in the morning is get some kind of movement activity going. Again, this doesn't have to be going for a run, but it could be a light walk, some stretching, some yoga. It could be going to the gym and lifting weights, but try to get your body moving. There is a lot of research to show that exercise can be as effective as medication. That's mind-blowing, and it's free. It's something you can do from home, and it's something that doesn't have huge side effects except for the fact that it's not as fun as we would like it to be. But create a routine. It doesn't have to be every day, either. You might put in your schedule that you just do it a couple of days a week, and that's a great start. But try to at least stretch, move your body, maybe move around the house, light dancing, whatever floats your boat, but get your body moving. 5. NOURISH YOUR BODY WITH FOOD The next morning routine activity that I really want to stress is to nourish your body with food. And I picked the word "nourish" very intentionally. I'm not just saying put breakfast in your mouth because I want you to be thinking of food as something that's fueling your body so that you can be at your best. Again, I believe strongly there is no right or wrong food or good or bad food, but I want you to think about, "How can I nourish my body? Do I need some water? Would it be nourishing to have too much coffee?" Again, coffee is not super helpful if you're someone with anxiety, and it's something you should limit as well. So, really be intentional about the food that you nourish in your body. 6. SET AN INTENTION FOR THE DAY And then the last piece of the morning routine for anxiety is to set an intention for a day of kindness. You are committing to kindness all day. If that doesn't feel good to you, flip it to "I am committing to no self-punishment, no self-judgment, no self-criticism." That can be a really effective goal. "Okay, if I'm going to do one thing today, I'm committing to no judging," because literally, there is no benefit to any of those things. Criticism, punishment, judgment, self-loathing, none of it. There's no benefit. It doesn't motivate you if you think that is true. It's actually been proven incorrect by science. These things are not the motivators. We want to work at reducing those. And there are tons of other episodes on the podcast talking about that. So, that's what we're going to focus on for the morning routine. STRUCTURING YOUR DAY FOR ANXIETY ROUTINE Now we're going to move on to structuring your day and creating an anxiety routine that is effective for you throughout the day. Now I want to first acknowledge that I don't know how much you have going on in the day. Some of you are working two jobs, some of you are a stay-at-home mom, some of you don't have a job at all, some of you are at school. Everybody's schedule is going to be different, but I want you all to be thinking about these ideas. WHAT WOULD YOU DO IF YOU DID NOT HAVE ANXIETY? The first one is plan and organize your day around what you would do if you didn't have anxiety. Sit down and really think about it. "If I didn't have anxiety today, what would I get done? How would I show up? What activities would I do?" And make sure you schedule those into your schedule because the main thing that you have to know about someone with anxiety is anxiety will interrupt your day and take you away from the things that you value. So please, please, please, think about this question: What would I do if I didn't have anxiety? And your job is to schedule and try and get as many of those things done as you could. We don't want anxiety to run the show here. PLAN YOUR DAY The next thing I want you to do is use a planner to activity schedule these things. There are apps to help track tasks and appointments. Do your best to plan and to have structure. People with anxiety and depression need structure. It helps us to be so overwhelmed and chaotic in our brain to have some structure. And believe me, some people will say, "No, it feels too controlled, and it takes away my creativity." No. In fact, people who have structure tend to report feeling more creative because their day isn't so overwhelming and they have a little bit of control over where they're doing, what they're doing, and where they're going. Now, if you struggle with this, we have an entire course for this as well. It's called The Optimum Time Management for Mental Health . I walk you through specifically how to manage time, specifically for those who have anxiety, depression, and OCD. I had to create this for myself. I had to read a whole ton of books and take courses. I found none of them really approached it from the perspective of those who had a mental health or a medical issue. And so I created that course specifically for those who struggle in that area. You again can go to CBTSchool.com to get information about that. SET REALISTIC GOALS Now, as you are structuring your day and planning your day, you have to be really intentional about setting realistic goals and prioritizing what's important. Sometimes when I look at the things I want to get done, there could be like 15, 20, 30 things to do. I know I'm not going to get all of those done, so I have to sit down and go, "Okay, which are the most urgent? Which are the things that must take priority?" and work at prioritizing those. Again, as you do those things, you're going to be using those mindfulness skills that we've already talked about. staying present. You're going to be using your willingness skills that we often talk about here on Your Anxiety Toolkit . Bringing compassion, radical acceptance, willingness to be uncomfortable—you're going to bring those with you throughout the day. Again, we are planning for anxiety to come with us every part of the day. SCHEDULE BREAKS IN YOUR DAY Now another important thing to do here is to schedule breaks. If you have anxiety, you know as much as anybody that anxiety is exhausting. Schedule breaks, but no breaks where you're scrolling on Instagram. That's not a true break. That doesn't actually give your brain a break. Go outside, sit in nature, listen to some music, read a book, do something that doesn't drain your battery, do something that increases your battery. It might be taking a walk or doing something active, but make sure you plan those breaks. SCHEDULE THERAPY HOMEWORK The next thing to do, and you have to do this every day, specifically if you have an anxiety disorder, is schedule your therapy homework. If you're not in therapy, still schedule time to be doing something that helps you to work on your mental health, even if it's correcting those thoughts that we talked about at the beginning of this episode. We want to make sure that with planning times to do exposure and response prevention, with planning time to do our mindfulness practice, with planning time to do our, again, cognitive restructuring, making sure that you've scheduled that helps you with your long-term recovery. Not just the recovery of today, not just getting through today, but when we schedule time to do our homework, it means that we push the needle forward in our recovery. EVENING ANXIETY ROUTINE Now we're going to move on to the evening anxiety routine. This is where we prioritize unwinding for the day. You've used all your energy, you've taken anxiety with you, you're exhausted. CELEBRATE YOUR WINS Number one, you have to celebrate. Celebrate what you did get done. Write down what you got done. Because so often, when we have anxiety, we go, "Oh, it's not a big deal. Everyone can do that. I shouldn't be celebrating." No, you've got to celebrate this stuff. You're working your butt off. And so we have to make sure that we're celebrating every win, even if it's just one teeny win for the day. WIND DOWN FOR SLEEP (SLEEP HYGIENE) The evening is where we must prioritize winding down for sleep. Sleep hygiene is maybe the most important part of your recovery in that it will set you up to do well tomorrow. If you're like me, not having a good night's sleep means your mental health hits the trash tomorrow. So we want to start the evening on how can we reduce the impact of being on technology. Do a digital detox if you can, at least an hour before bed. Do something relaxing. Do something pleasurable. Read, take a warm bath, take a walk, garden, talk to a friend, connect with them—anything you can do. Make a lovely meal, watch a funny TV show, whatever you can do to bring yourself down and rest and repair for the day so that you can be ready for bed and moving into the nighttime routine. CREATE A NIGHTTIME ROUTINE WITH A CONSISTENT WAKETIME You will need a nighttime routine. Have a time or an alarm. You could get an Apple Watch or set an alarm on your phone to prompt you to moving towards the bedroom routine where you brush your teeth or you wash your face or you light a candle or you brush your hair or you start reading, turn the sheets down. Whatever that is, set a timer so that you are prompted to go to bed on time. What we want to do with anxiety is have a very solid routine of waking up at the same time and falling asleep at the same time, as much as possible that you can achieve. That internal body clock of yours really benefits by having it be as balanced and as routine as we can. LIFESTYLE CONSIDERATIONS FOR YOUR ANXIETY ROUTINE Now, there are some lifestyle considerations you have to consider here if you have anxiety. Number one, you have to also make sure that you've had some time for connection. And some of you are like, "No problem. I've had connection during the day or my colleagues at work or my family or my partners or my friends." That's great. But if you're somebody who has anxiety and it's kept you home alone and it's kept you in avoidance, now that's going to be really important that you do some type of connection, have a support system, whether it be a support group that you attend or a therapist that you go to because that again is so important for your long-term recovery. MEDICATION AND THERAPY In terms of overall, we may want to incorporate some kind of medication or therapy into your day or into your week. You may need to set alarms to remind you to take your medication. That's okay, too. Please, please utilize as many alarms as you need to help this go as well as you can. Because again, I want to emphasize, anxiety can make all of this routine go out the window. Before you know it, you've spent four hours on TikTok, or you've gotten into bed and pulled the sheets up and hidden there, or it could be disrupting your day by having you go into avoidance behaviors. Absolutely, I understand that. Please be gentle with yourself. But if you're somebody who's really struggling, please do not hesitate to reach out to a cognitive behavioral therapist who treats anxiety. They will be able to help you set up more structure and create a plan specifically for you. FIND A STRATEGY THAT WORKS FOR YOU So, what do we need to remember here? Number one, your routine should have some strategy to it. You will have to sit down and plan for it. I spend about an hour a week planning my week. And while that might sometimes feel like a waste of time, having a plan, knowing what I need to do, making sure I've prioritized me makes me so much more effective, makes my anxiety management and my recovery so much better. So, sit down and make a plan. BE WILLING TO HAVE SOME HARD DAYS Remember, anxiety will come along the way. We actually want to invite it. Tell it, "Come on, anxiety, we're going to get groceries right now. Come on, anxiety, it's time to have a coffee. Come on, anxiety, let's go and do the hard thing or do my homework and my exposures." That is a positive thing. BE GENTLE WITH YOURSELF/ PRACTICE SELF-COMPASSION The last thing I want to incorporate here is to be gentle with yourself. There will be days where this falls apart, and that's okay. Self-compassion for anxiety is so important. We're all learning here. So when it does fall apart, because it will, your job is to take a look and see what happened, what got in the way, how can I plan for that tomorrow so that that doesn't happen again. CONCLUSION So there you have it. There is the routine that I want you guys to consider. Some things will work for you, some will not. Just take what you need and leave the rest. But this is an anxiety routine that you can play around with, experiment with, and see what works for you. Before we end, let's do the "I did a hard thing" segment. I'm going to try my best to bring this back. This one is from Lindsay, and Lindsay said: "I've been going through a lapse, or what I like to call a flare-up, for the last month. There have been decent days, blah days, and downright crappy days." We can agree with you, Lindsay. "The hard thing I've done is to decide it's time for an ERP refresher, and I have started that this week. I will admit that I'm terrified to be venturing into ERP again. However, I refuse to let fear control me. To anyone who's going through a lapse or a flare-up, embrace where you are, love yourself, and fight for yourself because you are so worth it." And I agree with you, Lindsay. Again, if there's anything we can do to support you on your journey, go to CBTSchool.com. We have all kinds of courses there that can help you get back into the swing of things or get started. So go to CBTSchool.com, and thank you so much for being here with me today.

Apr 19, 2024

Helping children navigate the complexities of Obsessive-Compulsive Disorder (OCD) requires a delicate balance of understanding, patience, and empowerment. Natasha Daniels, a renowned expert in this field, shares invaluable insights into how parents can support their children in overcoming OCD with positivity and resilience. Normalizing OCD: One of the first steps in supporting children with OCD is normalizing the condition. Both parents and children need to understand that they are not alone in this journey. Natasha emphasizes the importance of taking things one step at a time and not allowing the overwhelming nature of OCD to overshadow the progress being made. Education is Key: Understanding OCD is crucial for effective support. Natasha urges parents to educate themselves about the condition, its symptoms, and the most effective treatment approaches. By arming themselves with knowledge, parents can better support their children through the challenges of OCD. The Concept of "Crushing" OCD: Natasha introduces the empowering concept of " crushing" OCD ." Instead of viewing OCD as an insurmountable obstacle, children are encouraged to see it as something conquerable. This shift in perspective can be transformative, instilling a sense of empowerment and resilience. Making Treatment Fun: To engage children in treatment , Natasha suggests incorporating fun activities. By turning exposures into games or playful challenges, children are more likely to participate actively in their own recovery journey. This approach not only makes treatment more enjoyable but also fosters a positive attitude towards facing fears. Bravery Points: Natasha introduces the idea of "bravery points" as a motivational tool for children. By rewarding bravery in facing OCD-related fears, children are incentivized to confront their anxieties and engage in exposure exercises. This gamified approach can be highly effective in encouraging progress. Adapting for Teens and Adults: While bravery points may resonate well with children, Natasha also offers insights into adapting these strategies for teenagers and adults. Creative incentives tailored to different age groups can help individuals of all ages stay motivated and committed to their treatment goals. Creative Exposures: Incorporating creative exposures into treatment can make confronting fears more engaging and less daunting for children. By turning exposures into interactive experiences, such as games or role-playing exercises, children can develop essential coping skills in a supportive environment. Collaborative Approach: Natasha emphasizes the importance of collaboration between parents and children in the treatment process. By working together to develop coping strategies and respond to OCD-related behaviors, families can create a supportive and empowering environment for children with OCD. Addressing Parenting Challenges: Managing the emotional challenges of parenting a child with OCD can be overwhelming. Natasha offers insights into coping with feelings of anger, frustration, and helplessness, providing strategies for maintaining patience and support during difficult moments. Long-Term Perspective: Supporting children with OCD requires a long-term perspective. Building resilience and fostering a family culture that promotes bravery and resilience are essential for long-term success. By focusing on progress rather than perfection, families can navigate the challenges of OCD with hope and determination. Conclusion: Natasha Daniels' insights offer a beacon of hope for families navigating the complexities of OCD. By normalizing the condition, educating themselves, and adopting creative and empowering approaches to treatment, parents can support their children in overcoming OCD with positivity and resilience. TRANSCRIPTION: Kimberley: Welcome everybody. Today we have Natasha Daniels. She's the go to person for the kiddos who are struggling with anxiety and OCD. And I'm so grateful to have her here. We are going to talk about helping your kid crush OCD and how we can make it fun and how we can get them across the finish line. So welcome Natasha. Natasha: Thanks for having me. I appreciate it. Kimberley okay. We've had you on before and I think so much so highly of you. I'm so honored to have you on here again talking. We were talking about kids as well last time but first of all let's just talk about the kiddo, right? The kiddo who has OCD. They're starting this process. Let's sort of even say like they're ready for help, like they want to get better, but at the same [00:01:00] time getting better feels like a huge mountain that they have to climb. What might you say to the kiddo and the parents at that beginning stage of treatment? Natasha: A lot of times I think kids don't even realize that they're not alone. They think they have like these really bizarre thoughts and that they'll never be able to stop those bizarre thoughts. So I the first step is really normalizing it for both the parent and the child and letting them know that lots of people have this struggle and that they are able to get through it and have a healthy, productive life. And for parents in particular. about tunnel vision, you know, because it can feel so big. And it's like, let's just, what's your next move? What's your next step that tunnel vision so that the overwhelm doesn't skew your perspective Kimberley: Yeah, what might be those steps? Like what, what, [00:02:00] what, how would you, how would you have that conversation? I mean, I know for parents, I think there's some relief in getting a diagnosis and being like, Oh, okay, so we know now what this is. And we're here to get treatment and we're assuming this is the right treatment. But they're still just, you know, it's such a mountain to climb. So what might you say to them? Natasha : The first step is really educating yourself. I think parents learn a little bit and they just like want to jump into the deep end. They learn a little bit, like, Oh, you shouldn't be accommodating the OCD. So they're like, well, now I don't know what to do because I was doing something that at least help my child in the, in the moment. But now I'm hearing that that actually makes it worse. And so they start to feel really overwhelmed by the little bit of information they get. So I would say. You know, get some education, whether you read a parent book, or you take a course, or you just watch a bunch of videos, but [00:03:00] like, get some basic foundation of what OCD is because it's going to shift and morph and change and look different. And so understanding, like, lay of the land of like, oh, okay, this is what OCD is. You know, it, it's demanding and it wants me, my child to do or avoid something to get that brief relief. And sometimes that hooks me in and the more they do or avoid that, the bigger it grows, like understanding it would be the first step. Kimberley: So you wrote an amazing workbook called Crushing OCD Workbook for Kids. Let's talk about this term crushing like crushing OCD and that's sort of the title of our episode as well Like do we want that mindset if we're gonna crush it? Like what does that look like? How does that change our mindset? Do we need to really think of it like crushing it? Can you kind of share a little bit more about that mindset shift? Natasha Yeah. I do use the word crushing a lot. [00:04:00] My courses are all about crushing. My, my book is crushing um, we're not getting rid of. Um, and so. There is a reason why I use crushing versus like overcoming or getting rid of, it is a powerful, kind of aggressive word. And, and I do feel like seeing OCD as kind of like this adversarial thing that you are crushing. Um, 1 can be very therapeutic and empowering for the child, especially when it's externalized and it's personified. So it's this Mr. OCD or this O cloud is us and we're going to crush it. Um, and then physiologically, do see it differently than anxiety. And I think sometimes with anxiety. we talk about, I kind of equate anxiety as like the overreactive lifeguard, and he's trying to, he's trying to look out for you, but just kind of, [00:05:00] he's sending the emergency alarm bells all the time. So maybe he needs some retraining. Maybe we crush him too, but that I think has more flexibility physiologically. Where I feel like OCD is like this foreign thought that's coming into my brain that is so incongruent with who I am, depending on the theme. And there's no part of it that feels like protective or aligned, um, in the way that OCD can show up. And it's very glitchy, you know, and physiologically, a different part of the brain. And it is. It's a, you know, it's more of a glitch versus an overreactive. So I do feel like about crushing it is a good analogy. Kimberley Well, I think too it's OCD can be so powerful and make us feel like we have to kind of like gulp down and, and wither it. Right. And so it does kind of require our kiddos to stand up to it. And I think crushing it [00:06:00] really gives that metaphor of like, we're going to stand up to it. We're going to win. This is like, we're going, you know, it's point systems or something like that. Like who's going to win this baseball match, but we're going to beat it against OCD. So I think that that is really helpful. And I think kids get behind it too, like Kids want to crush things. Natasha: Yeah. And, and they really need to feel empowered because it is so overpowering more than really any other disorder. It is just, it's they're being bombarded with these thoughts and feelings and to, to sit in a storm. And not do what OCD wants you to do a, is a really brave thing to do. And I do feel like kids can really get behind the idea of overcoming and crushing, not overcoming, but crushing it and feeling empowered that they have more strength than OCD does. Kimberley: Okay. So in the workbook, you talk about these fun activities and I have found having my own [00:07:00] children, but also being a clinician, if it's not fun, they're not that interested. What's the payoff really? So, so can you share with us some of the fun activities or ways in which we can start to approach this topic with our kids? Natasha: Yeah, I think anything can be fun and we want our kids to, to have fun and we want to gamify it. So a lot of the workbook talks about One, how to view OCD in a really fun way. So I use a lot of cartoons and a lot of metaphors so they can see it. Um, also talking about incentivizing them and, you know, adding points or bravery points to do, do scary things. And so it becomes kind of this, Gamified version of, of, of crushing their OCD. Kimberley: So bravery points. What does that mean? Natasha: So bravery points can be different for different families. Um, and we use them in my, my house as well for [00:08:00] my own kids with OCD, where we set up kind of like a virtual store. And there are certain things you can have this pretty structured or not structured where you points and, um, you know, kids can do things that OCD will not. Want them to do or do things or not do things that OCD wants them to do, whichever way OCD is working or do exposures they're purposely triggering OCD and then they earn points and they can cash those points in and so Even at my house, you know, my child does not get Roebucks unless he cashes his points in There's like a direct line there. My daughter doesn't get slime from very expensive place, unless she wants to cash her points in. And those are done through steps that are, that's crushing their anxiety and OCD. Kimberley: And so I was actually going to ask this in terms of bravery points. This is not just for kids. This is for teens too. So you might be doing this for like, how might this apply to [00:09:00] teens or do we use bravery reward points for teens as well? Natasha: Yeah. I think it can be used for anyone. I mean, I think even adults can, can gamify their battles with anxiety and OCD. Um, I mean, I've set that up for myself where I've done something that would be really hard. And then I've offered myself incentives, you know, ironically, or not really ironically, but interestingly. Intrinsic incentive does start to happen. You start to get traction. Um, I know for, for the kids that I've worked with in my practice and even my own kids, I've seen the, the pride when they've done something really scary and the relief of like, Oh my gosh, that was not nearly as bad as I thought it was going to be. And then the empowerment. So I kind of want to preface this with. can have these external reinforcers, but they're there to celebrate those brave moves. They're there to make the association of this is really fun, but the internal motivation does start to get some traction down the [00:10:00] road. And so even with teens offer them incentives, and that might look different. I know, um, I've used this example a lot, like for my older daughter, she would net, she would not be driving today. Absolutely not be driving. If it wasn't for me. ordering her Starbucks. And I would just order her Starbucks and I'd be like, okay, it's ordered, you know, you just need to go pick it up. And she, she has social anxiety as well. So she'd like, and she feels bad about spending money. So there was all sorts of things that were actually working in my favor. Cause she felt so bad. She's like, mom, you just ordered it. But I said, I wasn't ready to drive. And I was like, you don't have to pick it up. It'll just be sitting there. It'll just be wastey wastey. And she would go there. I mean, she had three. cycles of driving school before I did this. Natasha: She was well skilled, but I mean, that's a very basic incentive. It was like, I'm going to reward you. Here's an extent, you know, an incentive to go do it. And, you can be creative with teens, [00:11:00] whether it is. I mean, in my practice, I would get like Xbox controls or like one girl wanted a green screen for her YouTube channel. Like, and it was just that weren't like far, far down the road, but little incentives to celebrate and say, you know, you're doing really hard stuff and it doesn't have to be all boring and, and miserable. It can be fun too. Kimberley: Yeah. In our house, it's Taylor Swift records. We're working our way to get every single one of them. Um, right. And, and, and you get them after you, you know, achieve a certain amount of things. So I think I love this. Um, and I think it, it can, again, it can be age dependent. My son is working towards Pokemon cards as well for different things as well. So I love that. Natasha: Yeah. Kimbelrey: So, okay. So bravery rewards. What about, um, The, the other work of treatment and crushing OCD, are there other [00:12:00] fun activities that you have found to be really powerful, whether it's more in how we educate and conceptualize OCD or get them to do the scary thing? Natasha: Yeah. I think you can get creative and really anything that you're doing, uh, exposures can be fun as far as creating things that are triggering the OCD on purpose. They don't always have to be serious and boring. Um, you can create. Fun things, um, you can do interesting exposures, whether you create a game and you're playing games around it, like go fish, but you change the go fish to different names related to what they're struggling with. Or used, like, um, jelly beans, you know, that tastes gross for my child that has, like, metaphobia and issues. And so thinking out of the box, um, in my practice, I would use, like. like two truths and a [00:13:00] lie they had moral OCD. And so we talk about, you know, I'm going to tell you two truths, but one and the, the third one will be a lie and you have to guess which one it is. And that's a fun game in general, uh, but very overwhelming for someone with moral OCD. And so I think sometimes we think it all has to be serious, but there are a lot of creative ways that we can do exposures that. that can make us laugh. And even when we're responding to our kids, and let's say you don't want to feed the OCD. And so, um, let's just use a concrete example. Like if your child has moral or scrupulosity OCD, and they're always saying, I'm sorry, I'm sorry, I'm sorry. You know, repetitively, that's kind of a compulsive thing and you know that you're not going to feed it. And so you come up with a plan of, I'm not going to accept your sorry. You can even do something silly with that, um, and I've had parents who like, they would say it in a different accent or they would sing it or they'd say, you know, sarcastically, I'm sorry. [00:14:00] You're sorry is not accepted or, you know, like you can, you can even come up with fun, sarcastic things in your response to OCD as long as you're partnering with your child. Kimberley: Tell me about the partnering though, right? So in an example of where you're like, you know, let's say you use your most funny Donald Duck accent, um, in saying, I don't, I don't want to, you're sorry. Um, um, You know, how, how, what if that doesn't feel like partnering to them? What if that feels like, you know, uh, like a, a betrayal to them or they, they're very invested in getting that compulsion done? What would you suggest? Natasha: Yeah. You definitely want to collaborate with your child first and say, you know, I know either they bring it to you or you bring it to them. Like I noticed that when you say this, it's actually your OCD saying that to me. And because I love you, I'm not going to give what OCD wants [00:15:00] anymore. So prefacing it with, I'm noticing that this is a compulsion that I'm part of, and I'm, I love you. And so I'm not going to be part of that compulsion. And can respond in these ways, how would you like me to be, or how do you, how would you like me to respond so you can partner if they can come up with a creative way? Um, like, for instance, in my case with my son, he said, tell me, say, I'm sorry, is not accepted. Like, he literally scripted it for me. when I said it in the moment, he wasn't happy with that because then he was panicking and he was feeling overwhelmed. And so he, I don't like when you say that, but that was our agreement. Um, I might pivot in that moment if he's looking really overwhelmed and I might not say anything because maybe it's not a time to be funny or maybe poking back in a really aggressive way isn't being well received in that moment, but that doesn't mean I'm going to feed the OCD. Okay. you might have a child that doesn't want to partner with you that says, I want you to do this and this makes me feel better. And [00:16:00] why are you being mean? Um, and in that case, humor is not appropriate. You know, you're not going to use humor. You might just say, well, I love you. And so I'm not going to respond and you let them know you're going to respond, but the humor part, if we're the only ones laughing, then it's not really funny. So we have to be very careful about that. Kimberley: Yeah. So, and I mean, it's true that crushing OCD or any, you know, mental health disorder is like a family affair. And so as a, as a parent, What is the training for them in this sort of idea of crushing it and making it fun? What, what personal work would you recommend they do, um, on their own in their own therapy, whether they're with a parenting coach or a therapist or with each other as partners, what would you suggest a parent do to prep for this [00:17:00] sort of marathon that we're on? Natasha: It's a great question because there is so much parenting work that, that needs to be done because it's our journey too. And so I feel like the parent journey is unique in and of itself, you know, raising a child with OCD Um, it's not for the faint hearted. So learning, how do you sit in discomfort when your child is sitting in discomfort? you handle your child being triggered and not swooping in and doing what your child's OCD wants? hard to, to be a witness to your child's struggles, to know that in the short term, you can do something. Some of the time. appeases the OCD, but then grows it long term. And so, um, getting your own support or finding your own way to ground or your own coping skills of how do you handle that when you're, when the child's OCD is having a tantrum. Um, and it will try to kind of break you down so that you [00:18:00] give in so that there's work in that area. I think also, how do we handle our own, how do we handle our own mental health when our child is having mental health issues? Because We are not a blank slate. We come with a lens and that lens has our own childhood. It has our own experiences, has our own mental health issues. And and so we're seeing our child's mental health issues through our lens no one can have a clear lens, but to have some awareness of I'm bringing this to the table, When my child does this, it triggers this for me, which is actually not about my child, but that's about my dad, or that's about my childhood experience. And how do I work through that so that it's not impeding how I'm my child. I'm not dealing with that. Yeah. Kimberley: Yeah, for sure. What's, what's interesting for me. is I was thinking about this about parenting in general is [00:19:00] sometimes I parent the way my parents parented without even Questioning. Is that the way I want to parent like it'd be sometimes I'll catch myself Parenting my child in the way my parents was when I'm like didn't help me like that wasn't helpful You know what? I mean? And and it's so automatic. It really takes slowing down and being like wait I'm What did I need during that time? How can I be that for my child? It's so automatic sometimes. And I think that, um, so many parents, I mean, I wish we were given a manual, but like, it's a lot of emotional regulation work of our own to sit while your child is struggling. Um, especially with anxiety, cause you know, we just, it's so easy to fix it by giving them the compulsion or. You know, so I really feel for the parents that I, you know, that we treat in that it's so much emotional regulation. Would there be a specific [00:20:00] set of tools that you would give them or do you think it's very much dependent on the person? Natasha: I think it's dependent on the person as far as what they're bringing. What they're bringing in the moment. Um, but I do talk about lovingly detach and, and a lot of times parents hear that and they get concerned because they think detachment means that I'm not present for my child. And it's actually the opposite to me. It's like, how can I be? 99 percent or 95 percent there for my child. I'm like, I'm an anchor for them and I'm not bringing anything to the equation. Kimberley: Yeah, Natasha: And that is hard. And a lot of it actually is this. It may seem really weird, but I feel like a lot of it is building up your skills. Through like mindfulness, you know, how do I stay in the moment? I'm only eating this food. I'm only petting my dog and that training like that mental training of your brain of like being Literally only in the [00:21:00] moment and learning how to fine tune that is actually a great survival tool because I find that When I'm in the moment with my kids and I have been working on that muscle in my brain, I'm able to not see as much through that lens of my own childhood or my own triggers. And I'm just like, what does she need from me right now? And that's the question I always tell parents to ask. What do they need from me right now? Like, what is my job in this moment right now? And sometimes it is to ignore them because I know with my daughter, at least, she doesn't like the attention of anxiety. Like when I can tell clearly she's having an anxiety attack, she doesn't want me to hover. And that's really hard because. Inside, you're feeling really anxious about it, but you know that your anxiety or your, your energy is contagious. And so yourself and be like, in this moment, she needs me to go, you know, about the morning routine and just act like nothing's happening. Or it might be the opposite for your child, right? But knowing it's not about us, what do they need in [00:22:00] that moment? Um, and that is a powerful skill that has to be, it's a daily practice. Kimberley: and different for each kid. Natasha: Right. Vastly Kimberley: Yeah, Natasha: Yeah. Kimberley: where it gets complicated. I think he's like because you know, we go Okay, this is the way we do it This is how we do it from now on and then you have another kid and you're like wait that doesn't work for them Natasha: Yup. Kimberley: let's shift it up and let's change it I'm wondering if we, you can quickly speak to a couple of emotions that I know show up with parents, you know, cause again, it's as much the parent game as it is the kids game. So where as clinicians and as parents, where they're to really champion our kids to ride the wave of discomfort and to use their skills and to manage it. What about for the parent they might be experiencing? I know a lot of parents report. anger that shows up at the, you know, when their kid isn't [00:23:00] using their skills and so forth. Um, do you have any, any advice to them when anger does show up or frustration? Yeah. Yeah. And Natasha: being angry then we're like, Oh, I responded angrily or I'm feeling frustrated and I shouldn't. And being accepting of the fact that it's okay, it's normal for me to feel angry. This is a frustrating situation and I want to change it and I want to steer the ship and I can't. Yup. You know, my child's not picking up their part. And so I think just validating that anger, um, which I can be, I think can be sometimes hard because we want to. Kind of we feel guilty about the anger, but then understanding where it's coming from and and again going inward There's so much inward work I think when you're raising a child with anxiety and OCD because it brings out all sorts of stuff for us So asking oh, it's interesting that I'm angry or that made me really [00:24:00] angry or sometimes I'll even say to myself like in my head like Natasha, that was like a huge response. why did you blow up so big on that? That was more than what was actually just happening then. And then do some self diving of like, what was that about it? Oh, that reminded me of this. Or I feel like I'm doing 99 percent of this and he's doing 1%. And what do we, what can we control? And so maybe if I'm feeling that way, then it's a shift of, to pull back. If I'm feeling like I'm doing 99 percent and that's making me angry. I can't control the pace of my child and their ability to use their skills because that's their journey, but I can control invested I am. And so if I'm doing 99 percent of this, then I'm going to pull back a little bit give, you know, invite them to meet me more in the middle. Kimberley: often I find under the fear is, I mean, so under the anger is the fear that we're going to be managing this for a while, or, you know, the parents grief [00:25:00] of This is interrupted the family system. So I think it's so normal. Um, I agree with you just to normalize that as a normal part of parenting, a kiddo who's struggling. Um, yeah. Okay. So in terms of getting that kid across the finish line or setting them up better things like setting them up for success, is there anything that you would tell the parents? as a mindset shift, like, you know, again, this is a marathon, not a sprint. What would you tell them in terms of the whole family system? How, what are skills and tools that they can be using to help set up a system or a family that can help this child crush OCD? Natasha: Yeah. I think mindset's really important because a lot of times is a perception of, I need to cure this, you know, or we need to get the skills and that they can overcome this and OCD is a chronic [00:26:00] condition. so we're wired, you know, if we're going to have anxiety or OCD, that this is going to pop up possibly in our life periodically. yeah, Yeah. So instead of thinking, like, how do I, you know, get rid of this cold or give them the skills and then we've we're done with this because that sets you and your child up for failure. I think having an idea of I'm going to create a home a family culture where we. Where we know we have the skills. We know what OCD is. We know how to identify it. Um, we live a life of exposures. We live a life of doing brave things. we talk about it and it doesn't have to be, I mean, I think once you're in maintenance, and you've really kind of. Learned all the skills that you have learned. I mean, we live in my house. It's a, it's a culture of anxiety. And OCD is kind of just part of our family culture. Like we do scary things or my kids might say that was an exposure or they earn points periodically. And so developing that in your, in your family as a system of like, just part of [00:27:00] your family, just the way your family functions and it works can be really helpful. And there's, there's, Brave things that anyone in the family can do. And so it can be a family affair where I had to go present at work and I didn't really want to present, you know, but I did it. It was really brave. And so using those analogy, using those examples, I think can be really. Normalizing for the child with with OCD. Kimberley: Yeah. So even, even for the non OCD kiddos, you would use that in terms of if they had to do a violin recital or a math. a national math test or that kind of thing. Natasha: Yeah, I mean, I think it can go way beyond OCD. It's how to build resilience because really at the crux of OCD is resilience. It's how to sit with discomfort, how to sit with uncertainty of not being 100 percent of something how to how to deal with something that feels uncomfortable and do it anyway. And so those are those are resiliency [00:28:00] tools that anyone Kimberley: Yeah. And it's such a great mind shift for everyone because parents are doing exposures. They are doing scary things by not accommodating their child as well. That's an exposure for a parent pretty well. Um, so you can conceptualize it that way. I love that. Yeah. Um, What does it look like? I love that you also mentioned in terms of like this is a long term thing. Like this is just a family culture thing. This is how we exist in the world. What does it look long term though? You know, do we do, I've had so many parents say to me, I don't want to give, but you know, the, the, um, The bravery points forever. I don't want to over saturate extrinsic motivation. Like, do you have any thoughts on that in terms of long term use of that method? Natasha: mean, it depends on your child's age and like where they are as far as building up skills. we have it in the background because I don't, [00:29:00] I don't give my kids money for chores, I don't. And so it's just been part of our thing where if they want, I guess what they would call in the UK pocket money, you know, if they want, they want spending money. In general, that really works for me for them to do brave things in general. Um, and so that is just part of the way that we have that now, my 20 year old's not earning like bravery points, you know, across, you know, state lines in California where she's in college, you know, but she's, she's, doing that lifestyle. And so I don't feel like you necessarily have to have these systems or incentives. Um, you might hit a bump and you might say, you want to earn something to overcome this thing that you're working on. Um, you know, a new struggle that they're having. So you might pull it out periodically for me. I don't want I'm like, I'm trying to teach my kids the idea of earning in general. And so it kind of. Fits well, because it's like, [00:30:00] you're not going to get things for free. And then there's this pride of like, oh, I earned that. Or let me work really hard at something. So you can get very ambiguous about it. You can have it be of just kind of your, your regular family incentives and how you're doing it, or you don't do it at all. I mean, It does eventually, um, get stale and so you have to either change it up or you take a break from it or your child is motivated by intrinsic motivation that they're feeling really great that they're able to go to school again or sleep on their own or do the things that were overwhelming for them. Kimberley: Right. Exactly. Yeah. I think that's the beauty is once you've done some exposures, you see that it works. There's a buy in. Um, but that buy in is hard at the beginning, which is why you do have to make it fun. And sometimes you do have to have it be sort of outside motivators to get you there. Yeah. Excellent. So, um, tell me about [00:31:00] your workbook where people can get it, where people can hear about you. Um, cause I know you have so many awesome resources. Natasha: Yeah. Well, I wrote, um, OCD workbook for kids because I wanted people to be able to have a book that was very simplistic that would walk them through basically what I would do in a therapy session, or therapy sessions. And so it just kind of walks them through OCD treatment. So it could be a great supplement to therapy. It could be great for a therapist to use, but it can also be a great standalone. Um, and it's meant for kids to be able to do either on their own or navigate with a parent depending on their age. And starts off with educating them on what is OCD because I told you, I feel like that's so important. Many disguises of OCD, um, normalizing it all the way to understanding how OCD works and then offense and defense about if OCD is knocking versus [00:32:00] knocking on OCD. How to do exposures at home and then how to, how to maintain that. And I also touch on like self esteem as well, because I feel like. OCD can really hurt the self esteem. So there's a little bit of empowerment and self identity in there as well. Kimberley: So important too. OCD can be mean, right? So, and knock people down. So I love that you're talking about that. And where can people find out more about you? Natasha: Um, well they can get the book on Amazon. They can find anything about me at my website at at parenting survival school. com. I mean, nope. At parenting survival, at parenting survival. com too many websites. Kimberley: No, I understand. I'm in the same boat. Well, thank you so much for coming on and talking about crushing OCD with kids. Is there anything you would leave parents and children with a little bit of inspiration or? One last point that you think that you really [00:33:00] want them to know. Natasha: Well, I think there's always hope. I mean, I have seen kids in very acute stages of struggling with OCD and I have seen kids make such big project progress. So there is always hope. And our kids are more than our, their OCD and kids with OCD tend to be the most, of the most compassionate, kindhearted, out of the box thinkers. And, and so I wouldn't even trade that with my own kids because I feel like the, the positive personality traits that, are underneath all those struggles are, are beautiful. So Kimberley: Yeah. Natasha: that's important to do. Track 1: And, and I think from, from my experience is nurture those parts that are not OCD, like what are their hobbies? How can we really build a life around OCD in terms of, you know, the instruments and the hobbies and the talents and the sports and the, you know, the community and that. So forth. So yeah, thank you so much Natasha for coming on. I am so I [00:34:00] love, I love your book. Thank you for writing it. I know writing a book is no easy feat. So congratulations on your book. Um, and I'm excited because you've got more on the, on the coming down the pipeline. I know you have a memoir coming out, so we'll be having you back on later in the year. Natasha: appreciate that. Thanks.

Apr 12, 2024

Navigating the intricate landscape of mental health can often feel like deciphering a complex puzzle, especially when differentiating between conditions ADHD vs.anxiety . This challenge is further compounded by the similarities in symptoms and the potential for misdiagnosis. However, understanding the nuances and interconnections between these conditions can empower individuals to seek appropriate treatment and improve their quality of life. ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity. While commonly diagnosed in childhood, ADHD persists into adulthood for many individuals, affecting various aspects of their daily lives, from academic performance to personal relationships. On the other hand, anxiety disorders encompass a range of conditions marked by excessive fear, worry, and physical symptoms such as heart palpitations and dizziness. The intersection of ADHD and anxiety is a topic of significant interest within the mental health community. Individuals with ADHD often experience anxiety, partly due to the challenges and frustrations stemming from ADHD symptoms. Similarly, the constant struggle with focus and organization can exacerbate feelings of anxiety, creating a cyclical relationship between the two conditions. A critical aspect of differentiating ADHD from anxiety involves examining the onset and progression of symptoms. ADHD is present from an early age, with symptoms often becoming noticeable during childhood. In contrast, anxiety can develop at any point in life, triggered by stressors or traumatic events. Therefore, a thorough evaluation of an individual's history is vital in distinguishing between the two. Moreover, the manifestation of symptoms can offer clues. For example, while both ADHD and anxiety can lead to concentration difficulties, the underlying reasons differ. In ADHD, the inability to focus is often due to intrinsic attention regulation issues. In anxiety, however, the concentration problems may arise from excessive worry or fear that consumes cognitive resources. Understanding the unique and overlapping aspects of ADHD and anxiety is crucial for effective treatment. For ADHD, interventions typically include medication, such as stimulants, alongside behavioral strategies to enhance executive functioning skills. Anxiety disorders, meanwhile, may be treated with a combination of psychotherapy, such as cognitive-behavioral therapy (CBT), and, in some cases, medication to manage symptoms. The integration of treatment modalities is paramount, particularly for individuals experiencing both ADHD and anxiety. Addressing the ADHD symptoms can often alleviate anxiety by improving self-esteem and coping mechanisms. Similarly, managing anxiety can reduce the overall stress load, making ADHD symptoms more manageable. In conclusion, ADHD and anxiety represent two distinct yet interrelated conditions within the spectrum of mental health. The complexity of their relationship underscores the importance of personalized, comprehensive treatment plans. By fostering a deeper understanding of these conditions, individuals can navigate the path to wellness with greater clarity and confidence. This journey, though challenging, is a testament to the resilience and strength inherent in the human spirit, as we seek to understand and overcome the obstacles that lie within our minds. TRANSCRIPT Kimberley: Welcome, everybody. We are talking about ADHD vs anxiety , how to tell the difference, kind of get you in the know of what is what. Today, we have Dr. Ryan Sultan . He is an Assistant Professor of Clinical Psychiatry at Columbia University. He knows all the things about ADHD and cannabis use, does a lot of research in this area, and I want to get the tea on all things ADHD and anxiety so that we can work it out. So many of you listening have either been misdiagnosed or totally feel like they don't really understand the difference. And so, let's talk about it. Welcome, Dr. Sultan. ADHD vs. ANXIETY Ryan: Thank you. I really like doing these things. I think it's fun. I think psychiatrists, which is what I am, I think one of the ways that we really fail, and medical doctors in general don't do well at this, which is like, let's spend some time educating the public. And before my current position, I did epidemiology and public health. And so, I learned a lot about that, and I was like, "You know how you can help people? We have a crisis here. Let's just teach people things about how to find resources and what they can do on their own." And so, I really enjoy these opportunities. WHAT IS ADHD vs. WHAT IS ANXIETY? I was thinking about your question, and I was thinking how we might want to talk about this idea of ADHD versus anxiety, which is a common thing. People come in, and they see me very commonly wanting an evaluation, and they think they have ADHD. And I understand why they think they have ADHD, but their main thing is basically reporting a concentration or focus issue, which is a not specific symptom. Just like if I'm moody today, that doesn't mean I have a mood disorder. If I'm anxious today, it doesn't mean I have an anxiety disorder. I might even feel depressed today; it doesn't mean I have a depression disorder. I could even have a psychotic symptom in your voice, and it does not mean that I have a psychotic disorder. It's more complicated than that. I think one of the things that the DSM that we love here in the United States—but it's the best thing we have; it's like capitalism and democracy; it's like the best things that we have; we don't have better solutions yet—is that it describes these things in a way that uses plain language to try to standardize it. But it's confusing to the general public and I think it's also confusing to clinicians when you're trying to learn some of these conditions. WHEN IS ADHD vs. ANXIETY DIAGNOSED? And certainly, one of the things that have happened in my field that people used to talk a lot about is the idea that, is pediatric, meaning kid diagnosis of ADHD, which often in my area here in the United States will be done by pediatrician, are they adequately able to do that? Because poor pediatricians have to know a lot. And ADHD, psychiatric disorders are complicated. Mental health conditions are super complicated. They're so complicated that there are seven different types of degree programs that end up helping you with them. PsyD, PhD, MD, clinical social worker, mental health counselor, and then there's nurse practitioner. So, like super complicated counseling. So, how do we think about this? The first thing I try to remind everyone is, if you're not sure what's going on with you, please filter your self-diagnosis. You can think about it, that's great. Write your notes down, da-da-da, but I would avoid acting purely on that. You really want to do your best to get some help from the outside. And I know that mental health treatment is not accessible to everyone. This is an enormous problem that existed before the pandemic and still exists now. I say that because I say that all the time, and I wish I had a solution for you. But if you have access to someone that you think can help you tease this throughout, you want to do that. SYMPTOMS OF ADHD vs. ANXIETY But what I would like us to do, instead of listing criteria, which you can all Google on WebMD, let's think about them in a larger context. So, mental health symptoms fall into these very broad categories. And so, some of them are anxiety, which OCD used to be under, but it's now in its own area. Another one, would be mood. You can have moods that are really high, moods that are really low. Another one you could take ADHD, you could lump it in neurodevelopmental, which would mix it with autism and learning disorders. You could lump it with attention, but the problem with that is it would also get lumped with dementia, which are processes that overlap, but they're occurring at different ends of the spectrum. So, let's think about ADHD and why someone might have ADHD or why you might think someone has ADHD, because this should be easier for people to tease out, I think. ADHD is not a condition that appears in adulthood. That's like hands down. Adult ADHD is people that had ADHD and still have ADHD as adults. And most people with ADHD will go on to still have at least an attenuated version, meaning their symptoms are a little less severe, maybe, but over 60% will still meet criteria. It's not a disorder of children. Up until the '90s, we thought it was a disorder of kids only. So, you turned 18, and magically, you couldn't have ADHD anymore, which didn't make any sense anyway. So, to really get a good ADHD diagnosis , you got to go backwards. If you're not currently an eight-year-old, you have to think a little bit about or talk to your family, or look at your school records. And ideally, that's what you want to do, is you want to see, is there evidence that you have, things that look like ADHD then? So, you were having trouble maintaining your attention for periods of time. Your attention was scattered in different ways. Things that are mentally challenging that require you to force yourself to do it, that particularly if you don't like them, this was really hard for you. You were disorganized. People thought that things went in one year and out the other. Now this exists on a spectrum. And depending on the difficulty of your scholastic experience and how far you pushed yourself in school, these symptoms could show up at different times. For example, it's not uncommon for people to show up in college or in graduate school. Less so now, but historically, people were getting diagnosed as late as that, because now they have to write a dissertation. For those of you guys who don't know, a dissertation is being asked to write a book, okay? You're being asked to write a book. And what did you do? You went to college. Okay, you went to college, and then you had some master's classes, and then you get assigned an advisor, and you just get told to figure out what your project is. It is completely unstructured. It is completely self-sufficient. It is absurd. I'm talking about a real academic classic PhD. That is going to bring it. If somebody has ADHD, that's going to bring it out because of the executive functioning involved in that, the organization, the planning. I got to make an outline, I got to meet with my mentor regularly, I got to check in with them, I got to revise it, I got to plan a study or a literature review. There's so many steps involved. So, that would be something that some people doesn't come up with then. Other kids, as an eight-year-old boy that I'm treating right now, who has a wonderful family that is super supportive, and they have created this beautiful environment for him that accommodates him so much that he has not needed any medication despite the fact that there's lots of evidence that he is struggling and now starting to feel bad about himself, and he has self-esteem issues because he just doesn't understand why he has to try so hard and why he can't maintain his attention in this scenario, which is challenging for him. So, ADHD kids and adults, you want to think of them as their brains as being three to five years behind everyone else in their development, okay? And they are catching up, but they're more immature, and they're immature in certain ways. And so, this kid's ability to maintain his attention, manage his own behaviors, stay organized, it's like mom is sitting with this kid doing his homework with him continuously, and if she stops at all, he can't hold it together on his own. So, when we think about that with him, like, okay, well, that's maybe when it's showing up with him. That's when it's starting to have a struggle with him. But let's relate it to anxiety. One problem would be, do you have ADHD or do you have anxiety? Well, there's another problem. Another problem is having ADHD is a major risk factor for developing an anxiety disorder, okay? So now I'm the eight-year-old boy, and this eight-year-old boy does not have the financial resources to get this evaluation, or the parents that are knowledgeable enough to know that, it might even have been years ago where there was less knowledge about this. And he's just struggling all the time, and he feels bad about himself, and he's constantly getting into trouble because he is losing things because he can't keep track of things because he's overwhelmed. And now he feels bad about himself. Okay. He has anxiety associated with that. So now we're building this anxiety. So he might even get mood symptoms, and now we have a risk for depression. So, this is just one of the reasons why these things are like these tangled messes. You ever like have a bunch of cords that you have one of the dealies, you keep throwing them in a box, and now you're like, "What do I do? Do I just throw the cords out or entangle them?" It's a very tangled mess. Of course, it takes time to sort through it. The reason I started with ADHD is that it has a clear trajectory of it when it happens. And in general, it's a general rule, symptomatology, meaning like how severe it is and the number of symptoms you have and how impairing it is. They're going to be decreasing as you get older. At least until main adulthood, there's new evidence that shows there might be a higher risk for dementia in that population. But let's put geriatric aside. There's a different developmental trajectory. Whereas anxiety, oh God, I wish I could simplify anxiety that much. Anxiety can happen in different ways. So, let's start with the easy thing. Why would you confuse them in this current moment? If I am always worried about things, if I'm always ruminating about things, I'm thinking about it over and over again, I'm trying to figure out where I should live or what I should do about this, and I just keep thinking about it over and over again, and I'm in like a cycle. Like, pop-pa-pa pop-pa pop-pa-pa-pa. And then you're asking me to do other things. I promise you, I will have difficulty concentrating. I promise you, I can't concentrate because it's like you're using your computer and how many windows do you have open? How many things are you running? I mean, it doesn't happen as much anymore, but I think most of us, I meant to remember times where you're like, "Oh, my computer is not able to handle this anymore." You're using up some of your mind, and you can call that being present. So, when people talk about mindfulness and improving attention, one of the things that they're probably improving is this: they're trying to get the person to stop running that 15, 20% program all the time. And it's like your brain got upgraded because you can now devote yourself to the task in front of you. And the anxiety is not slowing you down or intruding upon you, either as an intrusive thought in an OCD way or just a sort of intrusive worry that's probably hampering your ability to do something concentration-intensive. And then if you have anxiety problems and you're not sleeping right, well, now your memory is impaired because of that. So, there's this cycle that ends up happening over and over again. IS HYPERACTIVITY ANXIETY OR ADHD? Kimberley: Yeah, I think a lot of people as well that I've talked to clients and listeners, also with anxiety, there's this general physiological irritability. Like a little jitteriness, can't sit in their chair, which I think is another maybe way that misdiagnosis can -- it's like, "Oh, they're hyperactive. They're struggling to sit in their chair. That might be what's going on for them." Is that similar to what you're saying? Ryan: Yeah. So, really good example, and this one we can do a little simpler. I mean, the statement I'm going to say is not 100% true, but it's mostly true. If you are an adult, like over 25 for sure, and you are physically jittery, it is very unlikely that that is ADHD. Because ADHD, the whole mechanism as we understand it, or one of the mechanisms causing the thing we call ADHD, which of course is like a made-up thing that we're using to classify it, is that your prefrontal cortex is not done developing. So, it needs to get myelinated, which is essentially like -- think about it like upgrading from dial up to some great, not even a cable modem. You're going right to Verizon Fios. Like amazing, okay. It's much faster, and it's growing. And that's the part of you that makes you most human. That's the most sophisticated part of your brain. It's not the part that helps you breathe or some sort of physiological thing, which, by the way, is causing some of those anxiety symptoms. They're ramped up in a sympathetic nervous system way, fight or fight way. It's the part that's actually slowing you down. That's like, "Whoa, whoa, whoa, whoa, whoa, calm down, calm down, calm down." This is why, and everyone's is not as developed. So, we're all developing this thing through 25, at least ADHD is through 28. Car insurance goes down to 25 because your driving gets better, because your judgment gets better, because you can plan better, because you are less risk-taking. So, your insurance has now gone down. So, the insurance company knows this about us. And our FMRI scans, you scan people's brains, it supports that change. These correlate to some extent with symptomology, not enough to be a diagnosis to answer the person's question that they're going to have that. I wish it was. It's not a diagnosis. We haven't been able to figure out how to do that yet. So, by the time you're 25, that's developed. And the symptoms that go away first with ADHD are usually hyperactivity, because that's the inability to manage all the impulses of your body, not in an anxious, stressed-out way, but in an excited way. You think of the happy, well-supported, running around ADHD kid is kind of silly and fun. It's a totally different mood experience than the anxiety experience. Anxiety experience is unpleasant for the most part. Unless your anxiety is targeting you to hyper-focus to get something done, which is bumping up some of your dopamine, which is again the opposite experience of probably having ADHD, it's a hyper-focus experience, certainly, the deficit part of ADHD, you're going to be feeling a different physiological, the irritability you talked about 100%. You're irritable because you are trying so hard to manage this awful feeling you have in your body. You physically feel so uncomfortable. It is intolerable. I have this poor, anxious young man that has to do a very socially awkward thing today. Actually, not that socially awkward. He created the situation, which is one of the ways we're working on it with him in treatment. And I'm letting him go through and do this as an exposure because it'll be fine. And he's literally interacting with another one of our staff members. But he finds these things intolerable. He talks about it like we are lighting him on fire. So, he's trying to hold it together, or whatever your physiological experience is. It may not have been as dramatic as I described. You're irritable when people are asking things of you because you don't have much left. You're not in some carefree mood where you're like, "Whatever, I'm super easygoing. I don't care." No, you're not feeling easygoing right now. You're very, very stressed out. Stress and anxiety are very linked. Just like sadness and depression are very linked, and like loneliness and depression are linked, but they're not the same thing. Stress and anxiety are very, very linked, and they're similar feelings, and they're often occurring at the same time and interacting with each other. ADD vs. ADHD Kimberley: Right. One question really quick. Just to be clear, what about ADD vs. ADHD ? Ryan: We love to change diagnostic criteria. People sit around. There's a committee, there's a whole bunch of studies. And we're always trying to epidemiologically and characterologically differentiate what these different conditions are. That's what the field is trying to do as an academic whole. And so, there's disagreements about what should be where. So, the OCD thing moving is one of them. The ADD thing, it's like a nomenclature thing. So, the diagnosis got described that the new current version of the diagnosis is attention deficit hyperactivity disorder, and then you have three specifiers, okay? So, that's the condition you have. And then you can have combined, which is hyperactive and inattentive. Just inattentive, just hyperactive. And impulsive is built in there. So, it's really not that interesting. People love to be like, "No, no, I have ADD. No, I don't have the hyperactive." And I'm like, "I know, but from a billing point of view, the insurance company will not accept that code anymore. It doesn't exist." DOES ADHD OR ANXIETY IMPACT CONCENTRATION? Kimberley: Yeah. So, just so that I know I have this right, and you can please correct me, is if you have this more neurological, like you said, condition of ADHD, you'll have that first, and then you'll get maybe some anxiety and some depression as a result of that condition. Whereas for those folks, if their primary was anxiety, it wouldn't be so much that anxiety would cause the ADHD. It would be more the symptoms of concentration are a symptom of the anxiety. Is that what you're saying? Ryan: Yes, and every permutation that you can imagine based on what you just said is also an option. Like almost every permutation. Like how are they interacting with each other? How are they making each other worse? How are they confusing each other? Because you can have anxiety disorders in elementary school. I mean, that is when most anxiety disorders, the first win, like the wave of them going up is then. And you think about all the anxiety you have. I got a friend of mine who's got infants. And it's fun to see like as they're developing, when they go through normal anxiety, that that is a thing that they're going to pass. And then there's other things where, at some point, we're like, actually, now we're saying this is developmentally inappropriate, which means, nope, we were supposed to have graduated from this and it's still around. And so, one of the earlier ways that psychiatric conditions were conceptualized, and it's still a useful way to conceptualize them, is the normal behavior version of it versus the non-normal behavior version of it. And again, I hate non-normal, I don't want to pathologize people, but non-normal being like, this is causing problems for you. And if you think about it from an evolutionary point of view, all of these conditions have pretty clear evolutionary bases of how they would be beneficial. Anxiety is going to save your ass, okay? Properly applied anxiety, it'll save your tribe. You want someone who's anxious, who's going to be like, "We do not have enough from this winter." An ADHD person was like, "It'll be fine. I'm just going to go find something else." And you're like, "No." And then when that winter's really bad and you save that little bit of extra food, that 30% that the anxious person pushed for, maybe you didn't eat all 30% of it, but you know what, it probably benefited you and it might've actually made the whole tribe survive or more people survive or better health condition. So, it's approving everyone's outcomes. The ADHD individual, you get them excited about something—gone. They're going to destroy it. They're going to find all the berries. They're going to find all the new places. They're going to find all the new deer. They're going to run around and explore. It's great. Great, great, great. Depression is like hibernation. And if you look at hibernation in a mammal, like what happens, there's a lot of overlaps. Lower energy, maybe you store up some food for the winter. It's related to the seasons. You're in California, right? This is not a problem you have, but for those of us in New York, where we have seasonality, seasonal depression is a thing. It's very much a thing. It's very noticeable, and it's packed on top of these conditions everyone else is having. But the idea is that the hibernation or the pullback is like something happens to you that upsets you, which is the psychosocial event that's kicking you in the face that might set off your depression. That's why people always say, "Oh, depressions just don't come out of nowhere. This biochemical thing isn't true." What they're saying is something has to happen to start to kick off the depression, but that's not enough. It's that you then can't recover from it. And so, a normal version of it is that you get knocked out and you spend a week or two, you think about it. Rumination is a part of depression for many people. You reevaluate, and you say, "You know, I got kicked in the face when I did that. That was not a good plan for me. I need a new plan. I either need to do something different or I need to tackle that problem differently." And so, that would be the adaptive version of a depressive experience. Whereas the non-adaptive version is like, you get stuck in that and you can't get out. Kimberley: Or you avoid. Ryan: The avoiding doing anything about it, and then that makes it worse. So, you started withdrawing. I mean, that's the worst thing you can do. This is a message to everyone out there. The worst thing that you can do is withdraw from society for any period of time. Look, I'm not saying you can't have a mental health day, but systematic withdrawal, which most of us don't even realize is happening, is going to make you worse because the best treatment for every mental health condition is community. It is really. All of them. All of them, including schizophrenia. I used to work in Atlanta. I did my residency. There'd be these poor guys that have a psychotic disorder. They hear voices. The kinds of people that, here in New York City, are homeless, they're not homeless there. Everyone just knows that Johnny's just a little weird and his mom lives down the street. And if we find Johnny just in the trash can or doing something strange, or just roving, we know he's fine, and someone just takes him back to his mom's house and checks on him. Because there's a community that takes care of him, even though he's actually quite ill from our point of view. But when you put him in an environment where that community is not as strong, like a city, it does worse, which is why mental health conditions are much higher rates in urban areas. Probably why psychiatry and mental health in general is such a central thing in New York City. TREATMENT FOR ADHD vs. ANXIETY Kimberley: Yeah. Okay, let's talk quickly about treatment for ADHD. We're here always talking about the treatment for anxiety, but what would the research and what's evidence-based for ADHD if someone were to get that clinical diagnosis? Ryan: So, you want to think about ADHD as a thing that we're going to try to frame for that person as much as how is it an asset, because it historically has made people feel bad about themselves. And so, there are positive aspects to it, like the hyper focus and excitability, and interest in things. And so, trying to channel into that and then thinking about what their deficits are. So, they're functional deficits. If you're talking adult population, functional deficits are going to be usually around executive functioning and organization planning. Imagine if you're like a parent of small children and you have untreated ADHD, you're going to be in crazy fight-or-flight mode all the time because there's so many things to keep track of. You have to keep track of your wife and their life. Kimberley: I see these moms. My heart goes out to them. Ryan: And they're probably anxious. And the anxiety is probably protecting them a little bit. Because what is the anxiety doing? You think about things over and over and over again, and you double check them. You know what that's not a bad idea for? Someone who's not detail-oriented, who's an ADHD person, who forgets things, and he gets disorganized. So, there's this thing where you're like, "Okay, there may actually be a balance going on. Can we make the balance a little bit better?" So, how do you organize yourself? MEDICATIONS FOR ADHD Right now, there's a stimulant shortage. Stimulants are the most effective medication for reducing ADHD symptoms. They are the most effective biological intervention we have to reduce the impact of probably any psychiatric condition, period. They are incredibly effective, like 80, 90% resolution of symptoms, which is great. I mean, that's great. That's great news. But you also want to be integrating some lifestyle changes and skills alongside of that. So, how do you organize yourself better? I mean, that's like a whole talk, but like lists, prioritizing lists, taking tasks, breaking them down into smaller and smaller pieces. Where do you start? What's the first step? Chipping away. You know what? If you only go one mile a day for 30 days, you go 30 miles. That's still really far. I know you would have gone 30 miles that day, especially if you have ADHD, but you're still getting somewhere. And so, that kind of prioritization is really, really important. And so, you can create that on your own. There are CBT-based resources and things to try to help with that. There are ADHD coaches that try to help with that. It's consistency and commitment around that. So, how do you structure your life for yourself? That poor PhD candidate really needs to structure their life because there is no structure to their life. The other things we want to think about with that, I mean, really good sleep, physical exercise. People with ADHD, we see on FMRI scans when you scan someone's brain, there's less density of dopamine receptors, less dopamine activity. You want to get that dopamine up. That's what the medications are doing, is predominantly raising the dopamine. So, physical activity, aerobic exercise, in particular, is going to do that. Get that in every day, and look, it's good for you. It's good for you. There is no better treatment for every condition in the world other than exercise, particularly aerobic. It basically is good for everything. If you just had surgery, we still want you to get out and walk around. Really quickly, that actually improves your outcome as fast as possible. So, those are the things I like people to start with if they can do that, depending on the severity of what's going on, the impact, what other things have already been tried. Stimulant medications or non-stimulant medications like Wellbutrin, Strattera, Clonidine are also pretty effective. Methylphenidate products, which is what Ritalin is. Adderall products mixed in amphetamine salts, Vyvanse, these are very effective medications for it. There's a massive shortage of these medications that people are constantly talking about, and is really problematic and does not appear to have an endpoint because the DEA doesn't seem ready to raise the amount that they allow to be made because they are still recovering from the opioid crisis, which is ongoing. And so, they're worried about that. Really, they want to be very thoughtful about this. These medications have a very low-risk potential for misuse. In fact, people with ADHD, they appear to reduce the risk of developing a substance use disorder. It's the most common thing that people worry about. So, treatment actually reduces that. That said, the worst -- I mean, I don't want to say the worst thing. I mean, people hate me. The really not great way to get psychiatric treatment is to show up to someone once and then intermittently meet with them where they write a prescription for a medication for you that's supposed to help you, and stimulant medications are included on that. So, that's probably why I didn't lead with that, even though there's actually more science to support them, is that by themselves, it's really going to limit how much help you're going to get. Kimberley: Can you share why? Ryan: Because you need to understand your condition, because you need to spend time with your clinician learning about your condition and understanding how it's affecting your life, and understanding how the medication is actually meant to be a tool. It should be like wearing glasses. It doesn't do the work for you. It doesn't solve all your problems, but it's easier to read when you put your glasses on than without it. It supports you. You still need to figure out how to get these things done. It lowers the activation energy associated with it. But you also want to monitor it. You can't take these medications 24 hours a day and just be ready to go and work, which is things that people have tried. It doesn't work because you need to sleep, because you will die. They've tried this. We know that you will literally die, like not sleeping. And in the interim, you are damaging yourself significantly. So, taking it and timing it in an appropriate way, still getting sufficient sleep, prioritizing other things—they are like a piece of a puzzle, and they are a really powerful piece. But you really don't want that to be the only thing driving your decision-making, or that be what the interaction is really about. And by the way, the same thing is true for all psychiatric medications. Kimberley: I was going to say that's what we know about OCD and anxiety disorders too. Medication alone is not going to cut you across the line. Ryan: And for most people, therapy alone is also not going to cut the line. You have to have a mild case for therapy alone to be okay. And I can trouble for that statement. But the other thing is lifestyle. What lifestyle changes can I make? And those together, all three, are going to mean that you get better faster, you get more better than you would have, you're more likely to stay better. And they start to interact with each other in a good way, where you get this synergistic effect of ripples of good things happening to you and personal growth. You look back, and you're like, "Geez, I'm on version 3.0 of me. I didn't know that there was a new, refined personal growth version of me that could actually function much better. I didn't actually believe that." DOES ADHD IMPACT SELF-ESTEEM? Kimberley: Well, especially you talked about this impact to self-esteem too. So, if you're getting the correct treatment and now you're improving, as you go, you're like, "Okay, I'm actually smart," or "I'm actually competent," or "I'm actually creative. I had no idea." Ryan: Yes. "I'm not stupid." Lots of people with ADHD think they're stupid. Kimberley: Yeah. So, that's really cool. One question I have that's just in my mind is, does -- Ryan: And that should be part of your treatment, is the working through. That was essentially a complex trauma. It's the complex trauma of having this condition that may not have been treated that made you think that you were an idiot because you were being shoved into a situation that you did not know how to deal with because your ADHD evolved to be an advantage for you as a hunter-gatherer for the hundreds of thousands of years that we had that, and that modern world is not very compliant for. It doesn't experience you as fitting into it well. And then you feel bad about yourself. ADHD IN MALES vs. FEMALES Kimberley: Right. You're the class clown, or you're the class fool, or the dumb girl, or whatever. Now, my last question, just for my sake of curiosity, is: does ADHD look different between genders? Ryan: This is an area of significant research. So, historically, the party line has been that ADHD is significantly more common in boys and girls. And the epidemiology, the numbers, the prevalence have always supported that. Like 3 to 1, 2 to 1, like a much more, much more common. Refining of that idea has come up with a couple of thoughts. One, for whatever reason, I don't know how much of this is genetic. I have no idea how much of this is environmental, sociological. All other things being equal, after a certain young age, girls just always seem to be ahead of boys in their development. I mean, talk to any parent that's had a lot of kids, and they'll tell you that they're like, "I don't know why the girls are always maturing faster." So, that's a bias that is going to always make at any given point. The boys look worse because their brains are not developed. So, they're going to be -- remember that immature younger thing? They're going to be immature and younger. And so at any given marker is that. The other thing that's come up is that the hyperactivity seems to be something we see a lot more in males than in females. That's another thing. And versus inattentiveness, which you see in both and is usually the predominant symptom. And the kid who gets noticed is the little boy who's like -- I mean, not that you could do this in today's world, but has scissors and is about to cut a kid's cord. I'm trying to make a silly imagery. That kid's getting a phone call. No one didn't notice that. The whole class called that. Whereas like daydreaming, I'm not really listening—this is a more passive experience of ADHD. And they're not disrupting the room. Forget about the gender thing. Just that presentation is also less noticed. So, I think the answer is the symptomology presentation is a little different. It tends to be predominantly hyperactive. Are the rates different? Yes, they're probably not as wide of a difference as we think they are, because we're probably missing a good number of girls. Are we missing enough girls to make it 50/50? I don't know. That would be a lot of -- it's a big gap. It's not close. It's a pretty big gap. Maybe we're certainly missing some. And then the other aspect of it is particularly post-puberty. Even before puberty, there's hormonal changes going on. And these hormones, particularly testosterone, which is present in everyone, we think about it as a male thing, but it's really just like a balance thing. You have significant amounts of both. It affects a number of things, and attention is one of them. So, there's so many complexing factors to it. That's why I said, it's something we're still trying to sort out. One of the things that's really interesting that goes back to the hormone thing is that if you talk to young women— so postmenstrual, they've gone through puberty—they will tell you over and over again that their symptomology, just like we have mood symptoms tend to be worse during that time period of when you're ovulating, the ADHD symptoms will be worse as well. And so, there's increasing evidence that if you're on ADHD medication and you have ADHD, which again, we're making lots of presumptions here, go get that confirmed, guys. But if you're on that time period just leading up to ovulation a little bit after, you may actually need a higher dose of your medication to get the same effect. That there's something about the way progesterone and whatever is changing that it affects functionally your attention and your experience of your symptomatology. Kimberley: Interesting. Yeah, thank you for sharing that. Is there anything you feel like we've missed or a point you really want to make for the folks who are listening who are trying to really untangle, like you said, that imagery of untangle, anxiety, ADHD, all of the depression, self-esteem? Ryan: This is like a sidebar that's related. So, one of my other areas of interest is cannabis. And here in New York, we've had a lot going on with cannabis. And there's a lot of science going on around, can cannabis be used to treat things, particularly psychiatric disorders? And I know that a lot of people are interested in that. One of the things that I've been really trying to caution people around with it is that the original thing that I was probably taught in the '90s about cannabis, marijuana being like this incredibly unsafe thing, is not true. But the narrative that it's totally fine and benign is also not true. And that it is probably going to be effective in reducing anxiety acutely, and it will probably be effective in maybe even improving your mood. And some people with ADHD even think it improves their attention by calming their mind. I am very cautious about people starting to use that as part of their treatment plan. And I can tell you why. Kimberley: Because you did say there's an increase in substance use. Ryan: The problem is that it's not rolled out in a way that reflects an appropriate medical treatment. So, if you do it recreationally, obviously, it's basically like alcohol. You just get what you want, and you decide what you want. If you do it medically, depending on the state, as a general rule, you just get a medical card and then you decide what you're going to do, which just seems crazy to me. I mean, you don't do that. You don't send people home with an unlimited amount of something that is mind-altering and tell them to use as much as they need. And the potencies, the strength of it has gotten stronger and stronger. And so, I really caution people around this because when you use it regularly, what ends up happening is you get this downregulation, particularly daily use. You get this downregulation of your receptors, your cannabinoid receptors. We all have cannabinoid receptors. And you have fewer and fewer of them. And because you have so much cannabinoid in your system because you're getting high that your body says, "I don't need these receptors." So then when you don't get high, those cannabinoid receptors that modulate serotonin, dopamine—so functionally, your attention, your mood, your anxiety level—there's none of them left because they've been getting bound like crazy to this super strong thing. And you're making almost none yourself, so you're going to feel awful. You're going to feel awful. And it's not dosed in any kind of appropriate way. We're not giving people guidance on this. So, I really caution people when they're utilizing this, which the reality is that a lot of people are, that they be thoughtful about that and thoughtful about the frequency that they're using and the amounts that they're using, and if they're at a point where they're really trying to self-medicate themselves, because that can really get out of control for people. They can get really out of control. And I think it's unfortunate that we don't have a better system to help people with that. That is more like the evaluation of an FDA-approved medication or something like that has a system through it. So, I just wanted to add that because I know this is something that a lot of people are thinking about. And I think it can be hard to get really good science information on since there's a big movement around making this change. When we're doing a big movement around pushing for a change, we don't want to talk about the reasons that the change might be a little problematic, and therefore slow the change down. So, we forget about that. And I think for the general public, it's important to remember that. Kimberley: Yeah, I'm so grateful that you did bring that up. Thank you. Where can our listeners learn more about you or be in touch with you? Ryan: So, if they want to learn more about my practice, my clinical practice, integrativepsych -- no, integrative-psych.org. We changed. We wrote .nyc. There we go. And then if you want to learn about my science and my lab and our research, which we also love, if you just go to Sultan (my last name) lab.org, it redirects to my Columbia page, and then you can see all about that and send some positive vibes to my poor research assistants that work so hard. Kimberley: Wonderful. I'm so grateful for you to be here. Really, I am. And just so happy that you're here. So much more knowledgeable about something that I am not. And so, I'm so grateful that you're here to bring some clarity to this conversation, and hopefully for people to really now go and get a correct assessment to define what's going on for them. Ryan: Yeah, I hope everyone is able to digest all this. I said a lot. And can hopefully make better decisions for themselves for that. Thank you so much. Kimberley: Thank you.

Apr 5, 2024

Exploring the relationship between faith and recovery, especially when it comes to managing Obsessive-Compulsive Disorder (OCD) , reveals a complex but fascinating landscape. It's like looking at two sides of the same coin, where faith can either be a source of immense support or a challenging factor in one's healing journey. On one hand, faith can act like a sturdy anchor or a comforting presence, offering hope and a sense of purpose that's invaluable for many people working through OCD. This aspect of faith is not just about religious practices; it's deeply personal, providing a framework that can help individuals make sense of their struggles and find a pathway towards recovery. The sense of community and belonging that often comes with faith can also play a crucial role in supporting someone through their healing process. However, it's not always straightforward. Faith can get tangled up with the symptoms of OCD , leading to situations where religious beliefs and practices become intertwined with the compulsions and obsessions that characterize the disorder. This is where faith can start to feel like a double-edged sword, especially in cases of scrupulosity, where religious or moral obligations become sources of intense anxiety and compulsion. The conversation around integrating faith into recovery is a delicate one. It emphasizes the need for a personalized approach, recognizing the unique ways in which faith intersects with an individual's experience of OCD. This might involve collaborating with religious leaders, incorporating spiritual practices into therapy, or navigating the complex ways in which faith influences both the symptoms of OCD and the recovery process. Moreover, this discussion sheds light on a broader conversation about the intersection of psychology and spirituality. It acknowledges the historical tensions between these areas, while also pointing towards a growing interest in understanding how they can complement each other in the context of mental health treatment. In essence, the relationship between faith and recovery from OCD highlights the importance of a compassionate and holistic approach. It's about finding ways to respect and integrate an individual's spiritual beliefs into their treatment, ensuring that the journey towards healing is as supportive and effective as possible. This balance is key to harnessing the positive aspects of faith, while also navigating its challenges with care and understanding. Justin K. Hughes, MA, LPC, owner of Dallas Counseling, PLLC, is a clinician and writer, passionate about helping those impacted by OCD and Anxiety Disorders. He serves on the IOCDF's OCD & Faith Task Force and is the Dallas Ambassador for OCD Texas. Working with a diversity of clients, he also is dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and mental health. A sought-after writer and speaker, he is currently mid-way through writing his first workbook on evidence-based care of OCD for Christians. He is seeking a collaborative agent who will help secure the best publishing house to help those most in need. Check out www.justinkhughes.com to stay in the loop and get free guides & handouts! Kimberley: Welcome, everybody. Today, we're talking about faith and its place in recovery. Does faith help your recovery? Does it hinder your recovery? And all the things in between. Today, we have Justin Hughes. Justin is the owner of Dallas Counseling and is a clinician and writer. He's passionate about helping those who are impacted by OCD. He is the Dallas ambassador for OCD Texas and serves on the IOCDF's OCD and Faith Task Force, working with a diversity of clients. He's also dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and OCD, most commonly Christians. But today, we're here to talk about faith in general. Welcome, Justin. Justin: Kimberley Jayne Quinlan, howdy. Kimberley: You said howdy just perfectly from your Texas state. Justin: Absolutely. Kimberley: Okay. This is a huge topic. And just for those who are listening, we tried to record this once before, we were just saying, but we had tech issues. And I'm so glad we did because I have thought about this so much since, and I feel like evolved a little since then too. So, we're here to talk about how to use faith in recovery and/or is it helpful for some people, and talk about the way that it is helpful and for some not. Can you share a little bit about your background on why this is an important topic for you? Justin: Absolutely. So, first of all, as a man of faith, I'm a Christian. I went to a Christian college, got my degree in Psychology, and very much desired to interweave studies between psychology and theology. So, I went to a seminary. A lot of people hear that, and they're like, "Did you become a priest?" No, it was a counseling program at a seminary, Dallas Theological Seminary. I came here and then found my wife, and I stayed in Dallas. And it's been important to me from a personal faith standpoint. And I love the faith integration in treatment and exploring that with clients. And of course -- or maybe I shouldn't say of course, but it's going to be a lot of Christians, but I work with a lot of different faith backgrounds. And there are some really important conversations happening in the broader world of treatment about faith integration and its place. And we're going to get into all those things and hopefully some of the history and psychology's relationship to faith, which has not been the greatest at different points. For me personally, faith isn't just an exercise. It's not something that I just add on to make my day better. In fact, a lot of times, faith requires me to do way more difficult things than I want to do, but it's a belief in the ultimate object of my faith in God and Christ as a Christian. I naturally come across a lot of people who not only identify that as important but find it as very essential to their treatment. And let's get into that, the folks that find it essential, the people who find it very much not, and the people who don't. But that's just a little bit about me and why I find this so important. Kimberley: Yeah. It's interesting because I was raised Episcopalian. I don't really practice a lot of that anymore for no reason except, I don't know, if I'm going to be really honest. Justin: So honest. I love that. Kimberley: Yeah, I've been thinking about it a lot because I had a positive experience. Sometimes I long for it, but for reasons I don't know. Again, I'm just still on that journey, figuring that piece out and exploring that. Where I see clients is usually on the end of their coming to me as a client, saying, "I'm a believer, but it's all gotten messed up and mushed up and intertwined." And I'm my job. I think of my job as helping them untangle it. Justin: Yeah. Kimberley: Not by me giving my own personal opinion either, but just letting them untangle it. How might you see that? Are you seeing that also? And what is the process of that untangling, if we were to use that word? Justin: It's so broad and varied. So, I would imagine that just like with clients that I work with and folks that come to conferences and that I talk with, the listeners in your audience, hi listeners, are going to have a broad experience of views, and it's so functional. So, I want people to hear right away that I don't think that there's just a cookie-cutter approach. There can't be with this. And whether we're treating OCD, anxiety disorders, or depression, or eating disorders, or BFRVs, fill in the blank, there are obviously evidence-based treatments which are effective for most, but even those can't be a cookie cutter when it comes down to exactly what a person needs to do or what is required of them in recovery. So, yes, let me just state this upfront for the folks that might be unduly nervous at this point. First of all, the faith piece, religious piece, does not have to enter into treatments for a lot of people to get the job done. In fact, actually, for a lot of people, it was much more healing for them, including many of my clients. I have friends and family members that sometimes look at me as scant. So like, "Wait, you went to seminary, and sometimes you don't talk about God at all." And it's like, "Yeah, sometimes we're just doing evidence-based treatment, and that is that." And as an evidence-based practitioner, that's important to me. So, when people come in, I want to work with what their goals are, their values. And a lot of people have found themselves, for any number of reasons, stuck, maybe compulsions or obsessive thoughts or whatever, are stuck in all things belief, religion, or faith or whatever else. And sometimes actually, the most healing thing for them to do is sometimes get in, get out, do the job clinically, walk away, experience freedom, and then grow and develop personally. But then I've also discovered that there's this other side that some people do not find a breakthrough. Some people stay stuck. And maybe these are the people that hit the stats that we see in research of 20% or so just turn down things like ERP, (exposure and response prevention) with OCD when they're offered. And then another 20 to 30% drop out. And we have great studies that tell us that most people who stick with it get a lot of benefits, but there's all the other folks that didn't. And sometimes it's because people -- no offense, you all, but sometimes people just don't want to put in the work and discipline. However, we can't minimize it to that. Sometimes it's truly people that are willing to show up, and there's a complex layer of things. And the cookie-cutter approach is not going to work for them. Maybe they have the intersection of complex health issues, intersection of trauma, intersection of even just family of origin things where life is really difficult, or even just right now, a loneliness epidemic that's happening in the world. And by the way, I'm a huge believer in the evidence base. There's a lot in the evidence base that guides us. And as I'm talking today, I want to be really clear that when I work with folks, even when we get into the spiritual, I'm working with the evidence base. Yeah, there's things that there's no specific protocol for, but a lot of folks, I think, can hopefully be encouraged that there's a strong research base to the benefits and the use and the application and also the care of practicing various spiritual practices through treatments. So, to come back to the original question, it depends so much. It's like if somebody asked me a question like, "Hey, Justin. Okay, so as a therapist, do you think that --" and I get these questions all the time, "Is it okay for me to...? Like, I am afraid of this." I got this question at one point. Somebody was curious if I thought it was okay for them to travel to another city. And it's like, it depends. It's almost always an "it depends." So, that's where I'm going to leave it, that nice, squeaky place that we all just want a dang answer, but the reality is, it is going to massively depend on the person and where they are, and what their needs are. Kimberley: Yeah, I mean, and I'll speak to it too, sometimes I've seen a client. Let's give a few examples of a client with OCD. The OCD has attacked their faith and made it very superstitious or very fear-based instead of faith-based. And I think they come in with that, "Everything's so messy and it used to make so much sense, and now it doesn't." For eating disorders, I've had a lot of clients who will have a faith component where there are certain religions that have ways in which you prepare foods and things, and then that has become very sticky and hard for them. The eating disorder gets involved with that as well. And let me think more just from a general standpoint, and I'll use me as an example, as just like a generally anxious person. I remember this really wonderful time, I'll tell you a funny story, when my daughter was like five, out of nowhere, she insisted that we go to every church. Like she wanted to go to a Christian and a Catholic and Jewish temple and Muslim and Buddhist. She wanted to try all of them, and we were like, "Great, let's go and do it." And I could see how my anxious brain would go black and white on everything they said. So, if they said something really beautiful, my brain would get very perfectionistic about that and have a little tantrum. I think it would be like, "But I can't do it that perfect," and I would get freaked out, but also be able to catch myself. So, I think that it's important to recognize how the disorder can get mixed up in that. Justin: Yeah, absolutely. Kimberley: Right? Let's now flip, unless you have something you want to add, to how has faith helped people in their recovery, and what does that look like for you as a clinician, for the client, for their journey? Justin: Yeah, absolutely. Well, on the clinical side of things, the starting place is always going to be the assessments and diagnosis and treatment plan. And then the ethics of it too is going to be working with the person where they are and their beliefs and not forcing anything, of course. And so folks are naturally -- I get it, I respect it. I would be nervous of somebody of a different belief background that's overt about things. Some people come in, they look at the wall, they see Dallas Theological Seminary, they've studied a few things in advance. So, yeah, the starting places, sitting down, honest, building rapport, trust, assessing, diagnosing. So, for the folks where the faith piece is significant, I'll put it into two categories. So, one is sometimes we have to talk about aspects of faith just from a pure assessment sample. So, a common example of that is scrupulosity in OCD. So, I have worked with even a person on the, believe it or not, Faith and OCD Task Force who is atheist. And so, why in the world do we need to talk about faith? Why is that person even on the Faith and OCD Task Force? Well, they're representing a diversity of views and opinions on the role of faith and OCD. Kimberley: Love it. Justin: And it's so interesting to look at it at a base level with something like OCD. But frankly, a lot of mental disorders or even just challenges in life, if clinicians, one, aren't asking questions about, hey, do you have any religious views, background, even just in your background? Do you have spiritual practices that are important to you? We're missing a massive component. And here's the research piece. We know from the research that, actually, a majority of people find things of faith or spirituality important, and secondarily, that a majority of people would like to be able to talk about those things in therapy. Straight-up research. So, a couple of articles that I wrote for the IOCDF on this reference this research. So, it is evidence-based to talk about this. And then when we get into these sticky areas of obsessions and anxiety disorders, of course, it's going to poke on philosophy, worldview, spirituality. And so, it could be even outside of scrupulosity, beliefs that at first it just looks like we need some good shame reduction exercises, self-compassion, and so forth, but we discover that, oh, the person struggling with contamination OCD has a lot of deeper beliefs that they think that somehow, they are flawed because they're struggling. They're not a good enough, fill in the blank, Christian. They're not good enough. Because if so, surely God would break through in a bigger way. If so... Wouldn't these promises that I'm told in scriptures actually become true? And the cool thing is, there's a richness in the theology that helps us understand the nuance there, and it's not that simple. But if we miss that component, and it's essential for treatment, it's not just like, "Oh, I feel bad about myself. And yeah, sometimes I'm critical with myself." And if we don't go at that level of core fear, or core distress, or core belief, oftentimes we're missing really a central part of the treatment, which we talk about in any other domain. People just get nervous sometimes, thinking about spirituality. It's like politics and religion, right? Nobody talks about those things. Well, if we're having deeper conversations, we usually are. And as clinicians, those of you that are listening to the podcast as clinicians, you know that you have to work with people of different political leanings, people of different faith leanings, people who actually live in California versus [inaudible]. I love California. So, the first category is, if we're doing good clinical work, we're going to be asking questions because it matters to most people. If we don't, we're missing a huge piece. It doesn't mean you're a bad therapist, but hey, start asking some questions if you're not, at a minimum. But then there's the second piece that most people actually want to know, and most people have some aspects of practice or integration, or even the most religion church-averse type of person will have any number of things come up such as, "Yeah, I pray occasionally," or "Yeah, I do this grounding exercise that puts me in touch with the universe or creation or whatever it is." So, there's the second category of when it is important to a person because it's part of the bigger picture of growth, it's part of the bigger picture of breaking free from challenges that they have, and, frankly, finding meaning. And I'll just make one philosophical comment here, because I'm a total nerd. Psychology can never be a worldview. Psychology tells us what. Psychology is a subset of science. And by worldview, I mean a collective set of beliefs, guidance, direction about how life should be lived. We can only say, "Hey, when you do this, you tend to feel this way, or you tend to do these behaviors more or do these behaviors less." At the end of the day, we have to make interpretations and judgments about right and wrong, how to live life, the best way to live life. These are in the realm of interpretation. So, surprise, surprise, we're in the realm of at least philosophy, but we very quickly get into theology. And so back to the piece that most people care about it, most people have some sort of spiritual practice that they'll resonate with and connect with. And then most people actually want to integrate a little bit into therapy. And then some people find that it is essential. They haven't been able to find any lasting freedom outside of going deeper into a bigger purpose, `bigger meaning. Kimberley: You said a couple of things that really rang true for me because I really want to highlight here, I'm on the walk here as well as a client. And I love having these conversations with clients, not about me, about them, but them when they don't have a spiritual practice, longing for one. I've had countless clients say, "I just wish I believed." And I think what sometimes they're looking for is a motivator. I have some clients who have a deep faith, and their North Star is that religion. Their North Star is following the word of that religion or the outcome of it, whether it be to go to heaven or whatever, afterlife or whatever. They believe like that's the North Star. That's what determines every part of their treatment. Like, "Why are we doing this exposure today?" "Because this is my North Star. I know where I'm heading. I know what the goal is." And then I have those clients who are like, "I need a North Star. I don't have one. I don't get the point." And I think that is where faith is so beautiful in recovery. When I witness my clients who are going to do the scary thing, they don't want to do it, but they're so committed to this North Star, whatever it might be. And maybe there's a better language than a North Star, again, whatever that is for that person. Like, "I'm walking towards the light of whatever that religion is." I feel, if I'm going to be honest, envious of that. And I totally get that some people do too. What would you say to a client who is longing for something like that? Maybe they have spiritual trauma in some respects or they've had bad experiences, or they're just unsure. What would you say to them? Justin: Yeah, that's really great. And first of all, I just want to really say that it takes a lot of vulnerability and strength to talk as you do. And one of the ways that I admire you, KQ, is through your ability to have these vulnerable conversations. So not just like the platform of expert, because at the end of the day, we're all just people and on a journey for sure. And so thanks for being honest with that. And I'm on a journey as well. And certainly, I realized jumping on podcasts, these things put us in the expert role and we speak at conferences and things like that. But I think that's a bit of the answer right there, is that being where we are to start with is so huge. And I mean, you're so good with the steps to take around acceptance and compassion. That's it. It's like fear presses towards a thousand different possibilities, and none of them come true exactly that way. And it can lead towards people missing a lot of personal growth stuff, spiritual growth stuff. And one of those things, I think, that we do is we sit with that. Clinically, I'm going to assess, ask a lot of questions, Socratic questions as a subset of the cognitive therapy side of doing that. Let me just come back to the simplicity. I think we get there. We sit in it for a second. And otherwise, we miss it. We're rushing to preconceived solutions or answers, but we're saying that we don't necessarily have an answer for that. So, what if we take some time to actually notice it and to be with that and to actually label it and be like, "I'm not sure. I'm yearning. I'm envious. I'm wanting something, but I don't know. So, put me in, coach." I'll sit with people. That's really the first thing. Kimberley: Yeah. What I have practiced, and I've encouraged clients is also being curious, like trying things out if that lines up with their values, going to a service, reading a book, listening to a podcast, and just trying it on. For me, it's also interesting with clients, is if they're yearning for it, try it on and observe what shows up. Is it that black-and-white thinking or perfectionism? Is it your obsessions getting involved? Is it that it just doesn't feel good in your body? And so forth. Again, just be where you are and take it slow, I think. I have a few other areas I want you to look at in terms of giving me your professional thoughts. If somebody wants to incorporate faith into their treatment, what can that look like? Can it look like praying together? What does that look like? Justin: You're asking all the good questions. Yeah, absolutely. And also, one other thing to reference, I know you're friends with Shala Nicely and Jeff Bell. And so they wrote a book. And for those that are on that, I would say, more "I'm seeking journey," it's When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty. And I love Shala and Jeff. They're so great, and they've been really pivotal people in my own life, not just as friends, but just as personal growth too. And so, that's an example specifically where Shala talks about the throes of her suffering. Is Fred in the Refrigerator? is her basically autobiography that goes into the clinical piece too, where at the end of the day, there was a bit of a pragmatic experience that she couldn't -- the universe being against her, she basically always had that view and she needed something that was different. And so she got there, I think. I hope I'm reflecting her sentence as well, but got there pragmatically. "The universe is friendly" is something that she said. Now, I just know that my Christian brothers and sisters, if they're listening to this, they're probably like, "What the heck is Justin talking about? The universe is friendly?" Because that's very, very different from the language that we've used, but it's just such a great example to me of just one step at a time, a person on the journey. They're looking at those things and assessing, okay, what is obsessive, what is compulsive, what is this thing that I can believe in and I ultimately do, but maybe I'm not. I don't want to or I'm not ready, or it doesn't make sense to me to make a jump into an organized religious plea for whatever else. And so, how does it look for clients? So in short, do I pray with clients? Yeah, absolutely. Do I open up the Bible? Yes, absolutely. Actually, it is a minority of sessions, which again, on my more conservative friends and family side of things are almost shocked and scratching their heads. Like, "You're a Christian, you do counseling, and you're not doing that." We're a bunch of weirdos. We're in that realm of the inter-Christian circle in a good sense. We believe so deeply that God loves us and God has interceded and does intercede, and interacts with our present, not just a historical event here and there, and we're left on our own, the deistic watchmaker, to use a philosophical reference there. That because we believe that so strongly, we're not going to take no for an answer in the sense of the deeper growth and deeper faith. So, sometimes that backfires though, especially getting into the superstitious, like, "Well, God's got to be in everything, and I'm not feeling it," as opposed to like, "Okay. Is it possible that I could just have a brain that gives me some pretty nasty thoughts sometimes and it doesn't necessarily reflect that I'm in a bad state, that I can be curious about what a person getting mangled by a car might look like mentally and then be terrified by that?" And then like, "Thanks, brain, for giving me the imagination. Glad I can think through accidents so I can maybe be a safer driver." Yeah, absolutely. But I will say that's one of those sticky points a lot of times for Christians because we believe that thoughts matter and beliefs matter. And so there can be this overinterpretation of everything is always something really big and serious about my status and my heart, and something that's really big and serious about spiritual things or demonic stuff, or fill in the blank. So, the faith integration piece, I do carefully, but I'm not scared of it. I've done it so often. It's through a lot of assessments. It has to be from the standpoint of the client's wanting that. Usually, the client is asking me specifically, like, "Hey, would you pray at the end of the session?" Sure, absolutely, in most cases. And this, such a deep topic. I'm fully aware that there are those in the camp that view faith integration as completely antithetical to what needs to happen in treatments. And they argue their case, they're going to argue it really strongly, but the same exists on the other side as well. And I try and work in that realm of, okay, what's good for the clients? And are there some things that I don't do? Yeah, but I'm not really asked to do them. I've had a number of Muslim clients throughout the year. I don't join in with Ramadan with clients in various practices or fasting with a client, for example. That's not my faith practice there. But can I walk with the client who is trying to differentiate between the lines of fasting and I had water at this point, and the sun was going down and I thought. And other people were having water, but I'm getting stuck on assessing, like, was it too early, and did I actually violate my commitment, my vow? Did I violate what I was supposed to be doing? I can absolutely work with that person, and I need to. I can't really work with OCD or anxiety disorders if I wanted to turn that person away at the door and be like, "Oh, well, I'm not Muslim, so I'm sorry." No, we're going to jump into it and be like, "Okay, so tell me about this thought and then this behavior that came up at this time, and you're noticing that that's a little different from your community, that other people are starting to drink water, eat food. And so, you mentioned that it was right at sunset, but what time was that?" "Well, actually, it was like 10:30 p.m. It's two hours dark." It's like, "But I think I saw a glow in the distance." And it's like, "Okay, now we're into a pretty classic OCD realm." And so the simplest way that I can say that faith integration can be done in therapy is carefully, respectfully, with good assessments. Kimberley: Do you have them consult with their spiritual leader if you're stuck on that? And does that involve you speaking with them, them speaking with them, all three of you? What have you done? Justin: Yeah, absolutely. So, there is a collaboration that goes in a number of different ways. Most of the time, people can speak with their clergy member or faith leader pretty directly, pretty separately, and that is going to work just fine. I would say in most cases, people don't need to, especially if I'm working with OCD. A lot of folks usually have a pretty good general sense of, "Okay, I know what my faith community is going to say about this is X, but I'm scared because it feels like it's on shaky ground, I'm obsessing," et cetera. So, the clarification with the clergy, for instance, or a leader is more from the standpoint of if there's not a defined value definition practice, and that does come up for sure. So, helping that person to even find who that might be, especially if they're not a part of that, and/or maybe a good article to read with some limits, like, okay, three articles max. Check out a more conservative view, a more liberal view, a more fill in the blank. And then my friend and colleague Alec Pollard up at St. Louis Behavioral Medicine Institute, he's been on scrupulosity panels with me. He uses this excellent form called the PISA, (Possibly Immoral or Sinful Act). And it's just a great several-question guide. That or any number of things can be taken to clergyperson, leader in Christian circles a lot of times, like a Bible study or community group. Maybe flesh those things out just a little bit, maybe once, maybe twice max. And so, back to how much others are integrated, yeah, it's a mix and match, anything, everything. For me, with direct conversations with clergy, it's actually because I'm pretty deep into this realm, I have pretty easy access to a lot of folks, so I don't really need to so much talk directly or get that person on a release. But a lot of people do, especially if they don't know that religious belief or faith traditions approach on certain topics. Kimberley: Yeah. It's so wonderful to talk about this with you. Justin: Thanks, Kimberley. Same here. Kimberley: Because I really do feel, I think post-COVID, there's more conversations with my clients about this. This could be totally just my clients, but I've noticed an increased longing, like you said, for that connection, the loneliness pandemic. Justin: Yeah, that's statistical. Kimberley: Such a need for connection, such a need for community, such a need for that, like what is your North Star? And it can be, even if we haven't really talked about depression, it can be a really big motivator when you're severely depressed, right? Justin: Absolutely. Kimberley: And this is where I'm very much like so curious and loving this conversation with my clients right now in terms of, where is it helpful? Where isn't it helpful? As you said, do you want to use this as a part of your practice here in treatment, in recovery? And what role does it play? I know I had mentioned to you, I'd even asked on Instagram and did a poll, and there were a lot of people saying, "It gave me a community. It immensely helps. It does keep me focused on the goal," especially if it's done intentionally without letting fear take over. Is there anything you wanted to add to this conversation before we finish up? Justin: Yeah, I guess two things. So, one is you talked about that, and we talked about a couple of those responses before we jumped on to recording. So, in summary, the responses were all across the board, like, "Ooh." Let me know if I'm summarizing this well, but, "I have to be really careful. That can be really compulsive or not so much. I don't like to do that. I don't think it's necessary." And then like, yeah, absolutely. This is really integral and really important. Is that a fair summary? Kimberley: Very much. Yep. Justin: Okay. And so, I'm building this talk, Katie O'Dunne and Rabbi Noah Tile, ERP As a Spiritual Practice. We're giving here at the Faith and OCD Conference in April, if this is out by then. And in my section that I have, I'm covering the best practices of treatments, specifically ERP (exposure and response prevention) for OCD, and clinically, but then also from a faith standpoint, what do we consider with that? And there's this three-prong separation that I'm making. I'm not claiming a hold on the market with this, but I'm just observing. There's one category of a person who comes into therapy, and it's like, yeah, face stuff, whatever. It doesn't matter, or even almost antagonistic against it. Maybe they've been burnt, maybe they've been traumatized or abused with faith. Yeah, I get it. So, that first camp is there. But then there's also a second camp that people like to add on spiritual practices. They might mix and match, or they might follow a specific system, belief system. And whether it gets into mindfulness or meditation practices or fasting or any number of things, they find that there's a lot of benefit, but it's maybe not at the heart of it. And then there's this third prong of folks that it is part and parcel of everything they do. And I work with all three. They come up in different ways. And sometimes people cycle between those different ones as well in treatments in the process. Kimberley: I'm glad you said that. Justin: Yeah. And so, I just thought that was interesting when you pulled folks that had come up. Really, the second thing, and maybe this is at least my ending points unless we have anything else, you had mentioned to the audience that graciously, we had some tech issues. You all, it wasn't Kimberley's tech issues. It was Justin's tech issues. I spilled coffee on my computer like a week or two prior. It zapped. It's almost like you'd see in a movie, except it wasn't sparking. And I'm like, "Oh my goodness." And it was in a client session. That was a whole funny story in of itself. And I'm like, "Oh my goodness." It wasted my nice computer that I use for live streaming and all of that. And so I'm using my little budget computer at home. It's like, "Oh, hopefully it works." And it just couldn't. It couldn't keep up with all the awesomeness that KQ's spitting out. And I shared with you, Kimberley, a little bit on the email, something deep really hit me after that. I felt a lot of shame when we tried back and forth for 30 minutes to do it, and my computer kept crashing, basically because it couldn't stand the bandwidth and whatever else was needed. And one might think it's just a technical thing, but I'd had some stuff happen earlier that week. I started to play in my church worship band, lead guitar, and there was something that I just wasn't able to break through, and I was just feeling ashamed of that. And it just really hit me. And one of my key domains that I am growing in is my own perfectionism, as a subset of my own anxiety, and perfectionism is all about shame. And I love performance, I love to perform well. I like to say, "Oh, it's seeking excellence, and it's seeking the best for other people's good." But deep down inside, perfectionism is this shame piece that anything shy of perfect is not good enough, and it just hit me. I felt like trash after that happened. I felt embarrassed. And you were so gracious, "It's okay, we'll reschedule." And so, I went for a walk, which I do. Clear my mind, get exercise. And I was just stuck on that. And one of the ways where my Christian walk really came in at that moment was, I started to do some cognitive restructuring. I started to -- for you all who don't know, it's looking at the bigger picture and being more realistic with negative thoughts. Like, "Ah, I can't believe this happened. I failed this," as opposed to like, "Okay, we're rescheduling. It's all right. It actually gave us more time to think about it." And I didn't know that then, but I could have said similar things. I was doing a bunch of clinical tools that are helpful, but frankly, it wasn't until I just tapped into the bigger purpose of, one, not controlling the universe. I don't keep this globe spinning. I barely keep my own life spinning. Two, God loves me. And three, it's okay. It's going to work that out. Four, maybe there's something bigger, deeper going on that I don't know. And I can't guarantee that it was for this reason. I'm not going to put that in God's mouth and say that, "Oh yeah, okay, well, He gave us a couple more weeks to prepare." I don't know. I really don't know. But it helped me to tap into like, "Okay, it's all right. It's really all right." And it took me about half a day, frankly. I'm slightly embarrassed to say, "No, I'm not embarrassed to say that as a clinician who works with this stuff. I have full days, I have full weeks. I have longer periods of time where I'm wrestling with this stuff." And yeah, areas have grown. I've improved in my life for sure, but I'm just a hot mess some days. Kimberley: But that's nice to hear too, because I think, again, clients have said it looks so nice to be loved by God all the time. That must be so nice. But it's not nice. I hate that you went through that. But I think people also need to know that people of faith also have to walk through really tough days and that it isn't the cure-all, that faith isn't the cure-all for struggles either. I think that's helpful for people to know. Justin: Yeah, that's right. So, thank you for letting me share a little bit of that. And yeah, the personalized example of why, at least for me, faith is important. If folks come into my office and they say, "Nah, no thanks," okay, I'm going to try lightly, carefully, or just avoid it altogether if that's what they want. But oftentimes it's really at the center of, okay, purpose, meaning, direction, guidance, and okay, you want to do that? I'll roll up my sleeves, and let's go. Kimberley: Yeah. See, I'm glad that it happened because you got to tell that beautiful story. And without that beautiful story, I would be less happy. So, thank you for sharing that and being so vulnerable. I think I shared with you in an email like I've had to get so good at letting people down that I get it. And I love that you have that statement, like God loves me. That is beautiful. That's like sun on your face right there. I love that you had that moment. Justin: Yeah, it comes up so much, so many times. In the Bible and even to -- like I wrote this article on Fear Not . So, the most common exhortation in all of the Christian Bible is fear not. So, one might think like, "Oh yeah, don't commit adultery," or "Don't kill, don't murder," or fill in the blank. Not even close. The most common exhortation in all of scriptures is actually fear not, and then love, various manifestations all throughout. I could go on, but I know we're out of time. Kimberley: Well, what I will say is tell people where they can hear about you and even access that if they're interested. I love to read that article. So, where will people hear about you and learn more about the work you do? Please tell us everything. Justin: Yeah, sure. And I'll include some stuff for your show notes that you can send to the things referenced. And then JustinKHughes (J-U-S-T-I-N-K-H-U-G-H-E-S) .com is my base of operations where the contact, my email practice information, my blog is on there. And you can subscribe to my newsletter totally free. Totally, totally free. And I do a bunch of eBooks as well on there that are free . JustinKHughes.com/GetUnstuck to join one of four of the newsletters. Other than that, that's where those announcements come out for different conferences. So, Faith and OCD, if this is out in time in April, but April every year, it's getting to be pretty big. We're getting hundreds of people attending. We're now in our fourth annual IOCDF (International OCD Foundation Conference), local conferences, various live streams. So, anyway, the website is that base, that hub, where you'll actually see any number of those different announcements. Thanks for asking. Kimberley: I'm going to make sure this is out before the conference. Can you tell people where they can go to hear about the conference? Justin: Yeah. So, IOCDF.org. And then I think it's /conferences, but you can also type into Google conferences and there's a series of all sorts of different conferences going on. And this is the one that's dedicated to OCD and faith concerns. And just when you think that it's just one specific belief system, then prepare to be surprised because we've done a lot of work to have a diverse group of folks, sharing and speaking and covering a lot of things, ranging from having faith-specific or non-faith nuns, support groups. So, there are literally support groups if you're an atheist and you have OCD, and that's actually an important part of where you are in your journey. But for Christians, for Muslims, for Jewish, et cetera, et cetera, we're trying to really have any number of backgrounds supported along with talks and in broad general things, but then we get more specific into, "Hey, here's for clinicians. Hey, here's for the tips on making for effective practices." Kimberley: Yeah, amazing. And I'll actually be speaking on self-compassion there as well. So, I'm honored to be there. Thank you for being here, Justin. This was so wonderful. Justin: Yeah, this really was. Thank you.

Apr 5, 2024

Exploring the relationship between faith and recovery, especially when it comes to managing Obsessive-Compulsive Disorder (OCD) , reveals a complex but fascinating landscape. It's like looking at two sides of the same coin, where faith can either be a source of immense support or a challenging factor in one's healing journey. On one hand, faith can act like a sturdy anchor or a comforting presence, offering hope and a sense of purpose that's invaluable for many people working through OCD. This aspect of faith is not just about religious practices; it's deeply personal, providing a framework that can help individuals make sense of their struggles and find a pathway towards recovery. The sense of community and belonging that often comes with faith can also play a crucial role in supporting someone through their healing process. However, it's not always straightforward. Faith can get tangled up with the symptoms of OCD , leading to situations where religious beliefs and practices become intertwined with the compulsions and obsessions that characterize the disorder. This is where faith can start to feel like a double-edged sword, especially in cases of scrupulosity, where religious or moral obligations become sources of intense anxiety and compulsion. The conversation around integrating faith into recovery is a delicate one. It emphasizes the need for a personalized approach, recognizing the unique ways in which faith intersects with an individual's experience of OCD. This might involve collaborating with religious leaders, incorporating spiritual practices into therapy, or navigating the complex ways in which faith influences both the symptoms of OCD and the recovery process. Moreover, this discussion sheds light on a broader conversation about the intersection of psychology and spirituality. It acknowledges the historical tensions between these areas, while also pointing towards a growing interest in understanding how they can complement each other in the context of mental health treatment. In essence, the relationship between faith and recovery from OCD highlights the importance of a compassionate and holistic approach. It's about finding ways to respect and integrate an individual's spiritual beliefs into their treatment, ensuring that the journey towards healing is as supportive and effective as possible. This balance is key to harnessing the positive aspects of faith, while also navigating its challenges with care and understanding. Justin K. Hughes, MA, LPC, owner of Dallas Counseling, PLLC, is a clinician and writer, passionate about helping those impacted by OCD and Anxiety Disorders. He serves on the IOCDF's OCD & Faith Task Force and is the Dallas Ambassador for OCD Texas. Working with a diversity of clients, he also is dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and mental health. A sought-after writer and speaker, he is currently mid-way through writing his first workbook on evidence-based care of OCD for Christians. He is seeking a collaborative agent who will help secure the best publishing house to help those most in need. Check out www.justinkhughes.com to stay in the loop and get free guides & handouts! Kimberley: Welcome, everybody. Today, we're talking about faith and its place in recovery. Does faith help your recovery? Does it hinder your recovery? And all the things in between. Today, we have Justin Hughes. Justin is the owner of Dallas Counseling and is a clinician and writer. He's passionate about helping those who are impacted by OCD. He is the Dallas ambassador for OCD Texas and serves on the IOCDF's OCD and Faith Task Force, working with a diversity of clients. He's also dual-trained in psychology and theology, regularly helping anyone to understand the interaction between faith and OCD, most commonly Christians. But today, we're here to talk about faith in general. Welcome, Justin. Justin: Kimberley Jayne Quinlan, howdy. Kimberley: You said howdy just perfectly from your Texas state. Justin: Absolutely. Kimberley: Okay. This is a huge topic. And just for those who are listening, we tried to record this once before, we were just saying, but we had tech issues. And I'm so glad we did because I have thought about this so much since, and I feel like evolved a little since then too. So, we're here to talk about how to use faith in recovery and/or is it helpful for some people, and talk about the way that it is helpful and for some not. Can you share a little bit about your background on why this is an important topic for you? Justin: Absolutely. So, first of all, as a man of faith, I'm a Christian. I went to a Christian college, got my degree in Psychology, and very much desired to interweave studies between psychology and theology. So, I went to a seminary. A lot of people hear that, and they're like, "Did you become a priest?" No, it was a counseling program at a seminary, Dallas Theological Seminary. I came here and then found my wife, and I stayed in Dallas. And it's been important to me from a personal faith standpoint. And I love the faith integration in treatment and exploring that with clients. And of course -- or maybe I shouldn't say of course, but it's going to be a lot of Christians, but I work with a lot of different faith backgrounds. And there are some really important conversations happening in the broader world of treatment about faith integration and its place. And we're going to get into all those things and hopefully some of the history and psychology's relationship to faith, which has not been the greatest at different points. For me personally, faith isn't just an exercise. It's not something that I just add on to make my day better. In fact, a lot of times, faith requires me to do way more difficult things than I want to do, but it's a belief in the ultimate object of my faith in God and Christ as a Christian. I naturally come across a lot of people who not only identify that as important but find it as very essential to their treatment. And let's get into that, the folks that find it essential, the people who find it very much not, and the people who don't. But that's just a little bit about me and why I find this so important. Kimberley: Yeah. It's interesting because I was raised Episcopalian. I don't really practice a lot of that anymore for no reason except, I don't know, if I'm going to be really honest. Justin: So honest. I love that. Kimberley: Yeah, I've been thinking about it a lot because I had a positive experience. Sometimes I long for it, but for reasons I don't know. Again, I'm just still on that journey, figuring that piece out and exploring that. Where I see clients is usually on the end of their coming to me as a client, saying, "I'm a believer, but it's all gotten messed up and mushed up and intertwined." And I'm my job. I think of my job as helping them untangle it. Justin: Yeah. Kimberley: Not by me giving my own personal opinion either, but just letting them untangle it. How might you see that? Are you seeing that also? And what is the process of that untangling, if we were to use that word? Justin: It's so broad and varied. So, I would imagine that just like with clients that I work with and folks that come to conferences and that I talk with, the listeners in your audience, hi listeners, are going to have a broad experience of views, and it's so functional. So, I want people to hear right away that I don't think that there's just a cookie-cutter approach. There can't be with this. And whether we're treating OCD, anxiety disorders, or depression, or eating disorders, or BFRVs, fill in the blank, there are obviously evidence-based treatments which are effective for most, but even those can't be a cookie cutter when it comes down to exactly what a person needs to do or what is required of them in recovery. So, yes, let me just state this upfront for the folks that might be unduly nervous at this point. First of all, the faith piece, religious piece, does not have to enter into treatments for a lot of people to get the job done. In fact, actually, for a lot of people, it was much more healing for them, including many of my clients. I have friends and family members that sometimes look at me as scant. So like, "Wait, you went to seminary, and sometimes you don't talk about God at all." And it's like, "Yeah, sometimes we're just doing evidence-based treatment, and that is that." And as an evidence-based practitioner, that's important to me. So, when people come in, I want to work with what their goals are, their values. And a lot of people have found themselves, for any number of reasons, stuck, maybe compulsions or obsessive thoughts or whatever, are stuck in all things belief, religion, or faith or whatever else. And sometimes actually, the most healing thing for them to do is sometimes get in, get out, do the job clinically, walk away, experience freedom, and then grow and develop personally. But then I've also discovered that there's this other side that some people do not find a breakthrough. Some people stay stuck. And maybe these are the people that hit the stats that we see in research of 20% or so just turn down things like ERP, (exposure and response prevention) with OCD when they're offered. And then another 20 to 30% drop out. And we have great studies that tell us that most people who stick with it get a lot of benefits, but there's all the other folks that didn't. And sometimes it's because people -- no offense, you all, but sometimes people just don't want to put in the work and discipline. However, we can't minimize it to that. Sometimes it's truly people that are willing to show up, and there's a complex layer of things. And the cookie-cutter approach is not going to work for them. Maybe they have the intersection of complex health issues, intersection of trauma, intersection of even just family of origin things where life is really difficult, or even just right now, a loneliness epidemic that's happening in the world. And by the way, I'm a huge believer in the evidence base. There's a lot in the evidence base that guides us. And as I'm talking today, I want to be really clear that when I work with folks, even when we get into the spiritual, I'm working with the evidence base. Yeah, there's things that there's no specific protocol for, but a lot of folks, I think, can hopefully be encouraged that there's a strong research base to the benefits and the use and the application and also the care of practicing various spiritual practices through treatments. So, to come back to the original question, it depends so much. It's like if somebody asked me a question like, "Hey, Justin. Okay, so as a therapist, do you think that --" and I get these questions all the time, "Is it okay for me to...? Like, I am afraid of this." I got this question at one point. Somebody was curious if I thought it was okay for them to travel to another city. And it's like, it depends. It's almost always an "it depends." So, that's where I'm going to leave it, that nice, squeaky place that we all just want a dang answer, but the reality is, it is going to massively depend on the person and where they are, and what their needs are. Kimberley: Yeah, I mean, and I'll speak to it too, sometimes I've seen a client. Let's give a few examples of a client with OCD. The OCD has attacked their faith and made it very superstitious or very fear-based instead of faith-based. And I think they come in with that, "Everything's so messy and it used to make so much sense, and now it doesn't." For eating disorders, I've had a lot of clients who will have a faith component where there are certain religions that have ways in which you prepare foods and things, and then that has become very sticky and hard for them. The eating disorder gets involved with that as well. And let me think more just from a general standpoint, and I'll use me as an example, as just like a generally anxious person. I remember this really wonderful time, I'll tell you a funny story, when my daughter was like five, out of nowhere, she insisted that we go to every church. Like she wanted to go to a Christian and a Catholic and Jewish temple and Muslim and Buddhist. She wanted to try all of them, and we were like, "Great, let's go and do it." And I could see how my anxious brain would go black and white on everything they said. So, if they said something really beautiful, my brain would get very perfectionistic about that and have a little tantrum. I think it would be like, "But I can't do it that perfect," and I would get freaked out, but also be able to catch myself. So, I think that it's important to recognize how the disorder can get mixed up in that. Justin: Yeah, absolutely. Kimberley: Right? Let's now flip, unless you have something you want to add, to how has faith helped people in their recovery, and what does that look like for you as a clinician, for the client, for their journey? Justin: Yeah, absolutely. Well, on the clinical side of things, the starting place is always going to be the assessments and diagnosis and treatment plan. And then the ethics of it too is going to be working with the person where they are and their beliefs and not forcing anything, of course. And so folks are naturally -- I get it, I respect it. I would be nervous of somebody of a different belief background that's overt about things. Some people come in, they look at the wall, they see Dallas Theological Seminary, they've studied a few things in advance. So, yeah, the starting places, sitting down, honest, building rapport, trust, assessing, diagnosing. So, for the folks where the faith piece is significant, I'll put it into two categories. So, one is sometimes we have to talk about aspects of faith just from a pure assessment sample. So, a common example of that is scrupulosity in OCD. So, I have worked with even a person on the, believe it or not, Faith and OCD Task Force who is atheist. And so, why in the world do we need to talk about faith? Why is that person even on the Faith and OCD Task Force? Well, they're representing a diversity of views and opinions on the role of faith and OCD. Kimberley: Love it. Justin: And it's so interesting to look at it at a base level with something like OCD. But frankly, a lot of mental disorders or even just challenges in life, if clinicians, one, aren't asking questions about, hey, do you have any religious views, background, even just in your background? Do you have spiritual practices that are important to you? We're missing a massive component. And here's the research piece. We know from the research that, actually, a majority of people find things of faith or spirituality important, and secondarily, that a majority of people would like to be able to talk about those things in therapy. Straight-up research. So, a couple of articles that I wrote for the IOCDF on this reference this research. So, it is evidence-based to talk about this. And then when we get into these sticky areas of obsessions and anxiety disorders, of course, it's going to poke on philosophy, worldview, spirituality. And so, it could be even outside of scrupulosity, beliefs that at first it just looks like we need some good shame reduction exercises, self-compassion, and so forth, but we discover that, oh, the person struggling with contamination OCD has a lot of deeper beliefs that they think that somehow, they are flawed because they're struggling. They're not a good enough, fill in the blank, Christian. They're not good enough. Because if so, surely God would break through in a bigger way. If so... Wouldn't these promises that I'm told in scriptures actually become true? And the cool thing is, there's a richness in the theology that helps us understand the nuance there, and it's not that simple. But if we miss that component, and it's essential for treatment, it's not just like, "Oh, I feel bad about myself. And yeah, sometimes I'm critical with myself." And if we don't go at that level of core fear, or core distress, or core belief, oftentimes we're missing really a central part of the treatment, which we talk about in any other domain. People just get nervous sometimes, thinking about spirituality. It's like politics and religion, right? Nobody talks about those things. Well, if we're having deeper conversations, we usually are. And as clinicians, those of you that are listening to the podcast as clinicians, you know that you have to work with people of different political leanings, people of different faith leanings, people who actually live in California versus [inaudible]. I love California. So, the first category is, if we're doing good clinical work, we're going to be asking questions because it matters to most people. If we don't, we're missing a huge piece. It doesn't mean you're a bad therapist, but hey, start asking some questions if you're not, at a minimum. But then there's the second piece that most people actually want to know, and most people have some aspects of practice or integration, or even the most religion church-averse type of person will have any number of things come up such as, "Yeah, I pray occasionally," or "Yeah, I do this grounding exercise that puts me in touch with the universe or creation or whatever it is." So, there's the second category of when it is important to a person because it's part of the bigger picture of growth, it's part of the bigger picture of breaking free from challenges that they have, and, frankly, finding meaning. And I'll just make one philosophical comment here, because I'm a total nerd. Psychology can never be a worldview. Psychology tells us what. Psychology is a subset of science. And by worldview, I mean a collective set of beliefs, guidance, direction about how life should be lived. We can only say, "Hey, when you do this, you tend to feel this way, or you tend to do these behaviors more or do these behaviors less." At the end of the day, we have to make interpretations and judgments about right and wrong, how to live life, the best way to live life. These are in the realm of interpretation. So, surprise, surprise, we're in the realm of at least philosophy, but we very quickly get into theology. And so back to the piece that most people care about it, most people have some sort of spiritual practice that they'll resonate with and connect with. And then most people actually want to integrate a little bit into therapy. And then some people find that it is essential. They haven't been able to find any lasting freedom outside of going deeper into a bigger purpose, `bigger meaning. Kimberley: You said a couple of things that really rang true for me because I really want to highlight here, I'm on the walk here as well as a client. And I love having these conversations with clients, not about me, about them, but them when they don't have a spiritual practice, longing for one. I've had countless clients say, "I just wish I believed." And I think what sometimes they're looking for is a motivator. I have some clients who have a deep faith, and their North Star is that religion. Their North Star is following the word of that religion or the outcome of it, whether it be to go to heaven or whatever, afterlife or whatever. They believe like that's the North Star. That's what determines every part of their treatment. Like, "Why are we doing this exposure today?" "Because this is my North Star. I know where I'm heading. I know what the goal is." And then I have those clients who are like, "I need a North Star. I don't have one. I don't get the point." And I think that is where faith is so beautiful in recovery. When I witness my clients who are going to do the scary thing, they don't want to do it, but they're so committed to this North Star, whatever it might be. And maybe there's a better language than a North Star, again, whatever that is for that person. Like, "I'm walking towards the light of whatever that religion is." I feel, if I'm going to be honest, envious of that. And I totally get that some people do too. What would you say to a client who is longing for something like that? Maybe they have spiritual trauma in some respects or they've had bad experiences, or they're just unsure. What would you say to them? Justin: Yeah, that's really great. And first of all, I just want to really say that it takes a lot of vulnerability and strength to talk as you do. And one of the ways that I admire you, KQ, is through your ability to have these vulnerable conversations. So not just like the platform of expert, because at the end of the day, we're all just people and on a journey for sure. And so thanks for being honest with that. And I'm on a journey as well. And certainly, I realized jumping on podcasts, these things put us in the expert role and we speak at conferences and things like that. But I think that's a bit of the answer right there, is that being where we are to start with is so huge. And I mean, you're so good with the steps to take around acceptance and compassion. That's it. It's like fear presses towards a thousand different possibilities, and none of them come true exactly that way. And it can lead towards people missing a lot of personal growth stuff, spiritual growth stuff. And one of those things, I think, that we do is we sit with that. Clinically, I'm going to assess, ask a lot of questions, Socratic questions as a subset of the cognitive therapy side of doing that. Let me just come back to the simplicity. I think we get there. We sit in it for a second. And otherwise, we miss it. We're rushing to preconceived solutions or answers, but we're saying that we don't necessarily have an answer for that. So, what if we take some time to actually notice it and to be with that and to actually label it and be like, "I'm not sure. I'm yearning. I'm envious. I'm wanting something, but I don't know. So, put me in, coach." I'll sit with people. That's really the first thing. Kimberley: Yeah. What I have practiced, and I've encouraged clients is also being curious, like trying things out if that lines up with their values, going to a service, reading a book, listening to a podcast, and just trying it on. For me, it's also interesting with clients, is if they're yearning for it, try it on and observe what shows up. Is it that black-and-white thinking or perfectionism? Is it your obsessions getting involved? Is it that it just doesn't feel good in your body? And so forth. Again, just be where you are and take it slow, I think. I have a few other areas I want you to look at in terms of giving me your professional thoughts. If somebody wants to incorporate faith into their treatment, what can that look like? Can it look like praying together? What does that look like? Justin: You're asking all the good questions. Yeah, absolutely. And also, one other thing to reference, I know you're friends with Shala Nicely and Jeff Bell. And so they wrote a book. And for those that are on that, I would say, more "I'm seeking journey," it's When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty. And I love Shala and Jeff. They're so great, and they've been really pivotal people in my own life, not just as friends, but just as personal growth too. And so, that's an example specifically where Shala talks about the throes of her suffering. Is Fred in the Refrigerator? is her basically autobiography that goes into the clinical piece too, where at the end of the day, there was a bit of a pragmatic experience that she couldn't -- the universe being against her, she basically always had that view and she needed something that was different. And so she got there, I think. I hope I'm reflecting her sentence as well, but got there pragmatically. "The universe is friendly" is something that she said. Now, I just know that my Christian brothers and sisters, if they're listening to this, they're probably like, "What the heck is Justin talking about? The universe is friendly?" Because that's very, very different from the language that we've used, but it's just such a great example to me of just one step at a time, a person on the journey. They're looking at those things and assessing, okay, what is obsessive, what is compulsive, what is this thing that I can believe in and I ultimately do, but maybe I'm not. I don't want to or I'm not ready, or it doesn't make sense to me to make a jump into an organized religious plea for whatever else. And so, how does it look for clients? So in short, do I pray with clients? Yeah, absolutely. Do I open up the Bible? Yes, absolutely. Actually, it is a minority of sessions, which again, on my more conservative friends and family side of things are almost shocked and scratching their heads. Like, "You're a Christian, you do counseling, and you're not doing that." We're a bunch of weirdos. We're in that realm of the inter-Christian circle in a good sense. We believe so deeply that God loves us and God has interceded and does intercede, and interacts with our present, not just a historical event here and there, and we're left on our own, the deistic watchmaker, to use a philosophical reference there. That because we believe that so strongly, we're not going to take no for an answer in the sense of the deeper growth and deeper faith. So, sometimes that backfires though, especially getting into the superstitious, like, "Well, God's got to be in everything, and I'm not feeling it," as opposed to like, "Okay. Is it possible that I could just have a brain that gives me some pretty nasty thoughts sometimes and it doesn't necessarily reflect that I'm in a bad state, that I can be curious about what a person getting mangled by a car might look like mentally and then be terrified by that?" And then like, "Thanks, brain, for giving me the imagination. Glad I can think through accidents so I can maybe be a safer driver." Yeah, absolutely. But I will say that's one of those sticky points a lot of times for Christians because we believe that thoughts matter and beliefs matter. And so there can be this overinterpretation of everything is always something really big and serious about my status and my heart, and something that's really big and serious about spiritual things or demonic stuff, or fill in the blank. So, the faith integration piece, I do carefully, but I'm not scared of it. I've done it so often. It's through a lot of assessments. It has to be from the standpoint of the client's wanting that. Usually, the client is asking me specifically, like, "Hey, would you pray at the end of the session?" Sure, absolutely, in most cases. And this, such a deep topic. I'm fully aware that there are those in the camp that view faith integration as completely antithetical to what needs to happen in treatments. And they argue their case, they're going to argue it really strongly, but the same exists on the other side as well. And I try and work in that realm of, okay, what's good for the clients? And are there some things that I don't do? Yeah, but I'm not really asked to do them. I've had a number of Muslim clients throughout the year. I don't join in with Ramadan with clients in various practices or fasting with a client, for example. That's not my faith practice there. But can I walk with the client who is trying to differentiate between the lines of fasting and I had water at this point, and the sun was going down and I thought. And other people were having water, but I'm getting stuck on assessing, like, was it too early, and did I actually violate my commitment, my vow? Did I violate what I was supposed to be doing? I can absolutely work with that person, and I need to. I can't really work with OCD or anxiety disorders if I wanted to turn that person away at the door and be like, "Oh, well, I'm not Muslim, so I'm sorry." No, we're going to jump into it and be like, "Okay, so tell me about this thought and then this behavior that came up at this time, and you're noticing that that's a little different from your community, that other people are starting to drink water, eat food. And so, you mentioned that it was right at sunset, but what time was that?" "Well, actually, it was like 10:30 p.m. It's two hours dark." It's like, "But I think I saw a glow in the distance." And it's like, "Okay, now we're into a pretty classic OCD realm." And so the simplest way that I can say that faith integration can be done in therapy is carefully, respectfully, with good assessments. Kimberley: Do you have them consult with their spiritual leader if you're stuck on that? And does that involve you speaking with them, them speaking with them, all three of you? What have you done? Justin: Yeah, absolutely. So, there is a collaboration that goes in a number of different ways. Most of the time, people can speak with their clergy member or faith leader pretty directly, pretty separately, and that is going to work just fine. I would say in most cases, people don't need to, especially if I'm working with OCD. A lot of folks usually have a pretty good general sense of, "Okay, I know what my faith community is going to say about this is X, but I'm scared because it feels like it's on shaky ground, I'm obsessing," et cetera. So, the clarification with the clergy, for instance, or a leader is more from the standpoint of if there's not a defined value definition practice, and that does come up for sure. So, helping that person to even find who that might be, especially if they're not a part of that, and/or maybe a good article to read with some limits, like, okay, three articles max. Check out a more conservative view, a more liberal view, a more fill in the blank. And then my friend and colleague Alec Pollard up at St. Louis Behavioral Medicine Institute, he's been on scrupulosity panels with me. He uses this excellent form called the PISA, (Possibly Immoral or Sinful Act). And it's just a great several-question guide. That or any number of things can be taken to clergyperson, leader in Christian circles a lot of times, like a Bible study or community group. Maybe flesh those things out just a little bit, maybe once, maybe twice max. And so, back to how much others are integrated, yeah, it's a mix and match, anything, everything. For me, with direct conversations with clergy, it's actually because I'm pretty deep into this realm, I have pretty easy access to a lot of folks, so I don't really need to so much talk directly or get that person on a release. But a lot of people do, especially if they don't know that religious belief or faith traditions approach on certain topics. Kimberley: Yeah. It's so wonderful to talk about this with you. Justin: Thanks, Kimberley. Same here. Kimberley: Because I really do feel, I think post-COVID, there's more conversations with my clients about this. This could be totally just my clients, but I've noticed an increased longing, like you said, for that connection, the loneliness pandemic. Justin: Yeah, that's statistical. Kimberley: Such a need for connection, such a need for community, such a need for that, like what is your North Star? And it can be, even if we haven't really talked about depression, it can be a really big motivator when you're severely depressed, right? Justin: Absolutely. Kimberley: And this is where I'm very much like so curious and loving this conversation with my clients right now in terms of, where is it helpful? Where isn't it helpful? As you said, do you want to use this as a part of your practice here in treatment, in recovery? And what role does it play? I know I had mentioned to you, I'd even asked on Instagram and did a poll, and there were a lot of people saying, "It gave me a community. It immensely helps. It does keep me focused on the goal," especially if it's done intentionally without letting fear take over. Is there anything you wanted to add to this conversation before we finish up? Justin: Yeah, I guess two things. So, one is you talked about that, and we talked about a couple of those responses before we jumped on to recording. So, in summary, the responses were all across the board, like, "Ooh." Let me know if I'm summarizing this well, but, "I have to be really careful. That can be really compulsive or not so much. I don't like to do that. I don't think it's necessary." And then like, yeah, absolutely. This is really integral and really important. Is that a fair summary? Kimberley: Very much. Yep. Justin: Okay. And so, I'm building this talk, Katie O'Dunne and Rabbi Noah Tile, ERP As a Spiritual Practice. We're giving here at the Faith and OCD Conference in April, if this is out by then. And in my section that I have, I'm covering the best practices of treatments, specifically ERP (exposure and response prevention) for OCD, and clinically, but then also from a faith standpoint, what do we consider with that? And there's this three-prong separation that I'm making. I'm not claiming a hold on the market with this, but I'm just observing. There's one category of a person who comes into therapy, and it's like, yeah, face stuff, whatever. It doesn't matter, or even almost antagonistic against it. Maybe they've been burnt, maybe they've been traumatized or abused with faith. Yeah, I get it. So, that first camp is there. But then there's also a second camp that people like to add on spiritual practices. They might mix and match, or they might follow a specific system, belief system. And whether it gets into mindfulness or meditation practices or fasting or any number of things, they find that there's a lot of benefit, but it's maybe not at the heart of it. And then there's this third prong of folks that it is part and parcel of everything they do. And I work with all three. They come up in different ways. And sometimes people cycle between those different ones as well in treatments in the process. Kimberley: I'm glad you said that. Justin: Yeah. And so, I just thought that was interesting when you pulled folks that had come up. Really, the second thing, and maybe this is at least my ending points unless we have anything else, you had mentioned to the audience that graciously, we had some tech issues. You all, it wasn't Kimberley's tech issues. It was Justin's tech issues. I spilled coffee on my computer like a week or two prior. It zapped. It's almost like you'd see in a movie, except it wasn't sparking. And I'm like, "Oh my goodness." And it was in a client session. That was a whole funny story in of itself. And I'm like, "Oh my goodness." It wasted my nice computer that I use for live streaming and all of that. And so I'm using my little budget computer at home. It's like, "Oh, hopefully it works." And it just couldn't. It couldn't keep up with all the awesomeness that KQ's spitting out. And I shared with you, Kimberley, a little bit on the email, something deep really hit me after that. I felt a lot of shame when we tried back and forth for 30 minutes to do it, and my computer kept crashing, basically because it couldn't stand the bandwidth and whatever else was needed. And one might think it's just a technical thing, but I'd had some stuff happen earlier that week. I started to play in my church worship band, lead guitar, and there was something that I just wasn't able to break through, and I was just feeling ashamed of that. And it just really hit me. And one of my key domains that I am growing in is my own perfectionism, as a subset of my own anxiety, and perfectionism is all about shame. And I love performance, I love to perform well. I like to say, "Oh, it's seeking excellence, and it's seeking the best for other people's good." But deep down inside, perfectionism is this shame piece that anything shy of perfect is not good enough, and it just hit me. I felt like trash after that happened. I felt embarrassed. And you were so gracious, "It's okay, we'll reschedule." And so, I went for a walk, which I do. Clear my mind, get exercise. And I was just stuck on that. And one of the ways where my Christian walk really came in at that moment was, I started to do some cognitive restructuring. I started to -- for you all who don't know, it's looking at the bigger picture and being more realistic with negative thoughts. Like, "Ah, I can't believe this happened. I failed this," as opposed to like, "Okay, we're rescheduling. It's all right. It actually gave us more time to think about it." And I didn't know that then, but I could have said similar things. I was doing a bunch of clinical tools that are helpful, but frankly, it wasn't until I just tapped into the bigger purpose of, one, not controlling the universe. I don't keep this globe spinning. I barely keep my own life spinning. Two, God loves me. And three, it's okay. It's going to work that out. Four, maybe there's something bigger, deeper going on that I don't know. And I can't guarantee that it was for this reason. I'm not going to put that in God's mouth and say that, "Oh yeah, okay, well, He gave us a couple more weeks to prepare." I don't know. I really don't know. But it helped me to tap into like, "Okay, it's all right. It's really all right." And it took me about half a day, frankly. I'm slightly embarrassed to say, "No, I'm not embarrassed to say that as a clinician who works with this stuff. I have full days, I have full weeks. I have longer periods of time where I'm wrestling with this stuff." And yeah, areas have grown. I've improved in my life for sure, but I'm just a hot mess some days. Kimberley: But that's nice to hear too, because I think, again, clients have said it looks so nice to be loved by God all the time. That must be so nice. But it's not nice. I hate that you went through that. But I think people also need to know that people of faith also have to walk through really tough days and that it isn't the cure-all, that faith isn't the cure-all for struggles either. I think that's helpful for people to know. Justin: Yeah, that's right. So, thank you for letting me share a little bit of that. And yeah, the personalized example of why, at least for me, faith is important. If folks come into my office and they say, "Nah, no thanks," okay, I'm going to try lightly, carefully, or just avoid it altogether if that's what they want. But oftentimes it's really at the center of, okay, purpose, meaning, direction, guidance, and okay, you want to do that? I'll roll up my sleeves, and let's go. Kimberley: Yeah. See, I'm glad that it happened because you got to tell that beautiful story. And without that beautiful story, I would be less happy. So, thank you for sharing that and being so vulnerable. I think I shared with you in an email like I've had to get so good at letting people down that I get it. And I love that you have that statement, like God loves me. That is beautiful. That's like sun on your face right there. I love that you had that moment. Justin: Yeah, it comes up so much, so many times. In the Bible and even to -- like I wrote this article on Fear Not . So, the most common exhortation in all of the Christian Bible is fear not. So, one might think like, "Oh yeah, don't commit adultery," or "Don't kill, don't murder," or fill in the blank. Not even close. The most common exhortation in all of scriptures is actually fear not, and then love, various manifestations all throughout. I could go on, but I know we're out of time. Kimberley: Well, what I will say is tell people where they can hear about you and even access that if they're interested. I love to read that article. So, where will people hear about you and learn more about the work you do? Please tell us everything. Justin: Yeah, sure. And I'll include some stuff for your show notes that you can send to the things referenced. And then JustinKHughes (J-U-S-T-I-N-K-H-U-G-H-E-S) .com is my base of operations where the contact, my email practice information, my blog is on there. And you can subscribe to my newsletter totally free. Totally, totally free. And I do a bunch of eBooks as well on there that are free . JustinKHughes.com/GetUnstuck to join one of four of the newsletters. Other than that, that's where those announcements come out for different conferences. So, Faith and OCD, if this is out in time in April, but April every year, it's getting to be pretty big. We're getting hundreds of people attending. We're now in our fourth annual IOCDF (International OCD Foundation Conference), local conferences, various live streams. So, anyway, the website is that base, that hub, where you'll actually see any number of those different announcements. Thanks for asking. Kimberley: I'm going to make sure this is out before the conference. Can you tell people where they can go to hear about the conference? Justin: Yeah. So, IOCDF.org. And then I think it's /conferences, but you can also type into Google conferences and there's a series of all sorts of different conferences going on. And this is the one that's dedicated to OCD and faith concerns. And just when you think that it's just one specific belief system, then prepare to be surprised because we've done a lot of work to have a diverse group of folks, sharing and speaking and covering a lot of things, ranging from having faith-specific or non-faith nuns, support groups. So, there are literally support groups if you're an atheist and you have OCD, and that's actually an important part of where you are in your journey. But for Christians, for Muslims, for Jewish, et cetera, et cetera, we're trying to really have any number of backgrounds supported along with talks and in broad general things, but then we get more specific into, "Hey, here's for clinicians. Hey, here's for the tips on making for effective practices." Kimberley: Yeah, amazing. And I'll actually be speaking on self-compassion there as well. So, I'm honored to be there. Thank you for being here, Justin. This was so wonderful. Justin: Yeah, this really was. Thank you.

Mar 29, 2024

Now fix this one error in thinking if you want to be less anxious or depressed, either one. Today, we are going to talk about why it is so important to be able to identify and challenge this one error in your thinking. It might be the difference between you suffering hard or actually being able to navigate some sticky thoughts with a little more ease. Let's do it together. Welcome back, everybody. My name is Kimberley Quinlan. I'm an anxiety and OCD specialist, and I am so excited to talk with you about this very important cognitive error or error in thinking that you might be engaging in and that might be making your life a lot harder. This is something I catch in myself quite regularly, so I don't want you to feel like you're wrong or bad for doing this behavior, but I also catch it a lot in my patients and my students. So, let's talk about it. The one error you make is black-and-white thinking . This is a specific error in thinking, or we call it a cognitive distortion, where you think in absolutes. And I know, before you think, "Okay, I got the meat of the episode," stay with me because it is so important that you identify the areas in your life in which you do this. You mightn't even know you're doing it. Again, often we've been thinking this way for so long, we start to believe our thoughts. Now, one thing to know, and let's do a quick 101: we have thoughts all day. Everybody has them. We might have all types of thoughts, some helpful, some unhelpful. But if you have a thought that's unhelpful or untrue and you think it over and over and over and over again, you will start to believe it. It will become a belief. Just like if you have a lovely, helpful thought and you think that thought over and over and over again, you will start to believe that too. And what I want you to know is often, for those with mental health struggles, whether that be generalized anxiety, panic disorder, depression, eating disorders, OCD , PTSD, social anxiety, the list goes on and on, one thing a lot of these disorders have in common is they all have a pretty significant level of errors in thinking that fuel the disorder, make the disorder worse, prevent them from recovering. My hope today is to help you identify where you are thinking in black and white so we can get to it and apply some tools, and hopefully get you out of that behavior as soon as possible. Here are some examples of black-and-white thinking that you're probably engaging in in some area of your life. The first one is, things are all good or they're all bad. An example might be, "My body is bad." That there are good bodies and bad bodies. There are good people and bad people. There are good thoughts and bad thoughts. That's very true for those folks with OCD . There are good body sizes and bad body sizes, very common in BDD and eating disorders. There are people who are good at social interaction and bad at social interaction. That often shows up with people with social anxiety. That certain sensations might be good, and certain sensations might be bad. So if you have panic disorder and you have a tight chest or a racing heart rate, you might label them as all bad. And this labeling, while it might seem harmless, is training your brain to be on high alert, is training your brain to think of things as absolutes, which does again create either anxiety or a sense of hopelessness, helplessness, and worthlessness specifically related to depression. So we've got to keep an eye out for the all good and the all bad. The next one we want to keep an eye out for is always and never. "I always make this mistake. I never do things right. I will always suffer. I will never get better." These absolutes keep us stuck in this hole of dread. "It'll always be this way. You're always this way." And the thing to know here is very, very rarely is something always or never true. We can go on to talk about this here in a little bit, but I want you just to sit with that for a second. It's almost never true that almost never is the truth. How does that sound for a little bit of a tongue twister? Next thing is perfect versus failure. If you're someone who is aiming for that is either perfect or "I'm a failure," we are probably going to have a lot of anxiety and negative feelings about yourself. This idea that something is a failure. I have done episodes on failure before, and I'll talk about that here in a second. But the truth is, there is no such thing as failure; it's just a thought. And all of these are just thoughts. They're just thoughts that we have. And if we think that our thoughts are facts, we can often again get into a situation where we have really high anxiety or things feel really icky. Another absolute black-and-white thinking that we do is that this is either easy or it's impossible. There's only those two choices. It should be either really easy or it's not possible at all. Again, it's going to get us into some trouble when we go to face our fears because facing fears is hard. We've talked about, it's a beautiful day to do hard things. And the reason I say that is to really challenge this idea that things should be easy. And just because they're hard doesn't mean they're impossible. Often people will say, "I can't." Again, just because they're hard doesn't mean that you can't do it. It just might take some practice. So, these are common ways that black-and-white thinking shows up. And by now, if you're listening, you're probably thinking, "Oh yeah, I've been called out." And that's okay. We all do this type of thinking. But let's talk about now tools and what you can do to target this. Let me tell you a story. Recently, I found myself managing what I would consider a crisis, a family crisis. It took several months for us to navigate this very, very difficult time. And I often leave voice recordings to my best friend. We communicate that way quite regularly. And every now and then, I listen back to what I've said to her just to hear myself and what I'm saying and where my head is. And I was shocked to hear me saying, "It's always going to be this way. It'll never get better. This is so bad. I failed. This is impossible. I can't do this anymore." I was doing all of the things. And for me, that awareness is what clicked me into like, "Oh, no wonder I'm panicking. No wonder I feel dread the minute I wake up in the morning because my story about this is exacerbating and making this harder on me. It's creating more suffering." So the first thing I did is what I would tell my patients as well—to start with just a simple awareness training. Just being aware of when you do it. We don't have to change anything. We're not going to judge ourselves, but we're just going to write down on a sticky note or an app on your phone every time you get caught in a black-and-white thinking, and we're going to jot it down. "I always will feel this way. I will never get better. This will forever be a failure." We want to just jot it down. And that is, in and of itself, a huge part of the work—just being aware when you catch it. We're not here to come down hard on you for doing it. Sometimes it's just a matter of going, "Oh, okay, Kimberley, I see that I'm doing black-and-white thinking." And that might be all that we do. Often, with my patients, I will have them log this for homework because, in CBT, we do a lot of homework. And so I will say, "I want you to write it down and come back to me next week because next week, we're going to work on the next tool." Now this may be a little different depending on the condition, and I want to make sure I'm really thorough here. If you have GAD ( generalized anxiety disorder ) or panic, we do a lot of cognitive restructuring. We do a lot of cognitive restructuring about how you cope with your discomfort. And in some cases, we might even restructure the content of your thought. However, if you have OCD, it's a little tiny bit different. We would still correct your thoughts about your ability to tolerate discomfort or your thoughts about yourself. But we want to be careful because sometimes when we start looking too close at the thought and trying to make sense of it and trying to correct it too much, we can actually start to be doing a little nuanced, subtle compulsion where we're getting reassurance, we're confessing, we are reinforcing the whole importance of this by going over it and correcting it, correcting it and correcting it. So just keep an eye out for that. If you're in therapy, bring it up with your therapist just to make sure that you're not using this skill today in a way that could become compulsive. Sometimes it does, sometimes it doesn't, depends on the person. For eating disorders, I know as my recovery from eating disorder, I did a lot of this, really examining, is my body all good or all bad? Is there such a thing as a perfect body or a failed body? This food or this body size, how do we determine its goodness or its badness? And looking at how extreme it can be. Now, another really important piece here is with depression. In depression, we use a lot of black-and-white thinking. "I'm all that. They're all good. I'm a failure. I'll never get better. It'll never get better. Things will never look up. It'll always be this way." Depression loves to use black-and-white thinking. And so when we talk about cognitive restructuring, what we're not talking about is just making it all positive. So here are a couple of examples. If you have depression, and for those of you, if you have depression and you don't have access to a therapist, we have a whole online course called Overcoming Depression , where we go through this in depth of the common errors, not just black and white thinking, but the common errors in depression. And we work at coming up with helpful ways to respond. But one of the tools and skills that we use is, we don't want to just come up with positive thoughts. It's going to feel crappy to you. It's going to feel fake. It's not going to land. But what we want to do is find corrections or rebuttals to that thought that are more evidence-based, more rational, more logical, more helpful—things that might feel truer to you, even if it's still somewhat distorted. It's better than thinking in these absolutes because, like I said before, if you're thinking in absolutes, you can guarantee you're going to feel crummy. Another example is with GAD (generalized anxiety disorder) or with panic disorder. A lot of it is catching our appraisal of sensations and feelings in our body. Now, again, we actually have a whole course on this as well called Overcoming Anxiety and Panic. Again, we go through a whole module of cognitive restructuring where we identify the specific thoughts that people with generalized anxiety and panic have. And it will be looking for where you make these black-and-white, all-or-nothing statements that "It would be bad if that happened. I will always again feel this way. I'll never amount to anything. This panic attack will never end. I'm not handling it well. I'm handling it all bad," or that "This sensation is impossible, and I can't tolerate it." So we go through it and really look at what are the things that you're worrying about, and how are you really bringing in black and white thinking? There are other distortions. In fact, there are 10 other distortions which we're not covering today. Those are all in those courses as well. But again, for today, I wanted to really double down on this one. This one is particularly pesky and problematic. The other thing to remember as we're looking at black-and-white thinking is to remember that usually, 99.999 % of the time, things happen in the middle, in the gray. I often will hear me say to clients, "Can you be a little more gray about that?" Not to say a little more dark and depressive. I'm saying gray in that, "Is there somewhere in the middle that is more true and factual? Is it all good or all bad or is it a little of both? Or is it none of either? Where in the middle does it land? Oh, you're having the thought that you're either successful or a failure? Where is everybody else in this continuum?" Most likely, they're in the gray. Can you learn to be more comfortable accepting the gray of the world and not going to these absolute black-and-whites? The beauty is in the gray. We know this. The beauty is being kind to yourself in the gray, which brings me to the last point here, which is to practice self-compassion. We are in the gray. This podcast episode in and of itself is neither all bad nor all good. It's going to be a variation, and a lot of that's going to be dependent on people's opinion, where they are, what they're thinking, their mood, that things are really black and white. And can we be gentle with ourselves and humble enough to allow ourselves to see that this is neither good, bad, success, failure, always, never? These skills and the awareness of when we're thinking this way can reduce a significant amount of our suffering, especially when you catch them, label them, and redirect in a kind, compassionate way. One thing I don't want you to do is identify how you're thinking in this black-and-white way and respond to that with black-and-white thinking by saying, "You'll always think this way. You'll never ever stop doing this." Ironic, but we do it all the time. Almost always, when people criticize themselves, they're using one of the two areas in thinking black and white thinking and labeling, which is like name calling. And again, we want to identify these areas in thinking. Again, if you want to go back and take a look at those courses, we go through this immensely in depth because there's such an important part of Overcoming Anxiety and Panic and Overcoming Depression. And again, that's the names of the courses. You can head over and look into that in the show notes, or go to CBTSchool.com. We have all of our courses listed there. All right, folks, that's it. Please fix this error in thinking if you want to be less anxious. Black-and-white thinking will create so much suffering in your life. And my hope is that these episodes and the work we do here at Your Anxiety Toolkit make you suffer a little bit less each week. Have a great day, everyone, and I'll see you next week.

Mar 22, 2024

Obsessive-Compulsive Disorder (OCD) is a challenging condition, but the good news is that it's highly treatable. The key to effective management and recovery lies in understanding the condition, embracing the right treatment approaches, and adopting a supportive mindset. This article distills essential guidance and expert insights, aiming to empower those affected by OCD with knowledge and strategies for their treatment journey. YOU ARE BRAVE FOR STARTING OCD TREATMENT Taking the first step towards seeking help for OCD is a significant and brave decision. Acknowledging the courage it takes to confront one's fears and commit to treatment is crucial. Remember, showing up for therapy or seeking help is a commendable act of bravery. YOU CAN GET BETTER WITH OCD TREATMENT OCD treatment , particularly through methods like Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT), has shown considerable success. These evidence-based approaches are supported by extensive research, indicating significant potential for individuals to reclaim their lives from OCD's grasp. The path may not lead to a complete eradication of symptoms, but substantial improvement and regained control over one's life are highly achievable. OCD TREATMENT IS NOT TALK THERAPY OCD therapy extends beyond the realms of conventional talk therapy, involving specific exercises, homework, and practical worksheets designed to confront and manage OCD symptoms directly. These tools are integral to the treatment process, allowing individuals to actively engage with their treatment both within and outside therapy sessions. THERE IS NO SUCH THING AS "BAD" THOUGHTS A pivotal aspect of OCD treatment involves changing how individuals perceive their thoughts and their control over them. It's essential to recognize that thoughts, regardless of their nature, do not define a person. Attempting to control or suppress thoughts often exacerbates them, which is why therapy focuses on techniques that allow individuals to accept their thoughts without judgment and reduce their impact. YOU CAN NOT CONTROL YOUR THOUGHTS, BUT YOU CAN CONTROL YOUR BEHAVIORS You will have intrusive thoughts and feelings. This is a part of being human, and it is not in your control. However, you can learn to pivot and change your reactions to these intrusive thoughts, feelings, sensations, urges, and images. YOU HAVE MANY OCD TREATMENT OPTIONS While medication can be a valuable part of OCD treatment, particularly when combined with therapy, it's not mandatory. Decisions regarding medication should be made based on personal circumstances, preferences, and professional advice, acknowledging that progress is still possible without it. In addition to ERP and CBT, other therapies such as Acceptance and Commitment Therapy (ACT), mindfulness, and self-compassion practices have emerged as beneficial complements to OCD treatment. These approaches can offer additional strategies to cope with symptoms and improve overall well-being. The accessibility of OCD treatment has expanded significantly with the advent of online therapy and self-led courses. These digital resources provide valuable support, particularly for those unable to access traditional therapy, enabling individuals to engage with treatment tools and strategies remotely. For those without access to a therapist, self-led OCD courses and resources can offer guidance and structure. Engaging with these materials can empower individuals to take active steps towards managing their OCD, underscoring the importance of self-directed learning in the recovery process. TREATMENT WILL NEVER INVOLVE YOU DOING THINGS YOU DO NOT WANT TO DO I am usually very clear with my patients. Here are some key points I share I will never ask you to do something I do not want you to do I will never ask you to do something that I myself would not do I will never ask you to do something that goes against your values. RECOVERY IS NOT LINEAR Recovery from OCD is not a linear process; it involves ups and downs, successes and setbacks. Embracing discomfort and challenges as part of the journey is essential. Adopting a mindset that views discomfort as an opportunity for growth can greatly enhance one's resilience and progress in treatment. There will be good days and hard days. This is normal for OCD recovery. There will be days when you feel like you are making no progress, but you are. Keep going at it and be as gentle as you can SETTING CLEAR TREATMENT GOALS Clarifying treatment goals is crucial for a focused and effective therapy experience. Whether it's reducing compulsions, living according to one's values, or tackling specific fears, clear goals provide direction and motivation throughout the treatment process. BE HONEST WITH YOUR THERAPIST The success of OCD treatment is significantly influenced by the honesty and openness of the individual undergoing therapy. Without reservation, sharing one's thoughts, fears, and experiences allows for more tailored and effective therapeutic interventions. IT IS A BEAUTIFUL DAY TO DO HARD THINGS. No question. You can do hard things! OCD is a complex but treatable condition. By understanding the essentials of effective treatment, including the importance of evidence-based therapies, the role of mindset, and the value of self-directed learning, individuals can embark on a journey towards recovery with confidence. Remember, every step taken towards confronting OCD is a step towards reclaiming control over one's life and living according to one's values and aspirations. TRANSCRIPT There is so much bad advice out there about OCD treatment . So today, I wanted to share with you the 11 things I specifically tell my patients on their first day of OCD therapy. Hello, my name is Kimberley Quinlan . I'm an OCD specialist. I specialize in cognitive behavioral therapy, and I have helped hundreds of people with OCD over the course of the 10, 15 years I have been in practice. Now, whether you have an OCD therapist or not, my goal is to help you feel confident and feel prepared when addressing your OCD treatment and symptoms, whether you have an OCD therapist or not. That is the big goal here at CBTSchool.com and Your Anxiety Toolkit podcast. Make sure you stick around until the end because I will also be sharing specific things that you can remember if you don't have a therapist, because I know a lot of you don't. And I'll be sharing what you need to know so that you don't feel like you're doing it alone. Now, if you're watching this here on YouTube, or you follow me on social media at Your Anxiety Toolkit, let me know if there's anything I've missed or anything that you were told on your first session that was particularly helpful, because I'm sure your knowledge can help someone else or another person with OCD who is in need of support and care and advice. So let's go. Here are the 11 things that I tell my patients on their first day of OCD therapy. Number one, I congratulate them for showing up, because showing up for OCD treatment is probably one of the most brave things you can do. I really make sure I validate them that this is scary, and I'm really glad they're here. And I'm pretty impressed with the fact that they showed up, even though it's scary. The second thing I tell them is that OCD treatment is successful. You can come a long way and make massive changes in your life by going through the steps of OCD treatment, showing up, being willing to take a look at what's going on in your life, and making appropriate changes so that you can get your life back, do things you want to do, spend more time with your family, your friends, the things you love to do, like hobbies, and that OCD treatment can be very effective. We're very lucky that OCD is a very treatable condition. It doesn't mean it'll go away completely, but you can have absolute success in getting your life back. Now, one thing to know here is, how do we know this? Well, OCD treatment research and OCD treatment articles. If you go onto Google Scholar, you will find a lot of articles that show a meta-analysis of the OCD treatments available, where it shows that ERP and cognitive behavioral therapy are the gold standard of treatment. And using a meta-analysis, that basically means that they've surveyed all of the large, well-done research articles and found which one shows the most results and shows that they have the most repeated results over periods of time. And that's why it is so important that you do follow the research because there is a lot of bad information out there, absolutely. Now, the third thing I tell my patients on their first day of therapy is that OCD treatment is not talk therapy. It's not just talking, that it requires OCD therapy exercises and homework and lots of worksheets. I have a packet that we give our patients at the center that I own in Calabasas, California. Everyone gets a welcome manual. And in the welcome manual, it's got worksheets on identifying obsessions and compulsions. It's got mindfulness worksheets. It's got logging worksheets. And I will send you home with those to do for homework. You'll come back. Let me know what worked, what didn't work, what was helpful, what wasn't. And you will be doing a lot of this work on your own. Now, again, as I mentioned at the beginning, if you do not have access to OCD therapy or you don't have the resources to get that, we have an online course called ERP School. It is a course specifically for people with OCD, where I walk you through the specific steps that I take my patients through. And all of those worksheets are there. They have worksheets on identifying your obsessions, identifying your compulsions, mindfulness, self-compassion worksheets, things that can remind you and prompt you in the direction of setting up a plan so that you can get moving and make the steps on your own. The fourth thing that you need to know on the first day of your therapy is that there is no such thing as bad thoughts. Let's just sit with that for a second. There is no such thing as bad thoughts. Your thoughts do not define you, nor do your behaviors, that you might have these thoughts that you think are going to really freak you out. You might have this idea, these thoughts, these intrusive, repetitive, scary thoughts, and you might think, "Well, I can't even tell Kimberley about them yet." I will often tell my patients like there is nothing these walls haven't heard, and you probably won't shock me because I haven't been shocked in many, many, many years working as an OCD therapist. I've heard it all. I've heard the most, what people perceive as the grossest thoughts. It's a normal part of the work that we do. And your thoughts are neither good nor bad and they do not define you. And I really make that point made because, as we move forward, I want you to know that I've seen a lot of cases and that "your thoughts aren't special" in that they're not something that I would be alarmed by. The fifth thing that I would tell my patients is that you cannot control your thoughts. And I bet you believe it because you've probably tried over and over again, and all you found is the more you try and control it, the more thoughts you have. The more you try to suppress your thoughts, the more thoughts you have. There are, as we've already discussed, OCD treatment options that will really solidify this concept. Now, the most important one is exposure and response prevention, which is the type of treatment that we use for OCD and is the type of treatment that all of those research articles I discussed before show and direct to as a really successful treatment for OCD. Now, in addition, there are other OCD treatment options. One of those treatment options is OCD treatment with medication. Now, again, when you do that meta-analysis, we have found that a combination of CBT and ERP with medication is the most successful. Now, that doesn't mean you have to take medication, though. I'm never going to tell my patients that they have to take medication. So we can have OCD treatment with medication. We can have OCD treatment without medication. In fact, some of my most difficult cases, the clients, for medical reasons or for personal values reasons, chose not to go on medication. You can still get better. It might make it a little more difficult. You may want to speak with your therapist, or if you're doing this alone, you might need to put in a little extra homework, have a team of support, and people who are really there holding you accountable. Absolutely. But medication is another treatment option that you may want to consider as you move through this process. Now there are also new treatments for OCD recovery. They might include acceptance and commitment therapy, mindfulness practices, self-compassion. We even have some research around dialectical behavioral therapy as other OCD treatment interventions. I will be implementing those as we go, depending on what roadblocks show up. And again, if you're doing this on your own, there are amazing resources that can also help you, and I'll share about those here in a bit. Again, as we've talked about, there is also OCD treatment online. Since COVID-19, we've done a lot of growing in terms of being able to utilize CBT via the internet, via our computers, via our smartphones. A lot of people come to us because they've looked for OCD treatment in Los Angeles, which is where we are. And even though they only live a few miles down the street, they're still doing sessions online because it's so convenient. They can do it at home between sessions with their work or between getting their kids to school. So, OCD treatment online has become a very popular way to also access treatment. And I give these to my clients as we go, because sometimes they're going to need a little extra help. Now, as I've mentioned to you earlier in there, if you don't have access to OCD treatment, there are tons of self-led OCD courses. Again, one of the ones that we offer is ERP School. Now you can go to CBTSchool.com, or you can click the link below in the show notes, where we have all of these courses for OCD and other anxiety disorders. But there are others as well—other amazing therapists who have created similar products. When we're really looking at treatment depending on your age, the treatment does look very similar for OCD treatment for adults and OCD treatment for children. They are very, very similar. With children, we might play more games, have more rewards, use those strategies, but to be honest with you, adults are just big kids in adult bodies. So I really believe that we want to make this as fun as we can. Have rewards. Have there be something that you're working towards. Make it fun. Make it a part of a game. I use a lot of games in treatment and a lot of ERP games because why do we want to make everything boring all the time? Why not make it a little bit fun if we can? Number seven, the main thing I'm going to tell you here, and this is really, really important, is I will not ask you to do something that you don't want to do. I have this in our welcome manual. We don't ask people to do things that go against their values, and we don't ask people to do things that I myself would not do. There are a lot of TV shows that sort of use ERP and exposure work as sort of like doing your worst, worst, worst, worst, worst case. And that's fine. But often we're not doing that. We're doing exposures, we're facing your fears so that you can get back to functioning, so you can get back to doing the things you want to do. So again, I'm not going to have you do anything you don't want to do. You're in charge. If you're taking ERP School, we do the same thing. You create your own plan. You create a hierarchy of what you want to start with, and we work our way up. And we do the same thing in therapy as well. Now the eighth thing that I will tell you, and by then you're probably getting a little tired and overwhelmed. We might take a little tea break really quick, but I would tell you that recovery is not linear. While we do have effective treatment for OCD, it will be an up-and-down process. You'll have really good days, and you'll have some hard days. And those hard days don't mean that you're doing anything wrong. It doesn't mean that your treatment's not successful. It just means we have to take a look here and see what's going well, what's not going well, what do we need to tweak, do we need to make a pivot here. Or do we need to reassess something and maybe apply some additional tools—mindfulness tools again, self-compassion skills, some distress tolerance skills, maybe? But just remember, your recovery will not be linear, and that is okay. Now the ninth thing I'm going to tell you is that your OCD treatment goals must be clear. You are going to get really clear on why you're here, what you want to do, why you're doing this treatment because it is hard work. Again, there's homework. I'm going to be giving you some things to do at home, and they're going to be a little bit difficult. They're going to cause you to feel some feelings that maybe you don't want to feel, some sensations you don't want to feel. And so, really again, I will ask them, like, what are your goals for treatment? Now, some common OCD goals for OCD therapy is to reduce compulsions. "I want to be able to not be doing these compulsions for hours and hours." Other people say, "I want to live my life according to my values. I don't want to let fear constantly be telling me what to do." Other people will say, "I want to learn how to tolerate this discomfort and this uncertainty because every time I try and run away from it, it just gets worse. It makes it worse. And now I'm stuck in this cycle." So it's important that you get really clear. Sometimes people will come in and they'll say, "I've never been to Paris. I want to be able to go to Paris with my family. And so, that's the goal." That's fine too. You could have a large goal like that, or you could have a really simple goal like, "I just want to have more space in my life to paint," or "I don't want to feel like I'm on edge all the time, like the scariest thing is going to happen all the time." And that's fine too. Now, the 10th thing that you're going to need to know and need to remember is, our recovery is really dependent on how open and honest you are. As I said at the beginning, some people don't feel yet like they can trust to tell me the depth of their intrusive thoughts, and that's okay. But throughout therapy, I'm going to need you to be really honest with me and really honest with yourself, because if you're not disclosing what's going on and the thoughts you're having, we can't actually apply the skills to it. And then it puts a wrench in the success of your treatment. So we want you to be as open, honest as you can. And I often will say to them, there is nothing I haven't heard. In fact, if you have taken ERP School already—a lot of you have—we actually play a couple of games where we play a game called One Up, which is where no matter what thought you have, you make it a little worse or little more scary. And I give some demonstrations and show like I'm not afraid to go there. I will go to the scary, yucky place just to show you that that's what I want you to do as well. Again, it doesn't have to be all serious. We're allowed to play games, and we do that in therapy as well. Often people will ask like, how do I tell my therapist about these horrible thoughts I'm having? Like, how do I share? If you're having a specific type of thought that you feel is particularly taboo or very scary to share, or you're afraid of the consequences of sharing, what I would encourage you to do is do a very quick Google search. There are some amazing websites and articles online of your obsession. Print it out and bring it to your therapist, and say, "Hey, this is what I'm dealing with. I'm too scared or I'm too vulnerable to share. It's so horrendous in my mind, but this is what I'm going through." And chances are, again, the therapist, if they're a trained OCD specialist, will go, "Ah, thank you for letting me know. I've treated that before. I'm good to go." Again, if they're a newer therapist, it's still okay because they're getting the education about really common obsessions that happen a lot in our practice. Okay. Here we go—drum roll to the last one. And I know you guys are probably already guessing what it is. It's something I say to my patients and to you guys all the time, and it's this: It's a beautiful day to do hard things. We have been taught that life should be easy, shouldn't be scary, shouldn't be hard, and that you should be Instagram-ready all the time. But the truth is, life is hard. And today is a beautiful day to do those hard things. I have found that those who recover the fastest and the most successful over time are the ones who see discomfort as a challenge, something that they're willing to have. They'll say, "Bring it on, let's go. Bring my shoulders back. I know it's going to be here." And they're really gentle with themselves when they have this discomfort. And I want you to really walk away feeling empowered that you too can handle some pretty uncomfortable things because you already are. So again, it's a beautiful day to do hard things. All right, let's round it out because I know I promised you some extra things here. Now, what have we covered? We've covered the mindset shifts that you need for OCD therapy, behavioral changes that you're going to need to make. We've talked about complementary tools, the most important being self-compassion. And also, guys, you can also follow Your Anxiety Toolkit because we have over 380 episodes of tools and core concepts, and everything like that. Now, for treatment, just so that you get an idea of what this would look like, I share with my patients what treatment looks like. So usually, once I've told them all of this, I send them home with their welcome manual, and I'll say, "The next two to three sessions, I'm going to be training you for this treatment. And a lot of that is going to involve psychoeducation, me giving you tools, giving you strategies, putting a plan together." And again, for those of you who don't have therapy, we do exactly that in ERP School. So if you feel like you need some structure, you can go to CBTSchool.com and access ERP School. We can go through that. Now, for those of you, again, who don't have an OCD therapist, does OCD therapy and treatment work for you too? Yes. We actually have some early research to show that self-led programs can be very successful for people with OCD and with other anxiety disorders. So, if you don't have access to therapy, you could take ERP School. You could buy some workbooks that you buy from Amazon or your local bookstore. There are a ton of workbooks out there. Shameless plug, I also wrote one called The Self-Compassion Workbook for OCD . You can get it wherever you buy books. There are also online groups. I'm a huge, huge proponent of online groups. So if there are support groups in your area, by all means, use those because just knowing other people who are struggling, what you're struggling with can be so validating and inspiring because you're seeing them do the hard thing as well. But either way, treatment requires a lot of homework. So, as I say to patients, showing up here once a week isn't going to get you better. You're going to have to practice the skills. And if you don't have a therapist, you're going to be doing that anyway. So I want to really hope that you leave here with a sense of inspiration and hope that you can get better even if you don't have OCD therapy at this time. So there you go, guys. There are the 11 things I tell my patients on the very first session. I will usually end the session by encouraging them and, again, congratulating them for coming in and doing this work with me. Let them know I'm so excited for them. I hope that this was helpful for you, and my hope is that you too will then go on to learn all the tools that you need in your tool belt and go on to live the life that you want to live because that's the whole mission here at Your Anxiety Toolkit. Have a wonderful day, everybody, and I'll talk to you next week.

Mar 15, 2024

In the realm of managing anxiety and panic attacks , we often find ourselves inundated with advice on what to do . However, the path to understanding and controlling these overwhelming experiences also involves recognizing what not to do. Today, we shed light on this aspect, offering invaluable insights for those grappling with panic attacks. Stop doing these things if you are having panic attacks, and do not forget to be kind to yourself every step of the way. 1. DON'T TREAT PANIC ATTACKS AS DANGER It's a common reaction to perceive the intense symptoms of a panic attack —rapid heartbeat, dizziness, or a surge of fear—as signals of immediate danger. However, it's crucial to remind ourselves that while these sensations are incredibly uncomfortable, they are not inherently dangerous. Viewing them as mere sensations or thoughts rather than threats can create a helpful distance, allowing for more effective response strategies. 2. DON'T FLEE THE SCENE The urge to escape a situation where you're experiencing a panic attack is strong. Whether you're in a grocery store, on an airplane, or in a social setting, the instinct to run away can be overwhelming. However, leaving can reinforce the idea that relief only comes from escaping, which isn't a helpful long-term strategy. Staying put, albeit challenging, helps break this association and builds resilience. 3. DON'T ACCELERATE YOUR ACTIONS During a panic attack, there might be a tendency to speed up your actions or become hyper-vigilant in an attempt to alleviate the discomfort quickly. This response, however, can signal to your brain that there is a danger, perpetuating the cycle of panic. Slowing down your breath and movements can alter your brain's interpretation of the situation, helping to calm the storm of panic. 4. AVOID RELIANCE ON SUBSTANCES Turning to alcohol or recreational drugs as a quick fix to dampen the intensity of a panic attack can be tempting. Nonetheless, this can lead to a dependency that ultimately exacerbates the problem. It's important to let panic's intensity ebb and flow naturally, without leaning on substances that offer only a temporary and potentially harmful reprieve. 5. STOP BEATING YOURSELF UP Self-criticism and judgment can add fuel to the fire of anxiety and panic. It's vital to adopt a compassionate stance towards yourself, recognizing that experiencing panic attacks doesn't reflect personal failure or weakness. Embracing self-kindness can significantly mitigate the added stress of self-judgment, creating a more supportive environment for recovery. SEEKING SUPPORT Remember, you're not alone in this struggle. Whether through therapy, online courses, or community support, reaching out for help is a sign of strength. Resources like "Your Anxiety Toolkit" are there to remind you that it's possible to lead a fulfilling life, despite the challenges panic attacks may present. Lastly, embrace the notion that it's a beautiful day to do hard things. Facing panic with acceptance rather than resistance diminishes its hold over you, opening the door to healing and growth. TRANSCRIPT: Stop doing these things if you have panic attacks . I often, here on Your Anxiety Toolkit, talk about all the things you need to do—you need to do more of, you need to practice skills that you can get better at. But today, we're talking about the things you shouldn't do if you are someone who experiences panic attacks, panic disorder, or any other disorder that you also experience panic attacks in. Let's get to it. Let's talk about the things not to deal. Welcome back. Stop doing these things if you have panic attacks. When I say that, in no way do I mean that the things we're going to discuss you should beat yourself up for. If you're doing any of the things that we talk about today, please be gentle. It is a normal human reaction to do these things. I don't want you to beat yourself up. Please feel absolutely zero judgment from me because even I am someone who needs to keep an eye out for this, keep myself on check with these things when I am experiencing panic attacks as well. Let's go through them. The number one thing to stop doing if you're having a panic attack is to stop treating them like they are dangerous . If you experience symptoms of panic or you experience panic disorder, you know that feeling. You feel like you're going to die. You feel like your heart is going to explode or implode, or your brain will explode or implode. You'll know that feeling of adrenaline and cortisol rushing around your body. You get it; I get it. It feels so scary. But we must remind ourselves that it's not dangerous, and we can't treat them like they're dangerous. We can't respond to these symptoms as if they're dangerous. We want to instead treat them like they are, which is sensations in the body or thoughts that appear in your brain. Once we can do that, then we have a little bit of distance from them and we can respond effectively. Now, the second thing I want you to stop doing if you have panic attacks is to never leave. If you are at the grocery store and you're having a panic attack, do not leave the grocery store. If you're on an airplane, boarding an airplane, and you're having a panic attack, do not leave the airplane. If you're in a room and you're experiencing panic, don't leave. Now, I know in that moment, it can feel so dangerous, as we just discussed, and so scary, but when we leave, we will associate relief with running away, and we actually don't want that. Instead, with panic, we want the relief to be that we wrote it out and we were able to tolerate that feeling and navigate that feeling effectively and compassionately and not from the place of running away and escaping. If you can do one thing, the most important thing to do is to not leave where you're at. Now, does that mean that you can't take a minute to step away for a second? That's fine. Does it mean that you can't, if you're in a conversation, just say, "Can I have a few minutes? I just need to run to the restroom," or whatever it be, take some time to get yourself back together? That's okay. We're not here to win any races or anything, but do your best not to leave the actual environment or place that you are having the panic attack. Now, the third thing you can not do if you're having a panic attack is don't speed up your actions. We talk a lot about this in our online course called Overcoming Anxiety and Panic. How you respond to a panic attack can really determine how your brain interprets the event. If you're having a panic attack and you really speed up and you start to act frantic or in an urgent way, and you're sort of like hypervigilant looking around or trying to urgently frantically change something, your brain will interpret that high-paced activity or that speeding up of your actions as if it is a danger, and it will keep sending out hormones like cortisol and adrenaline, which will keep the panic attack and the anxiety going. What we want to do instead is slow it down, slow your breath down, slow your actions down, really get in tune. If you can just slow it down a little and change how you respond. And what we want to do here—and we do this in Overcoming Anxiety and Panic, if you're interested in taking this course and you don't have access to therapy or you're wanting a step-by-step way of working through generalized anxiety and panic, go ahead and take a look. It's at CBTSchool.com. You can go and check it out there, but if not, you can also do this with your clinician or by yourself—is do an inventory of how you respond when you are panicking. What safety behaviors do you engage in to try and get it to go away? What do you do to respond to it as if it is dangerous? Do you leave? Do you speed up? Do you become hypervigilant? Do you seek reassurance? Do you do mental compulsions? We can go through and do an audit of those behaviors and see what you're doing to sort of control and manage that anxiety. And we want to really work hard at reducing those behaviors. Do an inventory and get very clear so that next time you are having a panic attack, you can instead change those behaviors or replace them with more effective behaviors. If you're interested again in that course, you can go to CBTSchool.com/overcominganxiety. Now, the fourth thing you need to stop doing if you have panic is to not rely on substances. And when I say substances, I mean alcohol or recreational drugs. There is a massive overlap between people with panic attacks and panic disorder and substance use, and I get it. Having a quick drink of alcohol can sometimes take the edge off a panic attack. However, once again, if that is your way of coping, you will build a reliance and a dependence on that behavior. And we want to work instead at allowing that discomfort to rise and fall on its own without intervening with ineffective behavior. And recreational substances are a really big no-no if you're someone who is experiencing a panic attack. Now, that is different from prescribed medications. If you have been prescribed a psychiatric medication and you're following the doctor's orders, that is a different story. And please do go and speak to your doctor about those specific directions. What I'm speaking about right here is substances like recreational drugs or alcohol to help manage that panic attack. Now, the last thing you need to stop doing if you have panic disorder or panic attacks is you have to stop beating yourself up. Beating yourself up will only make it worse. In fact, we have research to show that the more you criticize yourself, beat yourself up, judge yourself, the more likely you are for your brain to release more anxiety hormones and increase the experience of anxiety and panic. And so, that goes against everything that we want and need. We don't need to add more anxiety to the mix if you're already experiencing a panic attack. And so, what we want to do here is work at not beating yourself up, not criticizing yourself for having this because it's not your fault. It doesn't mean there's anything wrong with you. It's a normal human reaction to want to run away and do everything you can to make it go away, including drinking substances and doing recreational drugs. We don't want to beat ourselves up, whether you've done those in the past or if you're currently doing them. If you're struggling, reach out for help. There are clinicians around the world who can help. We have, again, online courses, if you haven't got access or you can't afford those services. There are books, there are podcasts like this one that are free. Do what you can to get support and get help so that you're not doing this alone. You aren't alone. Thousands and millions of people around the world struggle with panic attacks. Again, they do not mean that there's anything wrong with you. And there are important, very effective skills you can use to manage them, and go on and live a very, very, very, very wonderful, successful, fulfilling life. Of course, I'm always going to end with this because I always do, but do also remind yourself it is a beautiful day to do hard things. The more you can willingly have panic and allow it to rise and fall on its own, the less power it has over you. So, do remember today is a beautiful day to do hard things. Thank you so much for being here with me. I look forward to seeing you next week on Your Anxiety Toolkit, and I'll see you there.

Mar 8, 2024

Anxiety can often feel like a relentless storm, clouding your thoughts and overwhelming your sense of calm. It's during these turbulent times that finding the right words can be akin to discovering a lifeline amidst the chaos. To aid you in navigating these stormy waters, we've curated a list of 20 empowering phrases based on expert advice. These phrases are designed to validate your feelings, soothe your inner critic, fill you with encouragement, and help you respond proactively to anxiety. Here's how you can incorporate them into your life to foster resilience, kindness, and self-compassion. VALIDATE THE DIFFICULTY "This is hard, and it's okay that it's hard for me." Acknowledge the challenge without judgment. "I'm doing the best I can in this moment." Remind yourself of your effort and resilience. "My feelings are valid and understandable." Affirm the legitimacy of your emotions. "I am human, and having a difficult day is okay." Normalize the ups and downs of human experience. "I give myself permission to feel this while being kind to myself." Embrace your feelings with compassion. SOOTHE THE CRITICAL VOICE "This is not my fault." Release unwarranted guilt and blame. "It's okay that I'm not perfect." Celebrate your humanity and imperfections. "It's okay to make mistakes." View errors as opportunities for growth. "My challenges do not define my worth." Separate your worth from your struggles. "May I be gentle with myself as I navigate this difficult season?" Practice self-compassion and kindness. FILL YOURSELF WITH ENCOURAGEMENT "It's a beautiful day to do hard things." Empower yourself to face challenges. "I can tolerate this discomfort." Recognize your strength and resilience. "This anxiety or discomfort will not hurt me." Acknowledge your capacity to withstand anxiety. "Humans are innately resilient." Remind yourself of your inherent ability to overcome adversity. "I am more than my worst days." Focus on the breadth of your life's narrative. GET CLEAR ON YOUR RESPONSE TO ANXIETY "I REFUSE to lead a life based on fear." Commit to acting on your values. "I choose to speak to myself with understanding and patience." Cultivate a compassionate inner dialogue. "I have already chosen how I'm going to respond, and now I'm going to honor that decision." Preemptively decide on positive actions. "I will treat myself with the same kindness that I offer others." Extend your empathy inward. "I'm going to honor my journey and respect my own pace." Accept your unique path and timing. BONUS PHRASE FOR CONTINUOUS SUPPORT "We are just going to take one step at a time." Focus on the present moment to manage overwhelm. These phrases, thoughtfully designed to address different facets of anxiety, are tools at your disposal. Use them to navigate through moments of anxiety, to remind yourself of your strength, and to cultivate a kinder relationship with yourself. Remember, it's not about employing all of them at once but finding the ones that resonate most with you. Anxiety is a complex and deeply personal experience, and thus, your approach to managing it should be equally personalized. Let these phrases be your guide as you continue on your journey toward a more peaceful and empowered state of being. TRANSCRIPTION: Here are 20 phrases to use when you are anxious. Now I get it, when you're anxious, sometimes it's so hard to concentrate. It's so hard to know where you're going, what you want to do, and it's so easy just to focus on anxiety and get totally stuck in the tunnel vision of anxiety or feel completely overwhelmed by it. Today, I want to offer you 20 phrases that you can use when you're feeling anxious or experiencing OCD . These are yours to try on and see if you like them. You don't have to use all of them. They're here for you to use as you wish, and hopefully, they're incredibly helpful. All right, my loves, let's talk about the 20 phrases you can use when you're feeling anxious. Now, I have prepared these in four different steps. You can actually go through and pick one or several of these and go through these, write them down, and have them in your pocket or in your wallet, or whatever you want, a sticky note on your fridge to use as you need. These are to help guide you towards a life where you lean into your fear. You treat yourself kindly. You encourage yourself. You champion the direction you want to go in. And my hope is that you can use these in many different scenarios, and they can help you get to the life that you want. Let's go and do it. The first category is validate the difficulty. Most people, when they're anxious, they get caught up in this wrestle of, "I shouldn't have this. Why do I have it? It's not fair," and I totally get it. But what we want to do is first validate the difficulty. If you can say that, and you can do that by using one of these five phrases: Number one, "This is hard, and it's okay that it's hard for me." Again, let's say it together. "This is hard, and it's okay that it's hard for me." The second phrase that I'm going to offer to you is, "I'm doing the best I can in this moment." The truth is, you are doing the best you can with what you have and given the circumstances. I want you to remember that as best as you can as well. Number three, "My feelings are valid and understandable." If anybody else was in this exact situation, they'd probably be thinking, feeling, and acting in the same way. The fourth one is, "I am human, and having a difficult day is okay." Not only is it okay, it's normal. Humans have difficult days. This is a total normal part about being human. You might be having an immense amount of anxiety, but please do remember the millions of other human beings around the globe who are having a very similar experience to you. It doesn't mean there's anything wrong with you. And then the fifth way I want you to validate the difficulty is to say, "I give myself permission to feel this while being kind to myself." Remember I said "while." I give myself permission to feel this way while being still kind to myself. Let's move on to the second category, which is soothing the critical voice. I know when we have anxiety, we can be really, really hard on ourselves. The phrase I want you to practice or trial is, number one, "This is not my fault." And it's not your fault. You did not ask for this. You can't stop the fact that your brain sometimes gets hijacked and throws a bunch of anxiety or thoughts, or feelings towards your urges. It is not your fault. The second one is, "It's okay that I'm not perfect." Nobody is. We want to remember that this is our first time being a human and we're not going to get it right the first time. It's okay that you're not perfect, nobody is. You might also want to try the phrase, "It's okay to make mistakes." That is how I learn and grow. Remember here of all the people who have succeeded in their recovery, or all the people who are succeeding in other areas of their life, they didn't get there because of easy, breezy times. They got there by making mistakes, and they'd keep going and they keep trying, and they'd go again and they go again and they learn and they grow. The next thing you may want to try on, and another phrase you can use is, "My challenges do not define my worth." You're not either better or worse for having this anxiety. You're not less than or more than depending on whether you have a mental illness or not. Your worth is not something that's up for discussion, and it's not up for measurement. We all have equal worth. And this challenge that you're experiencing or this anxiety you're experiencing does not define your worth. Now, the last one I want you to practice here, you can actually practice more from a meditation or a meditation practice, which is a practice of loving kindness. We could call it a metta meditation or a loving-kindness meditation. And the goal from this is to actually meditate on sending yourself loving kindness. Now, if you're someone who wants to learn how to do this, we have an entire meditation vault called the Meditation Vault, where I have created over 30 different meditations for people, specifically with anxiety, to help you practice meditation and learn how to practice loving kindness. You can go to CBTSchool.com to learn more about that. I would, again, need to spend a whole other episode talking to you about that. But if you want to practice the art of sending yourself loving kindness, you can go there to learn more. But for right now, to finish out this category, what we want to do is practice one of those meditations, which is to offer yourself the phrase, "May I be gentle with myself as I navigate this difficult season?" What we are doing here is we're offering ourselves a promise per se of saying, "May I be gentle with myself?" In a true loving-kindness meditation, often what we do say is, "May I be happy? May I be well? May I live with ease?" And if you particularly like my voice and it feels very soothing to you, all of those meditations are there in the meditation vaul, and we go through that extensively. The next section is to fill yourself up with encouragement. Now, when we are anxious, it's easy to feel very discouraged and just want to run away and change every part of our plans for the day. But what we want to do is we want to fill yourself up with encouragement. Here are some phrases that you can use to help with that goal. Number one, you know I'm always going to say this, "It's a beautiful day to do hard things." We can do hard things. We have to keep repeating this to ourselves. You may even want to add some sass to it and add a little swear word. A lot of my patients have said, "It's a beautiful day to blank hard things." Now that's okay too. You can sass it up, whatever feels most empowering to you. Another way you can fill yourself up with encouragement is to offer yourself the phrase, "I can tolerate this discomfort," because you can, and you have, and you will. "I can tolerate this discomfort." Another thing you can offer is, "This anxiety or this discomfort will not hurt me. I am stronger than I could ever know." And the truth is, anxiety does not hurt you. It's uncomfortable, and it's painful. I understand that. But it won't hurt you. It won't damage you. It won't destroy you, that we're stronger than we could ever, ever believe we could be. The next thing you may offer to yourself, and this is one that I particularly love, is that humans are innately resilient. They do most of their growing through hard things. And I've already mentioned this to you before. Most of the really successful people got there, not because it was easy and breezy; it's because we are resilient, and that's how we grow, and that's how we learn, that we can get through very, very difficult things. And then the last thing is, "I am more than my worst days." That this might be a difficult day, but I am more than this difficult day. There's a bigger story here for me. This uncomfortable moment or this uncomfortable day is just a part of that story. But the bigger picture is that I am much more than these hard, difficult days. And then the last category, which you have to also include, is to get very clear on how you are going to respond. This is where we get a little more firm with ourselves in the phrases. You will hear, I get a little sassy myself in this, and we get a little more decisive or confident. Even if you don't feel confident, we want to speak in this confident, assured way. Number one is, "I REFUSE," and I've written refuse in capital letters. "I REFUSE." And I say this to myself, I want you to say this to yourself. "I REFUSE to lead a life based on fear." I will move forward, acting on my values and my beliefs, and who I want to be. That's the first phrase. And we want to emphasize, "I refuse to act out on this fear." The second is, "I choose to speak to myself with understanding and patience." I'm choosing that because it's so easy to fall back into criticism and blame and humiliation and critical self-punishing words. I choose to speak to myself with understanding and patience. Now, the third one involves you being very proactive. Now, I'll give you the phrase first, and then I'll explain it to you. The phrase is, "I have already chosen how I'm going to respond, and now I'm going to honor that decision." What I want you to do, if you are someone with anxiety, is to create a plan ahead of time—to have a plan on how you are going to respond to anxiety. Now, if this is difficult for you, we have two courses that I want you to rely on. Number one is Overcoming Anxiety and Panic, and the other one is ERP School. And that's for people with OCD and health anxiety. If you're someone who struggles with generalized anxiety or panic or OCD, you are going to need a plan ahead practice. You're going to need to know what fear and obsessions and thoughts and fear and all the things get you to do normally. And then you're going to have to be able to break that cycle with a specific plan on attack on how you're going to handle that. And we go through those steps in those two courses or any of our courses. We break it down so that you have a specific plan on how you're going to handle this, what you're going to do, what you're not going to do, how you're going to treat yourself, and so forth. If you haven't got a therapist and you want to learn how to do that, head over to CBTSchool.com. Those courses, there is low cost as we could make them, and they're there for you to help you have a plan so that you can say to your anxiety when you're struggling, "I've already chosen how I wish to respond, and now I'm going to honor that decision. " Now, the reason that I say that phrase that way is when you have a plan up ahead head, that's one part of it, but then you have to honor your plan. And what often happens is, when we have a plan and we don't honor that plan, that's often when we start to feel like we distrust ourselves. We feel like we've let ourselves down. And so what we want to do is we want to make a plan, and then we want to choose to honor that plan. And by honoring the plan that you set out -- and I'm not going to tell you what that plan should be. The cost isn't going to tell you what you have to do. You get to decide that for yourself based on your own core values. But once you do that, and when you follow through by honoring that decision that you made ahead of time, that's when you start to trust yourself. That's when you start to really feel empowered. That's when you start to break that cycle of anxiety because you've stood firm on the ground on what your plan was and how you're going to show up. I'll repeat it again. "I have already chosen how I want to respond, and now I'm going to honor that decision because I matter, and this is my life, and I want to follow through in the way I said I would." Now, the fourth one is, "I will treat myself with the same kindness that I offer others in this situation." Again, we're speaking firmly and kindly with conviction to ourselves. "I will treat myself with the same kindness that I would offer to others." And then the last one is, "I'm going to honor my journey and respect my own pace." This doesn't have to be a straightforward, linear process. In fact, it won't be. And we have to honor our own journey and our own pace, because sometimes it takes longer for us than it does for others. And that's okay. We're going to honor our journey. We're going to respect our own pace. And I will offer you a bonus phrase, which is, "We are just going to take one step at a time." Just focus on one step at a time. Because if you're looking too far ahead, it will get overwhelming. You are handling a huge, huge discomfort. And so we want to be as gentle as we can. We want to honor our values. We want to lead with our values, not lead with fear. And my hope is one or many of these phrases will help you get there. I hope this has been helpful. Again, I want to remind you, some of these won't land for you, and that's entirely okay. Just practice and try the ones that you feel will be helpful, and leave the rest. This is your journey. You get to choose it. I just hope that some of these skills and tools that we talk about on Your Anxiety Toolkit are helpful. And I hope you have a wonderful, wonderful day.

Mar 1, 2024

THE RISING TIDE OF TEEN DEPRESSION: UNDERSTANDING AND ADDRESSING A MODERN CRISIS In recent times, the specter of teen depression has loomed larger than ever before, casting a long shadow over the lives of young individuals across the globe. With reports indicating a significant upsurge in cases of depression among adolescents, the need to unravel the complexity of this issue and explore effective strategies for intervention has never been more urgent. At the heart of the matter is the alarming statistic that suicide rates among teenagers aged 15 to 19 have surged by 76% since 2007, with a particularly distressing increase observed in teen girls. The rates of suicide have doubled among female teens compared to their male counterparts, underscoring a gendered dimension to the crisis. Moreover, the youngest demographic, children between the ages of 10 and 14, has witnessed the highest rate of increase in suicide across all age groups, a fact that underscores the severity and early onset of mental health challenges in today's youth. This escalation in teen depression and suicidal ideation can be attributed to a myriad of factors, ranging from societal pressures and the rapid pace of cultural shifts to the unique challenges posed by the digital age. The omnipresence of social media and technology, while offering new avenues for connection, has paradoxically fostered a sense of isolation and disconnection among adolescents. The digital landscape, with its relentless comparison and instant feedback loops, has exacerbated feelings of inadequacy, anxiety, and despair among young people. Furthermore, the impact of depression is not confined to any single demographic. Contrary to previous beliefs that African-American families were less likely to experience suicidal ideation, recent research has unveiled an elevated risk among African-American boys aged five to 11. This revelation challenges preconceived notions about the protective factors supposedly inherent in certain communities and underscores the indiscriminate nature of mental health challenges. The narrative surrounding teen depression and despair is further complicated by the conflation of despair with clinical depression. While depression is a diagnosable condition characterized by a specific set of symptoms persisting over time, despair can embody similar feelings of hopelessness and sadness without necessarily meeting the criteria for a clinical diagnosis. This distinction is crucial for understanding the breadth and depth of the emotional turmoil experienced by adolescents, which may not always fit neatly into diagnostic categories. Addressing this burgeoning crisis requires a multifaceted approach, centered around the power of connection and the cultivation of resilience. Building resilience in young people involves fostering internal coping mechanisms as well as providing robust external support systems. Parents, educators, and mental health professionals play a pivotal role in modeling healthy coping strategies and offering unwavering support to adolescents navigating the tumultuous waters of mental health challenges. One of the key strategies for combatting teen depression involves nurturing meaningful connections between young people and their caregivers. The act of showing up for adolescents in both significant moments and the mundane details of daily life can have a profound impact on their sense of belonging and self-worth. Consistency in presence and support, coupled with genuine engagement in activities that resonate with the interests of young people, can fortify their emotional resilience and counteract feelings of isolation and despair. In the digital realm, it is imperative to strike a balance between leveraging technology for connectivity and mitigating its potential negative impacts on mental health. Encouraging responsible and mindful use of social media, fostering face-to-face interactions, and emphasizing the importance of digital detoxes can help alleviate the pressure and anxiety associated with online environments. As society grapples with the escalating crisis of teen depression, it becomes increasingly clear that a collective effort is required to address the underlying causes and provide a supportive framework for adolescents. By prioritizing mental health education, advocating for comprehensive support services, and fostering an environment of openness and understanding, we can begin to turn the tide against teen depression. In doing so, we not only alleviate the immediate suffering of young individuals but also lay the groundwork for a healthier, more resilient generation. TRANSCRIPTION Kimberley: Welcome, everybody. I am so delighted to have our guest on today, Dr. Chinwé Williams. Welcome, Dr. Chinwé Williams . I'm so happy to have you here. Chinwé: Oh, I'm so excited to be here. Thanks so much for having me. Kimberley: As I said to you, several months ago, I was having a massive influx of cases of teens, my teen clients and my staff's teen clients reporting really strong waves of depression, including not just my clients, but also my pre-teen, also reporting that that's what some of our friends are reporting. I think it's everywhere. And I really feel that, even though we always talk about anxiety here, I really wanted to make sure we're addressing the really high rates of depression and despair in teens. So, thank you for writing the most wonderful book. As I went to research that, I found your book, it's called, Seen: Despair and Anxiety in Kids and Teenagers and the Power of Connection . So, thank you for writing that book. Chinwé: Thank you so much for reading it. Yes. Kimberley: Yes, I actually listened to it. So, I actually got to hear your voice, which I thought was really beautiful because you and Will Hutcherson, who wrote it, it was lovely. You bounced back and forward between the two of you. Chinwé: Yes, we did. We did. Kimberley: What made you decide to write this book? Chinwé: I started my career as a high school counselor, my goodness, probably now 18 years ago, which is so weird for me to admit that, or even wrap my mind around that. And I loved working with adolescents. And in the particular high school that I was working at, we were really, really able to do the work of promoting and supporting the mental and emotional well-being of students, not just the academic well-being. And a lot of my school counselor friends at other schools, they were really focused on the schedule and post-secondary options, and SATs. So, I was really fortunate to be at a school where I saw students almost like how I'm seeing clients clinically, 10 o'clock, 11 o'clock, 11:15, 11:30. And so, that was such a great experience for me, especially early in my career. The reason we wrote the book is because, back then, 18 years ago, I saw a little bit of self-harm. I saw anxiety. I saw depression. I certainly saw despair. I saw kids, students struggling with relationships, struggling with, what is my future going to look like? However, what we are seeing today, what I am seeing in my clinical practice, I still work with adolescents, but I do work with a great deal of adults. I work with parents and families, and I have conversations with just my friends and people that I'm doing life with. The episodes or experiences of anxiety and depression has really just increased significantly. Kimberley, I am sure that you are so aware of just the stats that are out there that really point to the shift that's occurred in our culture, specifically as it relates to youth mental health. Just for example, and this seems like such a long time ago, but I think it really gives us an idea of how much has changed, a good bit has changed in a relatively short period of time. But the stats are pointing to the fact that since 2007, suicide rates have increased a whopping 76% for teenagers between the ages of 15 and 19. So 76%. So the bulk of that number really is pointing to how our teen girls are struggling. Suicide rates are double in teen girls versus our boys. The highest rate of increase in suicide among all age groups—and this is where I always have to take a deep breath still—is in kids. These are kids between the ages of 10 and 14 is what the research is showing. The alarming part of this whole thing is that we're seeing younger and younger kids impacted by what we sometimes think of as, yes, adolescence is tough. There are hormones. There's social pressures. There are academic pressures. Kids are worried about the future. Well, younger and younger kids are also being impacted by feelings of hopelessness and discouragement. And the other thing—you and I talked about this before we started recording. The other thing that's been really shocking for a lot of people to learn is when I started my career, way back in the day, we were told that families of color, specifically African-American families, were really the least likely to take their own lives. But what we have learned recently, and this is a stat that has really shocked, but also confused and confounded a lot of clinicians, as well as mental health researchers, is that there's an elevated risk of suicidal thoughts for African-American boys between the ages of five and 11. So once again, just younger and younger kids are experiencing really hopeless feelings, but we are seeing the most anxiety, the most despair, and depression among adolescents and young adults. So that's why we wrote the book. Kimberley: I get teary just hearing about it. My heart aches, and I feel like it's a crisis. It's a crisis that they're experiencing and parents. I think what was really also very beautiful that you talked in the book about how, I think, even as clinicians, we perceive kids who are struggling with, "Oh, they must have gone through a trauma." But also, it's just kids who haven't been through a trauma. I mean, I think the COVID in and of itself and all of the unrest of our world is traumatic for everybody. But it was also very validating to see that this is also for reasons that we yet don't really understand. Do you want to speak to that at all? Chinwé: Yes, absolutely. So in the book, I wrote about clients that I've experienced throughout the years. I've changed factors and variables that would easily identify them. But many people will point to some of the illustrations in the book that are of kids who come from really supportive families. Many of them are high achieving. Many of them have a lot of resources that they just have access to, and yet they still experience levels of anxiety, sadness, even are self-harming, even espouse suicidal thoughts, or we call it suicidal ideation. What that tells us, again, I think just sort of zooming out, is the bigger picture of just so many things that have shifted in our culture, so many things that have shifted from a societal perspective where young people are feeling disconnected, they're feeling more anxious, they are more resourced. The research tells us that Gen Alpha and Gen Z are the most diverse, more resourced, tech-savvy. They're so connected to the technological and global world, but they feel so disconnected oftentimes from themselves, from their family members, and also their friends. And so, I think it really is so interesting that it really speaks to, regardless of the walk of life or where you or your family falls from an income perspective, none of us are immune. I try to be pretty transparent. My daughter has given me permission to share. She is 20 years old. She's in college. She is brilliant and kind and thoughtful and highly sensitive and gifted and has a mother who's a mental health professional. And at 13, she experienced high, high anxiety and high levels of despair. And again, she's given me permission to share, and I do share this when I talk to parents and educators across the country, and I'm so grateful that she's given me that permission. But just to show that she had resources. She was in private school. She's my bonus daughter. She had support from me, her dad, and also her biological mom, and her grandparents, and she still experienced what a lot of kids across the country are experiencing. Kimberley: I'm so grateful you share that. I think that that's it too. We would assume that if your bonus mom is a therapist and you have all the resources, it just wouldn't happen to you. But it doesn't discriminate, does it? It can affect any family. As a clinician, I don't think I was really trained to really understand that either. I was trained to think like, okay, there must be something wrong with the family, they must be fighting at home, or there must be discord at home, or so forth. So I'm so grateful that you share that. And thank you to her. How brave and wonderful that she struggled and obviously came through on the other side, absolutely. In the book, this blew my mind, really, honestly. I'm almost embarrassed to say, but it blew my mind that you described that there is a difference between despair and depression. Can you share what that is all about? Chinwé: Yes. As you know, depression is a clinical term. It's a diagnosis that has a set of symptomology that's connected to it. So, we as clinicians are looking for certain symptoms that exist more days than not over a two-week period of time, right? At that two-week mark, I'm starting to pay a lot of attention when parents are sharing what's happening with their kids. Because when you're an adolescent, we know that hormones will shift your mood, you'll be high on something that you're watching on TV. Not high literally, because we got to make that distinction. You're not vaping or using marijuana, but you're feeling euphoric and you're elated about something maybe you're seeing on television. And then you look down at your phone, or your mom asks you to clean your room or do your work. And then you can look like you have a level of despair. But that may not be the case, right? We know with adolescents, there are just normal ups and downs that are just a part of that stage of development. So it's important to really share that in order to get a diagnosis of depression. You want to see a number of symptoms for a period of time that really impact your child's level of functioning in a persistent and pervasive way. Maybe they're not functioning as well as they normally would at school or if they have an after-school job or an extracurricular activity or you're noticing that some things at home. So those are some things that we look at from a clinical perspective. Now, despair is something different, but not by a whole lot. There's a whole lot of overlap, and we do go into it with pretty great in-depth in the book, but essentially, despair really has a lot of those same symptoms of depression where you're feeling lethargic, perhaps low energy. You struggle with thoughts that tell you maybe that you're not enough, you're inadequate, or inferior. Sometimes you don't feel like doing those things that you normally love to do. In clinical terms, we call it anhedonia, right? Those things that you typically enjoy that make you happy—playing with your pet, going for a walk, hanging out with your friends. If you're not doing those things, we do start to wonder about some mood issues, some internalizing disorders. So, anxiety, mood issues such as depression, but with despair, and we make this distinction on purpose with intentionality, and here's why. Despair does share a lot of the symptoms as depression, but it doesn't need to meet the criteria for major depression for us to really know that is a tough place to be. And many of us, especially young people, we may not be able to just relate or connect to having major depression or bipolar, but many of us on this earth can relate to having an experience of loss or grief or deep disappointment, or pain that we just continue to stuff and we rally and we show up for the next thing and we show up for the next thing. But that pain is still there, and it doesn't really have a place to go because we haven't really shared with people that we were going through this pain. We just kept going with our routine. Despair can make you feel the exact same way, but it doesn't necessarily rise to the level of a mental health diagnosis. And it's important to point out because young people right now are going to social media outlets like TikTok, and they're hearing from social media influencers—I put that in quotation marks—that are saying, "If you have this symptom, then you have this diagnosis." And so, young people are attaching to those labels, and we did not want that in this book. This book is for anyone who has a child, a student, someone that you're coaching, leading, guiding, that is struggling with a mental health issue, or just struggling emotionally, but it doesn't necessarily lead to a criteria that indicates that there's some sort of diagnosis. Kimberley: Thank you for differentiating that, because that was really cool for me to hear from a clinician diagnostically. That was really cool to know. Let's talk about solutions. So we know this is happening. You talk about, and I am too is going to say, like we're sending all the love to the parents who are navigating this. We're sending all the love to the clinicians and the teachers and the school counselors and the guidance counselors who are navigating this with their teens. What can we do for our teens, or how can we help them? Chinwé: Excellent question. As a mental health practitioner and a parent of three kids, I know how difficult it can be to sort of see the big picture when your child is struggling. We all can relate to feeling overwhelmed, again, even as a professional. I've talked to my pediatrician friends and my medical doctor friends. It's the same thing when it's your kid. You have all the head knowledge, but sometimes it can still be difficult. I think for all of the families that are listening right now, I want you to remember a really important word that's actually overused. That word is resilience. We're hearing a whole lot about resilience. We're hearing a whole lot about emotional resilience, mental resilience. In the book Seen , we call it grit. We acknowledge because I'm talking to educators across the country that are seeing this and parents and even employers that are feeling this. We acknowledge that in a lot of ways, the younger generation, they have lost their grit. They don't appear to be as resilient as the older generations. But where I want to step in is by saying that we don't shame them or blame them. And how many times have we turned on the news and we heard, "Oh, these kids are snowflakes," or "These kids are weak," or "They're not tough, and they just need to pull their pants up," and whatever the saying is. Kimberley: Pull them up by the bootstraps. Chinwé: Thank you. And your big girl panties—I've heard that too. And I was traveling the other day, someone said, "Yeah, my dad always said, 'Just put some mud on it, put some dirt on it, and keep it going.'" And the older generation, we have a tendency to blame the younger generation for experiencing this mental health crisis, and that just isn't fair. We do want to help them to develop grit and build grit, but the way that we help them with resilience is remembering that a key element of resilience is internal coping resources with external support. That external support is key. When young people are facing any sort of mental health challenge, again, it doesn't have to be depression; it could just be a period of high anxiety or sadness that's just gone on for too long. They need to know that they have what it takes, but they need people to remind them and people to walk alongside them because life will be full of difficulty, of course. But we want to teach our young people that they can face this, anything that overwhelms them. They can experience that overwhelm, but also know that they have the ability to pull on those internal coping resources, assuming that they've been taught those resources, and also access the support of families. The first thing that I want to tell parents is to model exactly what you want to see. And this is big, and this could be its own episode, and maybe you've already done an episode. But the way that we help young people when they're having a tough time is to model good mental health even—and this is important—even when you're struggling. Because I struggle sometimes, and I have the coping resources. Life can feel really overwhelming and can test us. But do we pretend like we don't struggle just because we're parents or adults or because I'm a licensed professional? Well, how's that going to help my child? So, it's important for parents to know that the very first lesson around mental and emotional wellness has to come from you. When your kids are able to see how you, first of all, identify that you're having a challenge and then respond to the challenge, that helps them. That helps them know that, okay, I can go through a tough situation or feel a level of distress, but I don't have to sit with it and rally, or I don't have to pretend like it hasn't happened or whatever's happening hasn't affected me. So, what a parent can do is when you get home from work or your day or a meeting with a friend that just was hard and heavy, acknowledge that. We don't want to weigh kids down, and I get that. We don't want to put our problems onto them, but it's okay to say in a very general or conversational way it has been a really long day. Or, "I met with mommy's friend, Cindy. Oh, she's had a lot going on in her family. Oh, I just need a moment. I think what I'm going to do is before I get dinner started, I'm going to go for a walk, or I'm going to just take a couple of deep breaths, or I'm just going to have a seat. I'm going to rest." How many of us—Kimberley, I'm guilty of this—come home, we've had a hard day, we heard something heavy, and we go straight to cooking and cleaning and checking homework and all the things. So, what happens to that energy? So, I feel like this is just a really good opportunity to show kids the value of acknowledging that every day isn't going to be great and it's not supposed to be, but what can you do about it? Kimberley: Yeah. That is so important, I think. And I think it's easier said than done. I think that parents are exhausted too, right? They're struggling at high rates too, I'm assuming. I don't know the research on that. So, I think we also need to wrap everyone in compassion in that we're doing the best we can. You also talked about social media before and about how much connecting to social media disconnects them from the family. And I think that as parents, sometimes we let them be on tech because parents need a break, you know what I mean? I know I've caught myself with that with my nine-year-old of, "I'm just going to let him have some tech time because I need a break," but then that's disconnecting them. Can you speak to the impact of social media for teens? Chinwé: Yeah. I think the first thing that would really highlight this topic is to mention that just so recently, I want to say probably a couple of months ago, we learned that the federal government, along with at that time 13 separate states—I'm sure it's more at this point—sued the social media giant, Meta, which many of your listeners will recognize Meta as the parent organization for Facebook and Instagram. Now, we use Facebook and Instagram to promote mental health. And so, there are benefits to social media 100%, and I think it's important to highlight that for parents because some kids really are getting information about causes that they want to support. They are getting information about mental health. Sometimes it's in the bite-size way where we want them to dig in a little bit more, right? But they're good aspects to mental health. But the reason for the lawsuit was because the social media giant was being accused of creating intentionality features that are causing addiction to social media, which is one of the things that has been identified as fueling this mental health crisis among youth. So, there are real stats that are -- we probably have always had a sense that being connected or over-connected to technology wasn't good. During COVID, what the heck else were we supposed to do as parents? We were doing Zoom school. I'm sure you had your own podcasts at that point. I was doing podcasts. I was doing telehealth. So I appreciated technology, but like you said, a lot of parents really leaned on technology during that time because we didn't have a whole lot else going on and kids still needed to stay connected, and so did we. But I think that balance is so key. I'm going to tell you, when I travel and people ask me, what's the thing that worries you the most about young people as a former high school counselor, someone who works with adolescent mental health? And I say very quickly, without hesitation, that I am really concerned about the fast-paced nature of our culture. We are moving, I think, at lightning speed as a culture. We're becoming increasingly more digitally connected, which means that we're becoming more and more less physically connected. So how does that impact our young people? And we're so quick to point to these things (I'm holding my phone right now) and ask young people, especially teenagers, to do less of this. But if we're honest, aren't we just as guilty as parents? I have a colleague, and I don't know if you would agree with this at all. I'm still kind of wrapping my mind around it because I like to see hard stats. But I had a colleague that said that he believes that most adults have some level of digital addiction. I don't know. I don't know that for a fact, but I know again that we are very much so attached to our phones. And so, the younger generation sees that. And if they're going through despair, if they're having thoughts of self-harming, if they're having anxious thoughts, and they see that we are super duper connected to our phones, where then do they go? Are we essentially modeling the same thing? So again, I'm not here to say that technology doesn't have its utility. It's not all bad. But when our world is moving so fast that our nervous systems can't keep up, what do we need to do? The answer is to slow down and have more face-to-face connections. Kimberley: Yeah. I think that without the research, I can say for myself, it's interesting. I actually had a colleague of mine, we both agreed we would track how many times we picked up our phone. And when I tracked it, it was always like, "Oh, I'm overwhelmed. I'll just watch Instagram for a minute," or "I'm feeling sad. I'll just watch Instagram for a second." And it was like, that's my first coping skill. This is not good. That's not good. So I totally agree with what you're saying. I have one more question for you. So, the real word that felt so yummy to my whole body when I read your book was the word connection and how important that is for our teens but also for, I think, all humans. How might we connect better with our teens? Chinwé: Oh gosh, can I throw a stat that's sticking in my head? Can I throw that out right now? Kimberley: Please. Chinwé: From birth to graduation, I still get goosebumps, and I've been saying this for about a year now. From birth to graduation, we have 936 weeks with our kids. 936 weeks and roughly 3,000 hours in one year. So, just depending on where you are in your parenting phase, depending on just who you are and the makeup of your nervous system, that's going to land differently for you. But I know the first time, and even today when I hear that, I'm like, "There's not enough time. Am I doing enough? Should I not be on this podcast? Should I be with her in school?" So it's fine. But I think that, like, am I spending enough time? Am I connecting? And I don't know one parent that I've counseled or that I do life with that doesn't want to be a good parent. And I always remind parents that it's not this whole connection piece that we're seeing in the attachment research and the neuroscientific research. It's not about being a perfect parent. It really is about being an intentional parent and showing up undistracted. So that whole conversation about before we check our kids, let's see if we're modeling the behavior we want them to see as it relates to technology. And again, tons of compassion. I'm a huge proponent on giving yourself the kindness that you would give someone else who might be struggling. So, that's really important. But showing up undistracted, but also showing up when it's not convenient. We know through brain research that connection can help bring down all of that energy that happens on the right side of the brain when an individual is highly activated, high anxiety for far too long, a state of despair for far too long, which can actually end up feeling like just numbness, like I feel nothing. So, what helps individuals to begin to heal, promote that healing is connection with another human being that they feel loved and cared for, that they feel respected, someone that respects them, someone that values who they are, not just what they do. "I love you just for who you are." That's something that I say. I'm actually being reminded of a Valentine's Day card that my third grader made for me. And he wrote the sweetest thing, and I'm not going to read all of it, but at the very end, he said, "Thank you for loving me even when I'm unlovable." And I sort of chuckled, and he read it to me and we laughed at the same time because that's something I say to him all the time. Regardless of the behavior, regardless of what we are facing right now, the correction or the challenge, or you're not getting along with your brother, I love you no matter what. So, even just hearing that, even just hearing that as adults that someone is going to be by our side and going to help us through a tough time, even when maybe we're not acting lovable or "acceptable" from society's perspective, what's better than that? One of the very first tools that we talk about in our book Seen , we have five connection tools. The very first tool is showing up and showing up when it's not convenient. As mama bears and papa bears, we have that instinct to swoop in and protect our kids when they're struggling. And we also show up during those huge milestone moments—the concerts, the graduations, the big sporting events. And by the way, kids want to look up and see us and see grandparents in the stands. That's important. But the kids that I've been counseling throughout the years, they want their parents to show up in the seemingly insignificant and mundane moments of life, just to do basic things. Not to check the homework, not to talk about the boy that texted last night, but go for a coffee to just connect. Go in the front yard and play basketball. Go fishing. The key is whatever is meaningful and valuable to your child, those are the things that we want parents to engage in. And consistency really matters. And we're talking about teenagers. This is what I've learned throughout the years, especially when I was a school counselor—the tendency is to think that as our kids get older, they need us less and less. And this is what my teenagers in therapy are telling me—I find that when they hit 13, 14, and 15, ooh, they are making huge life decisions. And even though there's sometimes that conflict that happens between parents and teenagers or parents and preteens that can cause parents to sometimes disconnect because we get our feelings hurt sometimes and disengage, that's when our kids are making really tough life decisions, so that's when they need us the most. Consistency matters. So, it's not showing up here and there. No knock on people who have busy lives and busy jobs, but the research shows that consistency builds trust. So, we show up, we show up undistracted, and we show up before they ask us to. Kimberley: So beautiful. For me, it's been a constant reminder of like, look them in the eyes. It's so easy to be talking while chopping vegetables or checking email. It's like, "Kimberley, stop and look at them in the eyes. That's what they need to be seen." So, I love that so much. I understand that you have a new book out. Please tell us all about where people can find you and learn about you. And you have a new book out. Tell us all the things. Chinwé: Oh, thank you so much. Yes, our first book was Seen , which is really a book for connecting with a young person, if you're a parent, educator, coach, regardless of mental health diagnosis. However, as we were traveling and sharing about the contents of Seen , everywhere we would go, parents would say, "Oh, this is awesome. I'm going to give this to my teenager." And Will and I would be like, "No, this is not for your teenager; this is actually for you and another caring adult." And then they would say, "Well, where's the book for teenagers or is there a workbook?" And so, we wrestled with this for about a year, and we decided, looking at the stats, that's really pointing to anxiety being super high, very rampant among all of us, including adults, 28% of adults have an anxiety disorder. We also are seeing that young people, adolescents, and young adults are struggling with anxiety. So we wrote a book that's specifically for strategies to help with anxiety, and it's called Beyond the Spiral: Why You Shouldn't Believe Everything Anxiety Tells You . And it's really going over six different lies that anxiety tells you. And here's a sneak peek: Anxiety tells you that you have no control. Anxiety tells you that you're going to miss out. Anxiety tells you that you should just ignore it, and anxiety tells you that you're not safe. And there are two more. But then every single chapter, we talk about the lie, we talk about what's happening in the brain that's really highlighting that lie. And then we talk about psychological strategies that are tried and true, probably many of the ones that you've written about in your books and resources, many of the ones that I use with my clients today. And then there's a spiritual piece for those who really have a strong faith. We bring in spiritual elements and practices that we believe are also really important to ease in anxiety. Kimberley: Amazing. Thank you so much for being here. Is there any social media handles or websites that people can find your information? Chinwé: Thank you for asking. So I am also pretty active on Instagram, and my Instagram handle is dr.chinwewilliams. So dr.chinwewilliams. And if you want to just learn a little bit more about me and my practice, I have a website, and it's drchinwewilliams.com. Kimberley: Amazing. And we'll link all that in the show notes. I am so grateful for this book. I'm so grateful for you. I love the work that you're doing. So thank you for coming on. Chinwé: Thank you for your kindness. Thank you for your -- I'll be honest with you, when I'm preparing for podcasts, I don't have a lot of time, but I really do think it's important to just get a flavor of the host, the content that they produce, the guests that they have on. But I don't have a lot of time, right? So, I usually have time to listen to maybe 15 or 20 minutes of maybe one or two podcast episodes. When I tell you, I was like, "Where am I going to start?" I was looking through your title list, and I was blown away. I listened to two and a half episodes, two entire episodes, and a half of one. And I was thinking, where has she been all my life? She's going to be an amazing resource for my clients who -- I'm a trauma therapist, and as you know, that was formerly considered an anxiety disorder. So this is something that I'm really excited to present to my clients. So thank you for the work that you do. Kimberley: Oh, thank you so much. I'm so grateful.

Feb 16, 2024

In the realm of mental health, the role of an anxiety therapist is often shrouded in mystery and misconceptions. To shed light on this crucial profession, Joshua Fletcher, also known as AnxietyJosh , shares insights from his latest book, " And How Does That Make You Feel? : Everything You (N)ever Wanted to Know About Therapy," in a candid conversation with Kimberley Quinlan on her podcast. Joshua's book aims to demystify the therapeutic process, offering readers an intimate look behind the therapy door. It's not just a guide for those struggling with anxiety but an engaging narrative that invites the general public into the world of therapy. The book's unique angle stems from a simple yet intriguing question: Have you ever wondered what your therapist is thinking? One of the book's key revelations is the humanity of therapists. Joshua emphasizes that therapists, like their clients, are complex individuals with their own vices, flaws, and inner dialogues. The book begins with a scene where Joshua, amidst a breakthrough session with a client, battles an array of internal voices—from the biological urge to use the restroom to the critical voice questioning his decision to drink an Americano right before the session. This honest portrayal extends to the array of voices that therapists and all humans contend with, including anxiety, criticism, and analytical thinking. Joshua's narrative skillfully normalizes the internal chatter that professionals experience, even as they maintain a composed exterior. The conversation also touches upon the diverse modalities of therapy, highlighting the importance of finding the right approach for each individual's needs. Joshua jests about "The Yunger Games," a fictional annual event where therapists from various modalities compete, underscoring the passionate debates within the therapeutic community regarding the most effective treatment methods. A significant portion of the book delves into the personal growth and challenges therapists face, including dealing with their triggers and the balance between professional detachment and personal empathy. Joshua shares an anecdote about experiencing a trigger related to grief during a session, illustrating how therapists navigate their emotional landscapes while maintaining focus on their clients' needs. The awkwardness of encountering clients outside the therapy room is another aspect Joshua candidly discusses. He humorously describes the internal turmoil therapists experience when meeting clients in public, highlighting the delicate balance of maintaining confidentiality and acknowledging the shared human experience. Joshua's book, and his conversation with Kimberley, paint a vivid picture of the life of an anxiety therapist. It's a role filled with challenges, personal growth, and the profound satisfaction of facilitating others' journeys toward mental wellness. By pulling back the curtain on the therapeutic process, Joshua hopes to demystify therapy, making it more accessible and less intimidating for those considering it. In essence, being an anxiety therapist is about embracing one's humanity, continuously learning, and engaging in the most human conversations without judgment. It's a profession that requires not only a deep understanding of mental health but also a willingness to confront one's vulnerabilities and grow alongside their clients. Through his book and the insights shared in this conversation, Joshua Fletcher invites us all to appreciate the intricate dance of therapy—a dance that, at its best, can be life-changing for both the therapist and the client. Transcript: Kimberley: I'm very happy to have back on the show Joshua Fletcher, a dear friend of mine and quite a rock star. He has written a new book called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. Welcome back, Josh. Joshua: It's good to be back. Thanks, Kim. When was the last time we spoke together on a podcast? I think you were on The Disordered podcast not so long ago. That was lovely. But I remember my guest appearance on Your Anxiety Toolkit was lovely. HOW DOES THAT MAKE YOU FEEL? Kimberley: I know. I'm so happy to actually spend some time chatting with you together. I'm very excited about your new book. It's all about therapy and anxiety and what it's really like to be an anxiety therapist and the process of therapy and all the things. How did this book come about? Joshua: I wanted to write a book about people who struggle with anxiety, but in the mainstream, because a lot of the literature out there is very self-help, and it's in a certain niche. One of my biggest passions is to write something engaging with a nice plot where people are reading about something or a storyline that they're interested in whilst inadvertently learning without realizing you're learning. That's my kind of entertainment—when I watch a show and I've learned a lot about something or when I've read a book and I've inadvertently learned loads of things because I'm taking in the plot. With this book, I wanted to write a book about therapy. Now, that initially might not get people to pick it up, might not interest you, might not interest you about anxiety therapy, but I wanted to write something that anyone could pick up and enjoy and learn lots because I want to share our world that we work in with the general public. And so, the hook that I focused on here was, have you ever wanted to know what your therapist is thinking? And I thought, well, I'm going to tell people what I'm thinking, and I'm going to invite people behind the therapy door, and you're going to see what I do and what's going on in my head as I'm trying to work with people who struggle with mental health. I wrote the pitch for it. People went bananas, and they loved it because it's not been done before. Not necessarily a good thing if it's not been done before. And here we are. I love it. I'm really proud of it. I want people to laugh, cry, be informed. If you go on a journey, learn more about therapy, learn more about anxiety. All in one book. THERAPISTS ARE HUMANS TOO Kimberley: Yeah. I think that one of the many cool things about it is, as a therapist, people seem to be always very curious or intrigued about therapists, about what it's like and what it's like to be in a room with someone who's really struggling, or when you're handling really difficult topics, and how to be just a normal human being and a therapist at the same time. Joshua: Yeah. What I want to write about is to remind people that therapists are humans. We have our vices and flaws. I'm not talking on behalf of you, Kim. I'm sure you're perfect. Kimberley: No, no. No, no. Flawed as flawed could be. Joshua: Yeah, but to a level that it's like, even our brains have different voices in them all the time, different thought processes as part of our rationalization. And I want people to peer inside that and have a look. So, one of them is like the book opens with me and a client and it's going really well, and this person's talking, this character's talking about where they're up to, and celebrating on the brink of something great. And then there's the voice of biology that just pops into the room, into my head. And it's the biology of you need to go to the toilet. Why did it? And then the voice of critic comes in and says, "Why did you drink an Americano moments before this client?" Now you're sat here, and you can leave if you want, but it would be distasteful. And you're on this brink of this breakthrough. And so, I've got this argument going on in my head, going, "You need the toilet." "Yeah, but this person's on a breakthrough." And then I got empathy, like, "Yeah, but they feel so vulnerable. They want to share this." And then you've got analytical and all the chaotic conversations that are happening as a therapist as I'm sat there nodding and really wanting the best for my client. THE VOICES IN OUR HEAD Kimberley: Exactly. That's why I thought it was so brilliant. So, for those of you who haven't read it, I encourage you to, but Josh really outlines at the beginning of the book all of these different voices that therapists and all humans have. There's the anxiety's voice and there's biology, which you said, like, "I need to go to the restroom," or there's the critic that's judging you, or there's the analytical piece, which is the clinical piece that's making sense of the client and what's going on and the relationship and all the things. And I really resonated with that because I think that we think as clinicians, as we get better and more seasoned, that we only show up with this professional voice we're on the whole time, but we're so not. We're so not on the whole time. This whole chatter is happening in the background. And I think you did a beautiful job of just normalizing that. Joshua: Thanks, Kim. It's a book that therapists will like, but do you know what? People will identify their own voices in this, particularly the anxiety. You and I talk about anxiety all day every day, always beginning with what if—that voice of worry that sits around a big table of thoughts and tries to shout the loudest and often gets our attention. And I tried to show that this happens to a lot of people as well. It's just the what-if is different. So, for some people, it's, "What if this intrusive thought is true?" For some people, it's, "What if I have a panic attack?" For some people, it's, "What if this catastrophe I've been ruminating on for so long happens?" For therapists, it's, "What if the worst thing that happens here, even in the therapy room?" I'm an anxiety therapist that has been through anxiety, and I still get anxiety because I'm human. So, I celebrate these voices as well. Also, because I'm human, I can be critical almost always of myself in the book. So, I'm not just criticizing the people I'm working with. Absolutely not. But that voice comes in, and it's about balancing it and showing the work and what a lot of training to be a therapist is. It's about choosing the voice. And I didn't realize how much training to be a therapist actually helps me live day-to-day. Actually, I'm more rational when making more life decisions because I can choose to observe each voice, which was integral to me overcoming an anxiety disorder, as well as just facing life's challenges every day. WHAT IS IT LIKE TO BE A THERAPIST? Kimberley: Right. Because we're really today talking a lot about what it's ACTUALLY like to be a therapist—and I emphasize the word 'actually'—what is it actually like to be a therapist, if we were to be really honest? Joshua: One thing I mentioned is that I talk about the therapeutic hour, which is how long, Kimberley? Kimberley: Fifty minutes. Joshua: Yeah. The therapy took out and I explained what we do in the 10 minutes that we have between clients on a busy day. And people imagine us doing meditation or grounding ourselves or reflecting or whatever. Sometimes I do do that. Sometimes I just scroll Reddit, look at memes, eat candy, and do nothing. And it's different each time. That's what I'm doing. I'm not some mystic sage in my office, sitting sinisterly under the lamplight waiting for you to come in. No, I'm usually faffing around, panicking, checking that I don't look like a scruff, putting a brush through my hair, trying to hide the stains of food I've got on my shirt because I overzealously consume my lunch. And there's obviously some funny stories in there, but also there's dark stuff in there as well. When I trained to be a therapist, I went through grief, and I made some quite unethical decisions back when I was training. Not the ones I'm proud of, but it actually shows the serious side of mental health and that a lot of therapists become therapists because of their own journeys. And I know that that applies to a lot of therapists I know. Kimberley: For sure. I have to tell a story. A few months ago—I'm a member of lots of these therapist Facebook groups—one of the therapists asked a question and said, "Tell me a little bit what your hour looks like before you see a client. What's your routine or your procedure pre-clients?" And all these people were saying, "I journal and I meditate and all of these things." Some people were like, "I water the plants and I get my laptop open." And I just posted a meme of someone who's pushing all the crap off my table and screeching into the computer screen and being like sitting up straight. And all of these people responded like, "Thank God," because all the therapists were beautifully saying, and I just came in here honestly, "Sometimes I literally sit down, open the laptop, and it is a mess. But I can in that moment be like, 'Take a breath,' and be like, 'Tell me how you're doing.'" Like you said, how does that end? We start the therapeutic hour. And I think that we have to normalize therapists being that kind of person. Joshua: Definitely. I think one of the barriers to people seeking therapy is that power dynamic, that age-old trope that someone stood leaning against a mahogany bookcase. You've probably got a mahogany bookcase. Your practice is really nice. I certainly have. I've got an Ikea KALLAX unit full of books I've never read. Kimberley: Exactly. Your books aren't organized by color because mine are not. Joshua: No, no. There's just some filler books in there. Just like, why is Catcher in the Rye? Why is Catcher in the Rye? I don't know, I just put it on there. I just want to look clever. Anyway, it's like people are afraid of that power dynamic of some authority figure going in there about to judge them, mind-read them, shame them, or analyze them. And no, I think dispelling that myth by showing how human we are can challenge that power dynamic. It certainly did for me. I would much rather open up to someone who isn't showing the pretense that they have all of life together. Don't get me wrong, professionalism is essential, but someone who's professional and human, because going to therapy is some of the most human experiences you'll ever do. I don't want someone who isn't showing too scared to show that sign or certain elements of being human, but obviously professionally. And it's a fine balance to get. But when you do find a therapist like that, for me personally, one who's knowledgeable, compassionate, empathetic, has humility, I think beautiful things can happen. Kimberley: Yeah. I think you use the word that I exactly was thinking of, which is, it's such a balancing act to, as a therapist, honor your own humanity from a place of compassion. Like, yeah, we're not going to have it all together and it's not going to be perfect, and we won't say the right thing all the time. But at the same time, be thoughtful and have the skills and the supervision to balance it so that you are showing up really professional and from that clinical perspective. DO THERAPISTS GET CONSULTATION? Tell me a little bit about consultation as a clinician. I know for me, I require a lot of consultation for cases, not because I don't know what I'm doing, but I'm always going to be honest with the fact that maybe I'm seeing it from a perspective that I hadn't thought of yet. What are your thoughts on that kind of topic? Joshua: Therapy's got to work for both people as well, because the therapeutic connection, I believe, is one of the drivers that promotes therapeutic growth and change. It promotes trust. I will consult with clients and my supervisor and make sure it's right. I'm not everyone's cup of tea, but for people, particularly with anxiety disorders, I think they like to know and come to therapy. I think I've used self-disclosure on my public platforms tastefully in the sense that I know what it's like to have gone through an anxiety disorder, whether it's OCD or panic disorder or agoraphobia, and come out the other side. But also, it's balancing that with, "Actually, I'm your therapist here. I will help you in a therapeutic setting and use my training." You know I'm not someone who's got everything worked out, but you do know that someone who can relate that can step into your frame of reference, something I talk about a lot in the book frame of reference and empathy. If you feel like a therapist has done that and is in your frame of reference and it's like, "Ah, yeah, they get it or they're at least trying," and we as therapists feel like there's a connection there too on a professional and therapeutic level, I think magic can happen. And I love therapy for that. Not all therapy is great and beautiful and wonderful. Some of it is messy, and some of it just doesn't work sometimes. And I do talk about that too, but it's about when you get that intricate dance and match between therapist and client, I think it's life-changing. WHAT TYPE OF PERSON DO YOU NEED TO BE TO BECOME AN ANXIETY THERAPIST? Kimberley: Yeah. What do you think about the type of person you would have to be to be an anxiety specialist, especially if you're doing exposure and response prevention? The reason I ask that is I have a private practice in California. I have eight clinicians that work for me. Almost every time I have a position that's open, and when I'm interviewing people to come on to my team, I would say 60% come in, and they're good to go. They're like, "I want to do this. I love the idea of exposure therapy." But there is often 40% who say, "I'm not cut out for this work. This is not how I was trained. It's not how I think about things." After I've explained to them what we do and the success rate and the science behind it, they clearly say, "This isn't for me." What are your thoughts about what it takes or what kind of person it takes to be an anxiety specialist? Joshua: That's a great question. First of all, you've got to trust and believe in the modality that you're trained in. You and I use the principles a lot of cognitive behavioral therapy and exposure response prevention. I've got first-hand experience of that. You've got to trust the science and what we know about human biology, which is really important. It's about what you're trading in that modality. What I talk about -- again, see how I'm segueing it back to the book. Brilliant. I've done my media training, Kim. It's like, "Always go back to the book. Come on, Josh." One of my favorite chapters in the book is explaining about modalities because a lot of people just think therapy is one big world where you see a therapist, they wave a magic wand, you feel better, and suddenly our parents love us again. No, that's not how it works. Kimberley: It's not? DIFFERENT TYPES OF ANXIETY THERAPISTS Joshua: No, it's not. Mental health has different presentations, and a modality is a school of thought that approaches difficulties in mental health. So, the first modality I go to is person-centered, which is counseling skills, listening, empathy, unconditional positive regard. The Carl Rogers way of thinking—I think I love that. Is that good for OCD, intrusive thoughts, exposure therapy, and phobias? Not really. It's nice to have a base of that because there's more chance of a therapist being understanding, stepping in your frame of reference, and supporting you through that modality. But I wouldn't say it's equipped for that. Whereas in CBT, a lot of it is psychoeducation, which I love. And that's a different modality. Cognitive behavioral sciences, whether it's third wave, when you're looking at acceptance commitment, where are you looking at exposure response prevention. There's lots of song and dance about I-CBT at the moment and things like that. They're all different modalities and skills of thought. Then you've got psychodynamic, which is the mahogany bookcase, lie on the sofa, let's play word association. Oh yeah, you want to sleep with your mom, Josh? No, I don't. That's nothing to do with why I keep having panic attacks in the supermarket. Stop judging me. But that's a different type of approach. Jungian approach can be quite insightful, but it's got to match what the presentation is for you. I think CBT is my favorite, but it sucks for stuff like grief. When I was grieving, I did not want CBT. I did not want my grief formulated. I did not want to see that my behaviors were perpetuating discomfort. I was like, "Yeah, that's just part of my grieving process." And in this chapter, I just talk about the different modalities. Therapists are very passionate about the modality of the school that they train in because you have to give part of yourself to it. You have to go through it yourself. And I'm very passionate about the modalities I'm trained in. And so, I play on this in the book. There's a chapter called The Younger Games or The Yunger Games, a play on words. And basically, it's once-a-year therapists from every modality, whether it's hypnotherapy, transactional analysis, CBT, person-centered, the trauma-informed. All of these, they all meet up in a field, and we all fight to the death. And the last remaining person is crowned the one true modality. Now last year, it was hypnotherapy. And what I also say is that a betting tip for next year is the trauma-informed. So, every year, I'll keep you updated on The Yunger Games. And basically, it's a narrative device to explain that. Within the world of therapy, there are different types of therapists. You and I, we love CBT. We'll bang the drum for that. We feel that there's not enough ERP out there that certainly isn't, particularly with the evidence and the points towards it and mountains of evidence. But other therapists may not feel the same. So, when people come to work at CBT School and they realize that Dumbledore, aka Kim Quinlan, is like, "No, we do ERP here; we've got to get down and dirty and do the horrible work," they're like, "That's not conducive to the softer step-back approach that I've trained in, in my modality." Kimberley: Yeah. I'm always so happy that they just are honest with me. I remember as an intern at OCD Center in Los Angeles very clearly saying, "Are you okay talking about really very sexual, very, very graphic topics?" He listed off. Like, "Here is what you're going to need to be able to talk about very clearly with a very straight face. You can't have a wincing look on your face when you talk about intrusive, violent sexual thoughts. You're going to have to be up for the game." And I think that was a big thing for me. But what I think is really cool about your book, and you see now I'm bringing it back to your book, is it doesn't mean the voice isn't in your head sometimes questioning you. As I was reading it, I'm like, there is an imposter in therapists all the time saying, like you said, the critic that's like, "You don't know what you're doing. You're a failure. You're a flake. You're a complete fraud. You haven't got it together. Maybe you haven't even worked on the thing yourself yet." That's going to be there. Joshua: Yeah, and I still get that. I can't speak for you. But I think what makes a good therapist is a therapist who self-doubts. You don't want to go and see a therapist who thinks that they've got it all worked out. That's a red flag in itself. A good therapist is one that always wants to improve and uses that doubt and anxiety to make themselves a better therapist. Don't get me wrong, I'm pretty confident in my ability to be a therapist now, but there are challenges. In the book, the voices that come up, there's 13 of them. One of them is escapist, which is, "I just want to get the hell out of you," or "Maybe I want to get rid of this client. I'm not equipped for it." And then the other voices come in and they're like, "But maybe this is just you being critical," or "The evidence suggests that actually you are trained for this," and navigating that doubt, the anxiety that your therapist has. And I think it's a beautiful thing. A lot of therapists are very harsh on themselves, but I think it's a gift to have that inner critic. Because if you stand there like one of these therapists, and these therapists do exist, unfortunately, I have completed all my training. I know everything inside out. My word is gospel. I worked out what the problem was with this person within 10 minutes. You don't want to talk to that person. What a close-minded moron. And there's a judgmental voice from a therapist. Kimberley: No, but I think that's informed. Joshua: So, it celebrates the vulnerability. You want a therapist who's not got everything worked out. Absolutely. I do anyway. Kimberley: Yeah, for sure. I'm wondering, how often have you had to work through your own shit in the room with a client? Meaning—I'll give you a personal example—the very first time I ever experienced derealization for myself was with a client, and I was sitting across from them. They were just talking, and all of a sudden, I had this shift, like everything wasn't real. Their head looked enormous and their body looked tiny. Like they were this tiny little bobbly head thing on the couch. And I knew what was happening. Thankfully, I knew what it was like. I knew what it was. Otherwise, I probably would have panicked, but I had to spend the rest of the session being as level and mindful as I could as I watched their head just bubble around in this disproportionate way. I got through it. I can say confidently I think I pulled it off really well, but it was hard. And I left the session being like, "What the heck just happened?" Has there been any experiences for you like that? Joshua: Yeah, all the time. I mean, first of all, I'd question if you did have derealization. I was your client with a giant head and a tiny body. I was like, "What's going on here?" There wasn't derealization. That's my body, Kim. Kimberley: No, that's just how I look, Kimberley. Joshua: It's just how I look. Kimberley: "Stop judging." Joshua: But in general, no, it's true. And again, one of the voices in my book, And How Does That Make You Feel? , it's called trigger because therapists, they have to give a lot of themselves and they're living a life and have had stuff in their past. One of the voices is trigger. One of the things I get asked a lot is, I don't know about you, Kim, "If you've had anxiety, how can you work with it all day?" I'm like, "Because I'm all right with it. It's okay now." Sometimes it creeps in, though, if I'm tired or have not slept well. There's stress in my personal life that you can't avoid. Maybe I've not eaten too well. Maybe it's just ongoing things. Sometimes trigger can happen, and it can be a stress-induced trigger or it could be a literal trigger from a traumatic event. So, in the book, I explain when people bring grief and death, that sometimes makes me feel vulnerable because of my own experiences with grief and death. No spoilers, but the book throughout, one of the themes is why I became a therapist. Not only because of my passion for anxiety disorders and to be self-righteous around other therapists, train different modalities, but also because it's a very grief-informed decision to want to help people. And there's several traumatic stories. One traumatic story around grief, that trigger, the voice of trigger will come up. So, a client could be talking about their life, like, "I've lost this person; I'm going to talk about it." And of all these 13 voices around the table, what your therapist is thinking, trigger then shouts loudest. It goes, "Ah, trigger." There's some pain that you've not felt for a while and I've got to navigate it. You navigated the derealization, the dissociation. You've got to navigate it somehow by pulling on the other voices. And not only do therapists do this, but people do this as well sometimes, whether you've got to be professional or you don't want to turn up to your friend's birthday and just listen to trigger and anxiety and start crying all over your friend's birthday cake. You might do. It's quite funny, but not funny. Kimberley: I was going to say, what's wrong with that? Joshua: Have you done it again? I thought you stopped that. Kimberley: Yeah. You haven't done that? Joshua: It's part of the interview at CBT School. You need to do really hard, tricky things. Go to your best friend's birthday and make it all about you. Kimberley: Exactly. Joshua: But yeah, it's one of those. It crops up. The book's funny a lot, but it's good. It takes some really serious turns, and it shows you a lot of stuff can creep in and how I deal with it as a therapist. And I'm sure you related to it as well, Kim, because we do the same job, but you just do it in a sunnier climate. SEEING CLIENTS IN PUBLIC Kimberley: Right. What I can say, and this will be the last thing that I point out, is you also address the awkwardness of being a therapist, seeing your clients in public and the awkwardness of that, or the, "Oh crap, I know this person from somewhere." Again, no trigger. I don't want to give the fun parts of the book, but as a therapist, particularly as someone who does exposure therapy, I might go across the road and take a client to have coffee because they've got to do exposures. We very often do see people, our clients, our friends in our work. How much does that impact the work that you do? Joshua: If you ever bump into your therapist, just know that you have all the power there. Your therapist is squirming inside, "I don't know what I'm doing. I don't know. Do I completely blank this person?" But then I look like a dick. "Do I give a subtle nod? Oh, you're breaking confidentiality. They're out with loved ones." It's up to you. You can put your therapist out of their misery by just saying, "Hey, Kim." "Hey, Josh." And then I will say hi back because that shows that you're okay with that. There is a very extreme shocking version of this story, of this incident in the book where, when I'm at my lowest, I do bump into a previous client. On a night out, when I'm off my face on alcohol. Oh, if you want to find out more about that... Media training's really paid off. Get him on the hip. Kimberley: I didn't want to give it all away, and you just did. Joshua: No, no, not giving any more away. A media training woman said, "Entice them, then leave it, because then they're more likely to read it." So, I have listened to that media woman because my previous tactic of just begging and screaming into a camera doesn't work. It's like... Kimberley: But going back exactly—going back, we are squirming. I think that is true that there is a squirm factor there when you see clients, and it happens quite regularly for me. But I think I've come to overcome that by really disclosing ahead of time. Like if I see you outside, you're in the place of power, you decide what to do, and I'll just follow your suit. It's a squirm factor, though. Joshua: See, that's clever, good therapy stuff because you do it all part of the contracting and stuff. Actually, I told all my clients this is okay. But also, when you're a new therapist or sometimes you forget, you're like, "Oh no." I used to run a music night in Manchester as part thing I did on the side. Enjoy it, love music, I was the host. One week I was on holiday, so a friend organized all the lineup of people to come down. Headline Act was a band name. Went along, and when I'm there, I'm having fun. I've got whiskey in my hand. I'm walking around telling irreverent, horrible jokes. No one in there would guess I was a therapist because I'm having fun and I'm entitled to a life outside the therapy room. What I didn't know was that the Headline Act was a current client, and they'd just arrived dead late. They didn't know, and they walked on stage, and I looked. It's something that they've gone on publicly to talk about, so this is why I'm saying it now. I got permission to use it because they said it publicly on the radio and stuff like that. And we just looked at each other. It was like, "Oh my God." And I stood there with this. I was like, "Oh my God." And I've said all this bad language and cracking jokes, roasting people in the audience, my friends usually. And it's like, yeah, I was squirming. So, at this point, I did just pretend I didn't know them because it was the best I could do. And they got me out of trouble. They were obviously confident in performance mode. And they got onto mic and was like, "Can you believe that guy is my therapist?" And I was like, "What?" I was like, "Wow." And then he said some really lovely things. And it wasn't really awkward in therapy. If anything, it was quite something we laughed about in therapy afterwards, and it contributed to it. But yeah, the horror I felt. Oh, I felt sick, and oh. I don't want to think about it. FINAL CONCLUSIONS Kimberley: I want to be respectful of time. Of course, before you share this all about you and where people can get a hold of you and learn about your book, is there anything you want to say final point about what it's like to actually be an anxiety therapist? Joshua: It's the best job in the world for me. It's the best job in the world. All my friends and family go, "I don't care how you can do that." I love it. I get to have the most human conversations with people without judgment. You mentioned before about intrusive thoughts. I've got the magic guitar in this room, and we make songs about horrible intrusive thoughts. There was one the other day about kicking babies down the stairs. You can't say that out loud. Yes, we do in here, to the three chords of the guitar I only know, particularly postpartum mothers. Kimberley: You told me we couldn't sing today. Joshua: No, I'm not singing. Kimberley: I wanted to sing today, and now you're telling me we can't sing. Joshua: I don't think it's going to be Christmas number one—a three-chord banger about harming loved ones or sexual intrusive thoughts—but you never know. Yeah, it's the most beautiful job. Kimberley: I am known to sing intrusive thoughts to happy birthday songs. Joshua: That's a good one. I have to close my window though in my office because I do get scared that people walk past and like, "Wow, that's a very disturbed man." No, he's not. I'm confident in the powers of ERP and how it can help. Kimberley: You are. I love it. Josh, tell us where we can hear more about your book and learn more about you. Joshua: I'm Joshua Fletcher, also known as AnxietyJosh on social media and stuff. The book is called And How Does That Make You Feel?: Everything You (N)ever Wanted to Know About Therapy. It follows the stories of the four client case studies, obviously highly scrambled and anonymized, and gone through a rigorous ethical process there. So, don't be like, "He's talking about his clients." No, that's not what the book's about. It's about appearing in behind the therapy room door. It's out in the US before the UK, which is here. I don't know if anyone's watching or whatever, but there it is. And it's also been commissioned to be a television show for major streaming services. We don't know which one yet, but it's exciting. Go get yourself a copy. It should be in your bookstore. Get it at Barnes & Noble and all the other US ones. And I think you'll really enjoy it. So, it's a really lovely endorsement. Kim has also said it's really good, and Kim is harsh. So, if Kim says it's good, then it's going to be good. And I hope you really enjoy it and pass it on to a loved one who doesn't have anxiety, and you'll find that, "Oh, I actually learned quite a lot there whilst laughing and being captivated by the absolute bananas behind-the-scenes life of being a therapist." Kimberley: Yeah, I love it. Josh, the way that you present it, if I was scared to go to therapy, I think it would make me less scared. I think it would make me feel like this is something I could do. Joshua: And that's the best compliment I can receive, because that's why I wrote the book. So, thank you so much. Kimberley: Yeah. So fun to have you. Thanks for being here. Joshua: Thanks, Kim.

Feb 9, 2024

In the realm of mental health, the significance of structured daily routines for depression cannot be overstated. Kimberley Quinlan, an anxiety specialist with a focus on mindfulness, Cognitive Behavioral Therapy (CBT), and self-compassion, emphasizes the transformative impact that Daily Routines for Depression can have on individuals grappling with this challenging condition. Depression , characterized by persistent feelings of sadness, hopelessness, and a lack of interest in once-enjoyable activities, affects every aspect of one's life. Quinlan stresses that while professional therapy and medication are fundamental in the treatment of depression, integrating specific daily routines into one's lifestyle can offer a complementary path toward recovery and mental wellness. THE POWER OF MORNING ROUTINES FOR DEPRESSION Starting the day with a purpose can set a positive tone for individuals battling depression. Quinlan recommends establishing a consistent wake-up time to combat common sleep disturbances associated with depression. Incorporating light physical activity, such as stretching or a gentle walk, can significantly boost mood. Mindfulness practices, including meditation , journaling, or gratitude exercises, can help foster a healthier relationship with one's thoughts and emotions. Additionally, a nutritious breakfast can provide the necessary energy to face the day, an essential component of "Daily Routines for Depression." DAYTIME ROUTINES FOR DEPRESSION Throughout the day, setting realistic goals and priorities can help maintain focus and motivation. Quinlan advocates for the inclusion of pleasurable activities within one's schedule to counteract the anhedonia often experienced in depression. Techniques like the Pomodoro Method can aid in managing tasks without becoming overwhelmed, breaking down activities into manageable segments with short breaks in between. Exposure to natural light and ensuring a balanced diet further contribute to improving mood and energy levels during the day. EVENING ROUTINES FOR DEPRESSION As the day draws to a close, engaging in a digital detox and indulging in relaxation techniques become crucial. Limiting screen time and investing time in hobbies or skills can provide a sense of accomplishment and fulfillment. Establishing a calming bedtime routine , including activities like reading or taking a bath, can enhance sleep quality, an essential factor in "Daily Routines for Depression." WEEKLY ACTIVITIES TO OVERCOME DEPRESSION Quinlan also highlights the importance of incorporating hobbies and community engagement into weekly routines. Finding a sense of belonging and purpose through social interactions and new skills can offer a much-needed respite from the isolating effects of depression. NAVIGATING TOUGH DAYS WITH COMPASSION Acknowledging that the journey through depression is fraught with ups and downs, Quinlan advises adopting a compassionate and simplified approach on particularly challenging days. Focusing on basic self-care and seeking support when needed can provide a foundation for resilience and recovery. In conclusion, Daily Routines for Depression are not just about managing symptoms but about rebuilding a life where mental wellness is prioritized. Through mindful planning and self-compassion, individuals can navigate the complexities of depression and move towards a more hopeful and fulfilling future. PODCAST TRANSCRIPT If you're living with depression today, we are going to go through some daily routines for your mental wellness. Welcome. My name is Kimberley Quinlan. I'm an anxiety specialist. I talk all about mindfulness, CBT, self-compassion, and skills that you can use to help you with your mental wellness. Let's talk about living with depression , specifically about daily routines that will set you up for success. My goal first is to really highlight the importance of routines. Routines are going to be the most important part of your depression recovery, besides, of course, seeing your therapist and talking with your doctor about medication. This is the work that we do at home every day to set ourselves up for success, finding ways that we can manage our depression, overcome our depression by tweaking the way in which we live our daily life because the way we live our lives often will impact how severe our depression can get. There are some behaviors and actions that can very much exacerbate and worsen depression. And there are some behaviors and routines that can very much improve your depression. So, let's talk about them today. DEPRESSION SYMTPOMS Let's first just get really clear on depression and depression symptoms. Depression is a common and can be a very serious mental illness and medical condition that can completely negatively impact your life—the way you feel, the way you think, the way you act. It often includes persistent feelings of sadness, emptiness, hopelessness, worthlessness that can really impact the way you see yourself and your own identity. It often includes a lack of interest in pleasure in the activities that you once enjoyed. Depression symptoms can vary from mild to very severe. They can include symptoms such as changes in appetite, sleep disturbances, loss of energy, excessive guilt, difficulty thinking or concentrating. Sometimes you can feel like you have this whole brain fog. And again, deep, overwhelming feelings of worthlessness and hopelessness. Now, it is important to recognize that depression is not just a temporary bout of sadness. It's a chronic condition. It's one that we can actually recover from, but it does require a long-term treatment plan, a commitment to taking care of yourself, including therapy and medication. So, please do speak to your medical professional and a mental health professional if you have severe depression or think you might have severe depression. It can also include thoughts of wanting to die and not feeling like you want to live on this earth anymore. Again, if that's something that you're struggling with, please go to your local emergency room or immediately seek out professional mental health or medical health care. It is so important that you do get professional help for depression because, again, depression can come down like a heavy cloud on our shoulders, and it tells a whole bunch of lies. We actually have a whole podcast episode about how depression is a big fat liar. And sometimes when you are under the spell of those lies, it's hard to believe that anything else might be true. So, it's very important that we take it seriously. And as we're here today to talk about, it's to create routines that help really nurture you and help you towards that recovery. TREATMENT FOR DEPRESSION Before we move into those routines, I want to quickly mention the treatment for depression . The best treatment for depression is cognitive behavioral therapy. Now there is often a heavy emphasis on mindfulness and self-compassion as well. Cognitive behavioral therapy looks at both your thoughts and your behaviors. And it's important that we look at both because both can impact the way in which this disorder plays out. If you don't have access to a mental healthcare professional, we also have an online course called Overcoming Depression. Overcoming Depression is an on-demand online course where I teach you the exact steps that I use with my clients to propel them into setting up their cognition so that they're healthy, their behaviors, so that they bring a sense of pleasure and motivation, and structure into their daily lives. And then we also very heavily emphasize self-compassion and that mindfulness piece, which is so important when it comes to managing highly depressive and hopeless thoughts. So, that's there if you want to go to CBTSchool.com/depression, or you could go to CBTSchool.com, and we have all the links right there. DAILY ROUTINES FOR DEPRESSION All right, so let's talk about daily routines for depression. Research shows that, specifically for depression, finding a routine and a rhythm in your day can greatly improve the chances of your long-term recovery. And so, I really take time and slow down with my patients and talk to them about what routines are working and what routines are not. I'm not here to tell you or my patients, or my students how to live their lives and what to do specifically. I'm really interested at looking at what's working for you and what's not. Let's first start with morning routines. What often very much helps—and maybe you already have this, but if not, this is something I want you to consider—is the importance of a consistent wake-up time. When you're depressed, as I mentioned before, a common depression symptom is sleep disturbance. Often, people lay awake all night and sleep all day, or they sleep all night and they sleep all day, and they're heavily overwhelmed with this sleepy exhaustion. It is really important when it comes to morning routines that you set a time to wake up every morning and you get up, even if it's for a little bit, if that's all you can handle. Try to set that really consistent wake-up time. What I want to emphasize as we go through these routines for depression is I don't mind if you even do tiny baby steps. One thing you might want to start from all of the ideas I give you today, you might just want to pick one. And if that's all you can do, that is totally okay. What we also want to do is we want to, if possible, engage in some kind of light movement, even stretching, to boost mood. There's a lot of routine, even just stretching or gentle walks outside. It doesn't have to be fast. It doesn't have to be for an hour. It could be for a quarter of a block to start with. But that light exercise has been shown to boost mood significantly. And then if you're able, maybe even to do that multiple times throughout the day. Another morning routine that you may want to consider is some type of mindfulness practice. Again, we cover this in overcoming depression and with my patients in CBT, but some kind of mindfulness practice. It might be journaling, it could be a gratitude practice, it could be preferably some kind of meditation. Often, what I will encourage my clients to do is just listen to a guided meditation, even if you don't really follow along exactly. But you're just learning about these concepts. You're learning about the tools. You're getting curious about them if that's all you can do. Or if you want, you could even go more into reading a book about mindfulness, starting to learn about these ideas and concepts because they will, again, help you to have a better relationship with your thoughts and your feelings. Another morning routine I want you to maybe consider here is to have some type of nutritious breakfast, something that supports your mental health. We want to keep an eye out for excessive sugar, not that there's anything wrong with sugar, but it can cause us to have another energy dump, and we want to have something that will improve our energy. With depression, usually, we don't have much energy at all. So, whatever tastes yummy, even if nothing feels yummy, but there's something that maybe slightly sounds good, have that. If it's something that you enjoy or have good memories about, or if it's anything at all, I'm happy just for you to eat anything at all if it's not something that you've been doing. Let's now move over to work-day or daytime strategies or routines. The first thing I want you to consider here throughout the day is setting realistic daily goals and priorities. We have a course at CBT School called Optimum Time Management , and one of the core concepts of that course, which teaches people how to manage their time better, is we talk about first prioritizing what's most important. If you have depression, believe it or not, one of the most important things you can do to prioritize in your daily schedule is pleasure. And I know when you have depression, sometimes nothing feels pleasurable. But it's so important that you prioritize and schedule your pleasure first. Where in the day can you make sure that you do something enjoyable, even if it's this enjoyable, even if nothing is enjoyable, but you used to find it enjoyable? We want to prioritize your self-care, prioritize your eating, having a shower, brushing your teeth. If nothing else gets done that day, that's okay. But we want to prioritize them depending on what's important to you. Now, if you're someone who's depressed because you're so overwhelmed with everything that you have to do—again, we talk about this in the time management course—we want to really look at the day and look at the schedule and say, "Is this schedule nurturing a mental health benefit to me? Is it maybe time for me to reprioritize and take things off my schedule so I can get my mental health back up to the optimum level?" I have had to do this so many times in the last few years, especially as I have suffered a chronic illness, really separate like an hour to really look at the calendar and say, "Are these things I'm doing actually helping me?" Sometimes I found I was doing things for the sake of doing them to check them off the list, but I was getting no mental benefit from them. No real value benefit from them either. Another daytime strategy you can use is a technique or a tool called the Pomodoro Technique or the Pomodoro Method. This is where we set a timer for a very short period of time and we go and we do the goal and we focus on the thing for a short period of time. So, an example might be I might set a timer for 15 minutes, and all I'm going to do during that 15 minutes is write email. If 15 minutes is too much for you, let's say maybe you need to tidy up your dishes, you might set a timer for 45 seconds and just get done with what you can for 45 seconds and then take a short break. Then you set the timer again. All I have to do is 45 seconds or a minute and a half or three minutes or five minutes, whatever is right for you, and put your attention on just getting that short Pomodoro little bout done. This can be very helpful to maintain focus. It can be very helpful to maintain the stress of that activity, especially if it's an activity that you're dreading. And so, do consider the Pomodoro technique. You can download free apps that have a Pomodoro timer that will set you in little increments. It was actually, first, I think, created for exercise. So, it sets it like 45 minutes on, 20 seconds off, 45 seconds on. And so, you can do that with whatever task you're trying to get done as well. Another daytime routine I want you to consider is getting some kind of natural light or going outdoors. There is so much research to show that going outside, even if it's for three minutes, and taking in the green of the earth or the dirt under your feet, really getting in touch and grounding with some kind of nature, or being in the sunlight, can significantly improve mood. So, consider that as well. And again, I'm going to mention, make sure you eat lunch. Eat something that boosts your mood and boosts your energy levels. Now let's talk about evening or wind-down routines for depression or practices. Now, number one, one of the things that we often do the most, which we really need to be better about, and this is me too, is doing some kind of digital detox in the evenings. Try your hardest to limit screen time before bed because we know screens before bed actually disturb our sleep. We also know that often we spend hours, hours of our day scrolling on social media. And even though that might feel pleasurable, it actually removes us from engaging in hobbies and things that actually make us feel good about ourselves. One of the best ways to feel good about who you are and to feel accomplished is to be learning something or mastering something. I don't care if it's something that you're starting and you're terrible at. We have a lot of research that even moving and practicing a skill will improve and boost your mood so much more than an hour of sitting and watching funny TikTok videos. Now, again, if all you want to do is that for right now, that's fine. Maybe spend five minutes doing some hobby or task—something that you enjoy or used to enjoy—that you feel like you're getting better at. Maybe you learn Spanish, you learn to crochet, you learn to knit, you do paint by number. It doesn't matter what it is. Just pick something and work at something besides looking at a screen, especially in the evenings. Another evening routine I want you to consider is some kind of relaxation technique for depression—reading, take a bath, maybe do again some stretching or some light yoga, maybe dance to one song. Anything you can do to, again, move your body. Again, we have so much research to show that moving your body gently, especially in the evening, can help with mood. Another thing here is to find a comfortable sleep routine and bedtime routine. So, if you can, again, go back to your scheduling, and if you're not good at this—we do have that online course for time management—create a nighttime routine that feels yummy in your bones. Maybe it's reading a book, a lovely warm blanket, the pillow you love, a scent—sometimes an oil diffuser would be lovely for you. Dim the lights, close the blinds, create a nice, warm, cozy nook where you can then ease into your sleep. Overall, weekly activities and routines that you may want to consider for your mental wellness include again finding hobbies. It doesn't have to be grand. You don't have to sign up for a marathon. You don't have to become an amazing artist. You can just pick something that you suck at. That's okay. I always tell my patients to do paint by number. It requires very little mental energy, but you do have this cool thing that you did at the end that you can gift somebody, or you can even scrap it at the end, it doesn't matter. Put it up on your wall—anything to get you out of your head and out of the mood piece—and really get into your body, moving your hands and thinking about focusing on other things. One of the most important things that you can do to help boost mood and decrease depression is to find a community of like-minded people. The social interaction and improving and maintaining connections between people are going to be so important. In fact, in some countries, the treatment per se for depression, no matter how depressed somebody is, the community go and get them, bring them out, they have a party for them, they cook for them, they surround them, they dance with them. And that's how those communities and tribes help people get through depression. And we in our Western world have forgotten this beautiful, important piece of community and being a part of a big community family. Now, if you have struggled with this and it's been difficult, I encourage you to reach out to support groups. There are so many ways—meet-up groups, local charities, volunteering, maybe finding again a hobby, but a place where you go and you're with other people, even just doing that. You don't have to spend a lot of time, but being around people. Even though when you're depressed, I know it doesn't feel like that's a helpful thing. We do know that it does connect those neural pathways in our brain and does help with the management and maintenance of depression recovery. Now, what do we do, and how can we maintain these routines on the really tough days? When it comes to handling the tough days, I understand it can feel overwhelming. All of this can feel like so, so much. But what I'm going to encourage you to do is keep it really simple. Just doing your basic functioning is all that's required on those really tough days. It doesn't matter if you don't get all the things done on your list. Be compassionate, be gentle, encourage yourself, look at the things you did do instead of the things you didn't get to do, and also seek support. Reach out to your mental health professional or a support group or your medical doctor or family or a friend or a neighbor if you're really needing support. There will be hard days. Depression is not linear. Recovery for depression is not linear. It's up and down. There will be hard days. So, be as gentle as you can. Keep it as simple and as basic as you can. Do one thing at a time. Try not to focus at the whole day and all the things you have to do. That's going to help you feel less overwhelmed and, again, help you get through one thing a day. Let me do a quick recap. The importance of routine is huge. Routines are going to be probably one of the most important parts of your long-term recovery, besides, of course, treatment and medication. It will help you to get through the hard and stressful days and will also allow you to slowly make steps into the life that you want, and often, because we have depression, depression can take away the life that we want. So, that routine can help you slowly build up to the things that you want to do and get back to the life that you do really value. I encourage you all to play around with this. Remember, look at the routine you have already, and maybe add one thing for now. Take what works for you, but if some of the things I mentioned today, don't leave them. Please don't feel judged or embarrassed if some of these aren't really working for you. We have to look at what works for us and be very gentle with ourselves with that as well. I hope this has been helpful. The routines have really saved me in my mental health. And so, I hope it helps you just as much as it's helped me. Have a great day, and I'll see you guys next week.

Feb 2, 2024

In the insightful podcast episode featuring Joanna Hardis, author of "Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way," listeners are treated to a deep dive into the concept of distress tolerance and its pivotal role in mental health and personal growth. Joanna Hardis, with her extensive background in treating anxiety disorders such as panic disorder, OCD , and Generalized Anxiety Disorder, shares her professional and personal journey toward understanding and teaching the art of effectively managing internal discomfort without resorting to avoidance or escape tactics. The discussion begins with an exploration of the title of Joanna's book, " Just Do Nothing ," which encapsulates the essence of her therapeutic approach: the intentional practice of stepping back and allowing thoughts, feelings, and sensations to exist without interference. This practice, though seemingly simple, challenges the common impulse to engage with and control our internal experiences, which often exacerbates suffering. A significant portion of the conversation is dedicated to " distress intolerance ," a term that describes the perceived inability to endure negative emotional states. This perception leads individuals to avoid or escape these feelings, thereby increasing vulnerability to a range of mental health issues including anxiety, depression, and substance abuse. Joanna emphasizes the importance of recognizing and altering the self-limiting beliefs and thoughts that fuel distress intolerance. Practical strategies for enhancing distress tolerance are discussed, starting with simple exercises like resisting the urge to scratch an itch and gradually progressing to more challenging scenarios. This gradual approach helps individuals build confidence in their ability to manage discomfort and makes the concept of distress tolerance applicable to various aspects of life, from parenting to personal goals. Mindfulness is highlighted as a crucial component of distress tolerance, fostering an awareness of our reactions to discomfort and enabling us to respond with intention rather than impulsivity. The podcast delves into the importance of connecting with our values and reasons for enduring discomfort, which can provide the motivation needed to face challenging situations. Joanna and Kimberley also touch on the common traps of negative self-talk and judgment that can arise during distressing moments, advocating for a more compassionate and accepting stance towards oneself. The idea of "choice points" from Acceptance and Commitment Therapy (ACT) is introduced, encouraging listeners to make decisions that align with their values and move them forward, even in the face of discomfort. The episode concludes with a message of hope and empowerment: everyone has the capacity to work on expanding their distress tolerance. By starting with small, manageable steps and gradually confronting more significant challenges, individuals can cultivate a robust ability to navigate life's inevitable discomforts with grace and resilience. EPISODE HIGHLIGHTS: The Concept of "Just Do Nothing": This core idea revolves around the practice of intentionally not engaging with every thought, feeling, or sensation, especially when they're distressing. It's about learning to observe without action, which can reduce the amplification of discomfort and suffering. Understanding Distress Intolerance: Distress intolerance refers to the belief or perception that one cannot handle negative internal states, leading to avoidance or escape behaviors. This concept highlights the importance of recognizing and challenging these beliefs to improve our ability to cope with discomfort. Building Distress Tolerance: The podcast discusses practical strategies to enhance distress tolerance, starting with simple exercises like resisting the urge to scratch an itch. The idea is to gradually expose oneself to discomfort in a controlled manner, thereby building resilience and confidence in handling distressing situations. Mindfulness and Awareness: Mindfulness plays a crucial role in distress tolerance by fostering an awareness of our reactions to discomfort. This awareness allows us to respond intentionally rather than react impulsively. The practice of mindfulness helps in recognizing when we're "gripping" distressing thoughts or sensations and learning to gently release that grip. Aligning Actions with Values: The podcast emphasizes the significance of connecting actions with personal values, even in the face of discomfort. This alignment can motivate us to face challenges and make choices that lead to personal growth and fulfillment, rather than making decisions based on the urge to avoid discomfort. These concepts together form a comprehensive approach to managing distress and enhancing personal well-being, as discussed by Joanna Hardis in the podcast episode. TRANSCRIPTION: Kimberley: Welcome, everybody, today. We have Joanna Hardis. Joanna wrote an amazing book called Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way . It was a solid gold read. Welcome, Joanna. Joanna: Thank you. Thank you for having me. Thank you for reading it, too. I appreciate it. Kimberley: It was a wonderful read and so on point, like science-backed. It was so good, so you should be so proud. Joanna: Thank you. Kimberley: Why did you choose the title Just Do Nothing ? Joanna: I mean, it's super catchy, but more importantly than that, it is really what my work involves on a personal level and on a professional level—learning how to get out of my own way or our own way by leaving our thoughts alone, learning how to leave uncomfortable feelings alone, uncomfortable sensations alone, uncomfortable thoughts alone. Because that's what creates the suffering—when we get so engaged in them. Kimberley: Yeah. It's such a hard lesson. I talk about this with patients all the time. But as I mentioned to you, even my therapist is constantly saying, "You're going to have to just feel this one." And my instinct is to go, "Nope. No thanks. There has to be another way." Joanna: A hundred percent. Yes. I mean, it really is something on a daily basis. I have to remind myself and work really hard to do. Kimberley: It is. But it is such powerful work when you do it. Joanna: Mm-hmm. Kimberley: Early in the book, you talk about this term or this concept called 'distress intolerance.' Can you tell us what both of those are and give us some ideas on why this is an important topic? Joanna: Sure, and this is what got me interested in the book and everything. Distress tolerance is a perception that you can handle negative internal states. And those internal states can be that you feel anxious, that you feel worried, you feel bored, vulnerable, ashamed, angry, sad, mad, off. There's an A to Z alphabet of those unpleasant and uncomfortable emotional states. And when we have that perception that we can handle it, our behavior aligns, so we tend to do things. When we are distress-intolerant, we have a perception—often incorrect—that we cannot handle negative internal states. So then we will either avoid them or escape them or try to figure them out or neutralize them or try to get rid of them, make them stop—all the things that we see in our work every day. Before I had my practice in anxiety disorders, I worked over a decade in an eating disorder treatment center, and we know that when someone has really low distress tolerance, they are more vulnerable to developing eating disorders, anxiety disorders, depressive disorders, substance use disorders. So, it's a really important concept. Kimberley: It's such an important concept. And you talk about how the thoughts we have which can determine that. Do you want to share a little bit about that? Because there was a whole chapter in the book about the thoughts you have about your ability to tolerate distress. Joanna: Sure, and I didn't answer the second part of your question., I just realized, which will tie into that, which is how it sounds. How it sounds is, "I can't bear to feel this way, so I'm going to avoid that party," or "I'm having too good of a day, so I can't do my homework," or "I can't bear if my kids see me anxious, so we're not going to go to the playground." And so, what drives someone's perception are their thoughts and these thoughts and these self-limiting stories that we all have, and that oftentimes we just buy into as either true, or perhaps at one point, they may have been true, but we've outlived them. Kimberley: Yeah. We're talking about distress tolerance, and I'm always on the hunt to widen my distress tolerance to be able to tolerate higher levels of distress. And I think what's interesting is, first, this is more of a question that I don't know the science behind it, but do you think some people have higher levels of distress which makes them more intolerant, or do you think the intolerance which is what makes the distress feel so painful? Joanna: I don't know the research well enough to answer it. Because I think it's rare that you see -- I mean, this is just one construct. So it's very hard to isolate it from something like emotional sensitivity or anxiety sensitivity or intolerance for uncertainty, or something else that may be contributing to it. Kimberley: Yeah. No, I know. It's just a question I often think about, particularly when I'm with patients. And this is something that I think doesn't really matter at the end of the day. What matters is—and maybe this will be a question for you—if our goal is to increase our distress tolerance, how might somebody even begin to navigate that? Joanna: Sure. I love that question. I mean, in the book, I take it down to such a micro level, which is learning how—and I think you've talked about it on podcasts—itch serve. So, one of the exercises in the book is learning how you set your timer for five minutes and you get itchy, which of course is going to happen. And it's learning how to ride out that urge to scratch the itch. So, paying attention to. If you zoom in on the itch, what happens? What happens when you zoom out? What else can you pay attention to? And so when someone learns that process, that is on such a micro level. I often tell patients it's like a one-pound weight. Kimberley: Yes. Joanna: And then what are some two-pound weights that people can use? So then, for many people, it's their phone. So, it's perhaps not checking notifications that come in right away. They begin to practice in low-distress situations because I want people to get confident that they know how to zoom in, they know how to zoom out. They know if they're feeling a sensation, the more that they pay attention to it, the worse it's going to feel. And so, where else can they put their awareness? What else can they be doing? And once they get the hang of it, we introduce more and more distress. So then, it might be their phone, then it might be them intentionally calling up a thought. And we work up that way with adding in, very gradually, more distress or more discomfort. Exercise is a great way, especially if it's not married to anxiety, to get people interacting with it differently. Kimberley: Yeah. We use this all the time with anxiety disorders. It's a different language because we talk about an ERP hierarchy, or your exposure menu, and so forth. But I love that in the book, it's not just specific to that. It could be like you talked about. It's for those who have depression. It's those who have grief. It's those who have eating disorders. It's those who have anger. I will even say the concept of distress tolerance to me is so interesting because there's so many areas of my life where I can practice it. Like my urgency to nag my kids another time to get out the door in time, and I have to catch like, "You don't need to say it the third time." Can you tolerate your own discomfort about the time it's taking them to get out the door? And I think that when we have that attitudinal shift, it's so helpful. Joanna: Yes. I find parenting as one of the hardest places for me, but it was also a reminder like the more I keep my mouth shut, the better. Kimberley: Yeah. And I think that's really where I was talking before. I found parenting to be quite a triggering process as my kids have gotten older, but so many opportunities for my own personal growth using this exact scenario. Like your fear might come up, and instead of engaging in that fear, I'm actually just going to let it be there and feel it and parent according to my values or act according to my values. And I've truly found this to be such a valuable tool. Joanna: Yes. And I have found what's been really interesting, when my kids were at home, that was where my distress was. Now that the two of the three are out of the house, my distress is when we're all together and everyone have a good time. And so, it morphs, because what I tell myself and my perception and the urgency, it changes. It's still so difficult with them, but it changes based on what's happening. Kimberley: Yeah. And I think this is an opportunity for everyone, too. How much do you feel that awareness piece is important in being aware that you are triggered? For the folks listening, of course, you're on the Your Anxiety Toolkit podcast. Most are listening because they have anxiety. Do you encourage them to be aware of other areas? They can be practicing this. Joanna: Yes. Kimberley: Can you talk to me about that? Joanna: 100%, because I feel like -- what is that metaphor about the onion? It's like the layers of an onion. So, people will come, and they'll think it's about their anxiety. But this is really about any uncomfortable feeling or uncomfortable sensation. And so. It may be that they're bored or vulnerable or embarrassed or something else. So, once someone learns how to allow those feelings and do what is important to them or what they need to do while they feel it, then yes, I want them to go and notice where else in their life this is showing up. Kimberley: Talk to me specifically about how in real-time, because I know that's what listeners are going to ask. Joanna: Of course. Kimberley: I have this scary thing I want to be able to do, but I don't want to do it because I'm scared, and I don't want to feel scared. How might someone practice tolerating their distress in real-time? Joanna: I'm going to answer two ways. One, I would say that might be something to scale. Sometimes people want to do the thing because doing the thing is like the goal or the sexy thing, but if it's outside of their window of tolerance, they may not be able to do it. So, it depends on what they want to do. So, I might say, as just a preface, this might be something that people should consider scaling. Kimberley: Gradual, you mean? Joanna: Yes. So, for instance, they want to go to the gym, but they're scared of fainting on the treadmill or something. Pretty common for what we see. It would be like, scale it back. So it might be going to the parking lot. It might be taking a tour. It might be going and standing on the treadmill. It might be walking on the treadmill. But we have to put it in smaller pieces. In the moment that we're doing something that is difficult, first, we have to notice if we're starting to grip. I use this "if we're starting to grip" something. If we're starting to zoom in on what we don't like, if we're starting to zoom in on a sensation we don't like, a thought we don't like, a feeling we don't like, I want people to notice that and you get better at noticing it faster. The first thing is you got to notice it, that it's happening, because that's going to make it worse. So, you want to be able to notice it. You want to be able to loosen your grip on it. So, that might be finding out what else is going on in my surroundings. So, I'm on the treadmill, I'm walking maybe at a faster pace, and I'm noticing that my heart rate is going up, and I'm starting to zoom into that. What else am I noticing, or what else am I hearing? What else do I see? What else is going on around me? Can we make something else a louder voice? And so, every time that my brain wants to go back to heart focus, it's like, no, no. It's taking it back to something else that's going on. And it helps to connect with why is this important to do? So, as I'm continuing to say, "I'm okay. I am safe. I'm listening. I'm focusing on my music, and I'm looking out the window," This is really important to do because my health is important. My recovery is important. It becomes that you're connecting to something that's important, and the focus is not on what we don't like because that's going to make it bigger and stronger. Kimberley: Right. As you're doing that, as we've already mentioned, someone might be having those can't thoughts, like I can't handle it, even if it's within their window of tolerance, right? It's reasonable, and it's an appropriate exposure. How might they manage this ongoing "You can't do this, this is too hard, it's too much, you can't handle it" kind of thinking? Joanna: I like "This may suck, and I can do it." Kimberley: It's funny. I will tell you, it's hilarious. In the very beginning of the book, you make some comments about the catchphrases and how you hate them, and so forth. I always laugh because we have a catchphrase over here, but it's so similar to that in that we always talk about, like it's a beautiful day to do hard things. And that seems to be so hopeful for people, but I do think sometimes we do get fed, like over positive ways. You have a negative thought, so we respond very positively, right? And so, I like "This is going to suck, and I'm going to do it anyway." Joanna: Yes. So you're acknowledging this may suck, especially if you're deconditioned, especially if you're scared. It may suck AND—I always tell people not the BUT—AND I can do it. Even in 30-second increments. So, if someone is like, "I can't, I cant," I'll say, "You can do anything for 30 seconds." So then we pile on 30 seconds. Kimberley: Yeah. And that's such an important piece of it too, which is just taking a temporary mindset of we can just do this for a little tiny bit and then a little tiny bit and then a little tiny bit. Joanna: Yes, I love that. I love that. Kimberley: Why do we do this? What's the draw? Sell me on why someone wants to do this work. Joanna: To do...? Kimberley: Distress tolerance. We talk about this all the time. Why do we want to widen our distress tolerance? Joanna: Oh my goodness. Oh my gosh. I think once you realize all the little areas that may be impacting one's life, it just blows your mind. But in a practical sense, people can stay stuck. When people are stuck. This is often a piece. It's absolutely not the whole reason people are stuck, but this is such a piece of why people get stuck. And so I think for anyone that might feel stuck, perhaps they want a different job or they want to show up differently as a parent or they feel like they are people-pleasers, or they're having trouble dating because they get super controlling. It can show up in any area of one's life. Kimberley: Yeah. For me, the selling point on why I want to do it is because it's like a muscle—if I don't continue to grow this muscle, everything feels more and more scary. Joanna: Oh, sure. Yeah, hundred percent. Kimberley: The more I go into this mindset of "You can't handle it and it's too much, it's too scary" things start to feel more scary. The world starts to feel more unsafe, whereas that attitude shift, there's a self-trust that comes with it for me. I trust that I can handle things. Whereas if I'm in the mindset of "I can't," I have no self-trust. I don't trust that I can handle scary things, and then I'm constantly hypervigilant, thinking when the next scary thing's going to happen. Joanna: Right. Another reason to also practice doing it, if you never challenge it, you don't get the learning that you can do it. Kimberley: Yeah. There's such empowerment with this work. Joanna: Yes. And you don't have to do big, scary things. You don't have to jump out of an airplane to do it or pose naked, because I see that on Instagram now, people who are conquering their fears by doing these. Very Instagram-worthy tasks, which could be very scary. We can do it, just like you say, with not nagging our kids, by choosing what I want to make for dinner versus making so many dinners because I am so scared that I can't handle it if my kids are upset with me. Kimberley: Right. And for those who have anxiety, I think from the work I do with my patients is this idea of being uncertain feels intolerable. That feeling. You're talking about these real-life examples. And for those who are listening with anxiety, I get it. That feeling of uncertainty feels intolerable, but again, that idea of widening your tolerance or increasing your ability to tolerate it in 10-second increments can stop you from engaging in compulsions that can make your disorder worse or avoiding which can make your disorder worse. Do you have any thoughts on that? Joanna: I 100% agree with you. I always say, let's demote intolerable to uncomfortable. Because I feel sometimes like I have to know I can't stand it, I'm crawling out of my skin. But if I'm then able to get some distance from it, that's the urgency of anxiety. Kimberley: Yeah. It's such beautiful work. Joanna: Yes, and especially the more people do, they're able to say, "You know what? I can do things." It may feel intolerable. That diffusion, it may feel intolerable. It's probably uncomfortable. So, what is the smallest next step I can take in this situation to do what I need to do and not make it worse? That's a big thing of mine—not making a situation worse. Kimberley: Yes. And that's where the do-nothing comes in. Joanna: Yes. That's the paradoxical part. Kimberley: Yeah. Is there any area of this that you feel like we haven't covered that's important to you, that would be an important piece of this work that someone may consider as they're doing this work on their own? Joanna: I think and I know that you are a big proponent of this too. I think it's very hard to do this work without some mindful awareness practice. And I talk about it in the book. It's just such an enhancer. It enhances treatment, but it also enhances our daily life. So, I can't say strongly enough that it is so important for us to be able to notice this pattern when we are saying, "Oh my gosh, I can't take this," or "I can't do this." And then the behavior and to think about what's the function of me avoiding. But if we're going so fast and our gas pedal is always to the floor, we don't have the opportunity to notice. Kimberley: Yeah, the mindfulness piece is so huge. And even, like you're saying, the mindfulness piece of the awareness but also the non-judgment in mindfulness. As you're doing the hard thing, as you're tolerating distress, you're not sitting there going, "This sucks and I hate it." I mean, you're saying like it will suck, and that's, I think, validating. It validates you, but not staying in "This is the worst, and I hate it, and I shouldn't be here." That's when that suffering does really show up. Joanna: Yes. The situation may suck. It doesn't mean I suck. That was a hard lesson to learn. The situation may, but I don't have to pour gas on it by saying, "How long is it going to last? Oh my gosh, this feeling's never going to end. Do I still feel it? Oh my gosh, do I still feel it as much?" All the things that I'm prone to do or my clients are prone to do that extend the suffering. Kimberley: Make it worse. Joanna: Yeah, exactly. Kimberley: It's a great question, actually. And I often will talk with my patients about it, in the moment, when they're in distress. Sometimes writing it down, like what can we do that would make this worse? What can we do that will make this better? And sometimes that is doing nothing at all. And you do talk about that in the book. Joanna: Yeah. Kimberley: The forward and the backward. Joanna: The choice points. Yes. Kimberley: Can you share just a little bit about that? Joanna: It's a concept from ACT (Acceptance and Commitment Therapy) that says, when we have a behavior, a behavior can either move us toward or forward what's meaningful in our values or can move us away from it. And so, as we're thinking about doing whatever the hard thing maybe or it may not even be a hard thing; it just may be something you don't want to do. Thinking about what your why is, what's the forward move? Why is it meaningful to you? What do you stand to get? What's on the other side? Because most of us are well versed, and if we give in, that's an away move. And we have to be able to do this non-judgmentally because some days it's just not in us, and that's totally fine. But I want people to be honest with themselves and non-judgmental about whatever decisions they make. But it does help to have a reason that moves us forward. Kimberley: Absolutely. I think that's such an important piece of the work. Again, that's the selling point of why we would want to be uncomfortable. There's a goal or a why that gets us there. Joanna: Yeah. And it's amazing how much pain we will put up with. I mean, think about all the things people like—waxing and some of these exercise classes. It's amazing because it's important to someone. Kimberley: Exactly. And I think that's a great point too, which is we do tolerate distress every day when we really are clear on what we want. And I think sometimes we have these things like I can't handle it, but you might even ask like, what are some harder things that I've actually tolerated in my lifetime? Joanna: Yes, exactly because there's a lot of things you're so right that we do that are uncomfortable, but it's worth it because, for whatever reason, it's worth it. Kimberley: Yeah, I love this. I have loved chatting with you. I know I've asked you this already, but is there any final words you want to share before we learn more about you and where people can get in touch with you? Joanna: I just want people to know that anybody can do this. It may be that it's just creating the right scale—a small enough step forward—but anybody can work on this. There are so many areas and ways in which we can strengthen this muscle. And so there is hope. No one is broken. It may be that people just don't know the next best move. Kimberley: I love that. Thank you. Where can people hear more about you and get in touch with you? Joanna: My website is JoannaHardis.com and my Instagram is the same thing, @JoannaHardis. And excitingly, the book just came out in audio yesterday. Kimberley: Congratulations. Joanna: Thank you. Thank you. Kimberley: That's wonderful. And we can get the book wherever books are sold. Joanna: Wherever books are sold, yes. Kimberley: I really do encourage people to buy it. I think it's a book you could pick up and read once a year, and I think that there's messages. You know what I'm saying? There are some books where you could just revisit and take something from, so I would really encourage people to buy the book and just dabble in the many concepts that you share. Joanna: Wonderful. Thank you. Kimberley: Yeah. Thank you so much for being on the show. This is such a concept and a topic that I'm really passionate about, and for myself too. I think it's something I'll be working on until I'm 99, I think. Joanna: Me too. I'm with you right there. Kimberley: There's always an opportunity where I'm like, "Oh okay. There's another opportunity for me to grow. All right, let's get on board. Let's go back to the school." So, I think it's really wonderful. Thank you so much for being here. Joanna: Thank you so much for having me.

Jan 26, 2024

Visual Staring OCD (also known as Visual Tourrettic OCD), a complex and often misunderstood form of Obsessive-Compulsive Disorder, involves an uncontrollable urge to stare at certain objects or body parts, leading to significant distress and impairment. In an enlightening conversation with Kimberley, Matt Bannister shares his journey of overcoming this challenging condition, offering hope and practical advice to those grappling with similar issues. Matt's story begins in 2009, marked by a sense of depersonalization and dissociation, which he describes as an out-of-body experience and likened to looking at a stranger when viewing himself in the mirror. His narrative is a testament to the often-overlooked complexity of OCD , where symptoms can extend beyond the stereotypical cleanliness and orderliness. Kimberley's insightful probing into the nuances of Matt's experiences highlights the profound impact of Visual Staring OCD on daily life. The disorder manifested in Matt as an overwhelming need to maintain eye contact, initially with female colleagues, out of fear of being perceived as disrespectful. This compulsion expanded over time to include men and intensified to such a degree that Matt felt his mind couldn't function normally. The social implications of Visual Staring OCD are starkly evident in Matt's recount of workplace experiences. Misinterpretation of his behavior led to stigmatization and gossip, deeply affecting his mental well-being and leading to self-isolation. Matt's story is a poignant illustration of the societal misunderstandings surrounding OCD and its variants. Treatment and recovery form a significant part of the conversation. Matt emphasizes the role of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in his healing process. However, he notes the initial challenges in applying these techniques, underscoring the necessity of a tailored approach to therapy. Kimberley and Matt delve into the power of community support in managing OCD. Matt's involvement with the IOCDF (International OCD Foundation) community and his interactions with others who have overcome OCD, like Chris Trondsen, provide him with valuable insights and strategies. He speaks passionately about the importance of self-compassion, a concept introduced to him by Katie O'Dunne, and how it transformed his approach to recovery. A critical aspect of Matt's journey is the realization and acceptance of his condition. His story underscores the importance of proper diagnosis and understanding of OCD's various manifestations, which can be as unique as the individuals experiencing them. Matt's narrative is not just about overcoming a mental health challenge; it's a story of empowerment and advocacy. His transition from a struggling individual to a professional peer support worker is inspiring. He is now dedicated to helping others navigate their paths to recovery, using his experiences and insights to offer hope and practical advice. In conclusion, Matt Bannister's journey through the complexities of Visual Staring OCD is a powerful testament to the resilience of the human spirit. His story offers valuable insights into the disorder, challenges misconceptions, and highlights the importance of tailored therapy, community support, and self-compassion in overcoming OCD. For anyone struggling with OCD , Matt's story is a beacon of hope and a reminder that recovery, though challenging, is within reach. Instagram - matt bannister27 Facebook - matthew.bannister.92 Facebook group - OCD Warrior Badass Tribe Email :matt3ban@hotmail.com Kimberley: Welcome back, everybody. Every now and then, there is a special person that comes in and supports me in this way that blows me away. And today we have Matt Bannister, who is one of those people. Thank you, Matt, for being here today. This is an honor on many fronts, so thank you for being here. Matthew: No, thank you for bringing me on, Kim. This is a huge honor. I'm so grateful to be on this. It's just amazing. Thank you so, so much. It's great to be here. Kimberley: Number one, you have been such a support to me in CBT School and all the things that I'm doing, and I've loved hearing your updates and so forth around that. But today, I really want you to come on and tell your story from start to end, whatever you want to share. Tell us about you and your recovery story. Matthew: Sure. I mean, I would like to start as well saying that your CBT School is amazing. It is so awesome. It's helped me big time in my recovery, so I recommend that to everyone. I'm an IOCDF grassroots advocate. I am super passionate about it. I love being involved with the community, connecting with the community. It's like a big family. I'm so honored to be a part of this amazing community. My recovery story and my journey started back in 2009, when—this is going to show how old I am right now—I remember talking on MSN. I remember I was talking; my mind went blank in a conversation, and I was like, "Ooh, that's weird. It's like my mind's gone blank." But that's like a normal thing. I can just pass it off and then keep going forward. But the thing is with me. It didn't. It latched on with that. I didn't know what was going on with me. It was very frightening. I believe that was a start for me with depersonalization and dissociation. I just had no idea of what it was. Super scary. It was like I started to forget part of my social life and how to communicate with people. I really did start to dissociate a lot when I was getting nervous. And that went on for about three or four years, but it gradually faded naturally. Kimberley: So you had depersonalization and derealization, and if so, can you explain to listeners what the differences were and how you could tell the differences? Matthew: Yeah. I think maybe, if I'm right with this, with the depersonalization, it felt like I knew how it was, but I didn't at the same time. It was like when I was looking in a mirror. It was like looking at a stranger. That's how it felt. It just felt like I became a shell of myself. Again, I just didn't know what was happening. It was really, really scary. I think it made it worse. With my former friends at that time, we'd make fun of that, like, "Oh, come on, you're not used to yourself anymore. You're not as confident anymore. What's going on? You used to try and take the [03:19 inaudible] a lot with that." With the dissociation, I felt like I was having an out-of-body experience. For me, if I sat in a room and it was really hitting me hard, as if I were anxious, it would feel like I was floating around that room. I couldn't concentrate. It was very difficult to focus on things, especially if it was at work. It'd be very hard to do so. That came on and off. Kimberley: Yeah, it's such a scary feeling. I've had it a lot in my life too, and I get it. It makes you start to question reality, question even your mental health. It's such a scary experience, especially the first time you have it. I remember the first time I was actually with a client when it started. Matthew: Yeah, it is. Again, it is just a frightening experience. It felt like even when I was walking through places, it was just fog all the time. That's how it felt. I felt like someone had placed a curse on me. I really believe that with those feelings, and how else can I explain it? But that did eventually fade, luckily, in about, like I said, three to four years, just naturally on its own. When I had those sensations, I got used to that, so I didn't put as much emphasis on those situations. Then I carried on naturally through that. Then, well, with going through actually depersonalization, unfortunately, that's when my OCD did hit. For me, it was with, I believe, relationship OCD because I was with someone at the time. I was constantly always checking on them, seeing if they loved me. Like, am I boring you? Because I thought of depersonalization. I thought I wasn't being my full authentic self and that you didn't want to be within me anymore. I would constantly check my messages. If they didn't put enough kisses on the end of a message, I think, "Oh, they don't love me as much anymore. Oh no, I have to check." All the time, even in phone calls, I always made sure to hear that my partner would say, "Oh, I love you back," or "I love you." Or as I thought, I did something wrong. Like they're going off me. I had a spiral, thinking this person was going to cheat on me. It went on and on and on and on with that. But eventually, again, the relationship did fade in a natural way. It wasn't because of the OCD; it was just how it went. And then, with relationship OCD , with that, I faded with that. A search with my friends didn't really affect me with that. Then what I can recall, what I have maybe experienced with OCD, I've had sexual orientation OCD . Again, I was questioning my sexuality. I'm heterosexual, and I was in another warehouse, a computer warehouse, and it was all males there. I was getting what I describe as intrusive thoughts of images of doing sexual acts or kissing and stuff like that. I'm thinking, "Why am I getting these thoughts? I know where my sexuality is." There's nothing wrong, obviously, with being homosexual or queer. Nothing wrong with that at all. It's just like I said, that's how it fades with me. I mean, it could happen again with someone who's queer, and it could be getting heterosexual thoughts. They don't want that because they know they're comfortable with their sexuality. But OCD is trying to doubt that. But then again, for me, that did actually fade again after about five or six months, just on its own. And then, fast forward two years later is when the most severe theme of OCD I've ever had hit me hard like a ton of bricks. And that for me was Visual Tourettic OCD, known as Staring OCD, known as Ocular Tourettic OCD. And that was horrendous. The stigma I received with this theme was awful. I remembered the day when it hit me, when I was talking to a female colleague. Like we all do, we all look around the room and we try and think of something to say, but my eyes just landed on the chest, like just an innocent look. I'm like, "Oh my God, why did I do that? I don't want to disrespect this person in front of me. I treat her as an equal. I treat everyone the same way. I don't want to feel like she's being disrespected." So I heavily maintained eye contact after that. Throughout that conversation, it was fine. It was normal, nothing different. But after that, it really latched onto me big time. The rumination was massive. It was like, you've got to make sure you're giving every single female colleague now eye contact. You have to do it because you know otherwise what stigma you could get. And that went on for months and years, and it progressed to men as well a couple of years later. It felt like my mind can't function anymore. I remember again I was sitting next to my friend, who was having a game on the PlayStation. And then I just looked at his lap, just for no reason, just looked at his lap, and he said, "Ooh, I feel cold and want to go and change." I instantly thought, "Oh my God, is it because he thought I might have stared that I creeped him out?" And then it just seriously latched onto me big time. As we all know, with this as well, when we think of the pink elephant allergy, it's like when we don't think of the pink elephant, what do we do? And that's what it was very much like with this. I remember when it started to get really bad, my eyes would die and embarrass somebody part places. It was like the more anxious I felt about not wanting to do it, the more it happened, where me and my good friend, Carol Edwards, call it a tick with the eye movement. So like Tourette, let's say, when you get really nervous, I don't know if this is all true. When someone's really nervous, maybe they might laugh involuntarily, like from the Joker movie, or like someone swearing out loud. This is the same thing with eye movement. Every time I was talking to a colleague face-to-face to face, I was giving them eye contact, my mind would be saying to me, "Don't look there, don't look there, don't look there," and unfortunately think it would happen. That tick would happen. It would land where I wouldn't want it to land. It was very embarrassing because eventually it did get noticed. I remember seeing female colleagues covering their hi vis tops, like across their arms. Men would cover their crotches. They would literally cross their legs very blatantly in front of me. Then I could start to hear gossip. This is when it got really bad, because I really heard the stigma from this. No one confronted me by the way of this face-to-face, but I could hear it crystal clear. They were calling me all sorts, like deviant or creep or a perv. "Have you seen his eyes? Have you seen him looking and does that weird things with his eyes? He checks everyone out." It was really soul-destroying because my compulsion was to get away from everyone. I would literally hide across a room. Where no one else was around, I would hide in the cubicles because it was the only place where I wasn't triggered. It got bad again. It went to my family, my friends, everyone around me. It didn't happen with children, but it happened with every adult. It was horrendous. I reached out to therapy. Luckily, I did get in contact with a CBT therapist, but it was talk therapy. But it's better than nothing. I will absolutely take that. She was amazing. I can't credit my therapist enough. She was awesome. If this person, maybe this is like grace, you're amazing, so thank you for that. She was really there for me. It was someone I could really talk to, and it can help me and understand as best as she could. She did, I believe, further research into what I had. And then that's when I finally got diagnosed that I had OCD. I never knew this was OCD, and everything else made sense, like, "Oh, this is why I was going through all those things before. It all now makes concrete sense what I was going through." Then I looked up the Facebook group called Peripheral Vision/Visual Tourettic OCD. That was a game-changer for me. I finally knew that I wasn't alone because, with this, you really think you're alone, and you are not. There are thousands of people with this, or even more. That was truly validating. I was like, "Thank God I'm not the only one." But the problem is, I didn't really talk in that group at first because I thought if other people saw me writing in that group, it's going to really kill my reputation big time. That would be like the final nail in the coffin. Even though it was a private group, no one could do that. But I didn't still trust it that much at that time. I was doing ERP, and I thought great because I've researched ERP. I knew that it's effective. Obviously, it's the gold standard. But for me, unfortunately, I think I was doing it where I was white-knuckling through exposures. Also, when I was hearing at work, still going back to my most triggering place, ERP, unfortunately, wasn't working for me because I wasn't healing. It was like I was going through the trigger constantly. My mind was just so overwhelmed. I didn't have time to heal. I remember I eventually self-isolated in my room. I didn't go anywhere. I locked myself away because I thought I just couldn't cope anymore. It was a really dark moment. I remember crying. It was just like despair. I was like, "What's happening to me? Why is all this happening to me?" Later on, I did have the choice at work. I thought, I can either go through the stillest, hellacious process or I can choose to go on sick leave and give my chance to heal and recover. That's why I did. And that was the best decision I ever made. I recommend that to anyone who's going through OCD severely. You always have a choice. You always have a choice. Never pressure yourself or think you're weak or anything like that, because that's not the case. You are a warrior. When you're going through things like this, you are the most strongest person in the world. It takes a lot of courage to confront those demons every single day to never ever doubt yourself with that. You are a strong, amazing individual. When I did that, again, I could heal. It took me two weeks. Unfortunately, my therapy ended. I only had 10 sessions, but I had to wait another three months for further therapy in person, so I thought, "Oh, at least I do eventually get therapy in person. That's amazing." And then the best thing happened to me. I found the IOCDF community. Everything changed. The IOCDF is amazing. The best community, in my opinion, the world for OCD. My god, I remember when I first went on Ethan's livestream with Community Conversations. I reached out to Ethan, and he sent me links for OCD-UK. I think OCD Action as well. That was really cool of him and great, and I super appreciate that, and you knew straight away because I remember watching this video with Jonathan Grayson, who is also an amazing guy and therapist, talking about this. I was like, again, this is all that I have. And then after that, I reached out to Chris Trondsen as the expert. What Chris said was so game-changing to me because he's gone through this as well and has overcome it. He's overcome so many severe themes of OCD. I'm like, "This guy is amazing. He is an absolute rock star. Literally like a true champion." For someone to go through as much as he has and to be where he is today, I can't ask for any more inspirement from that. It's just incredible. He gave some advice as well in that livestream when we were talking because I reached out and said, how did you overcome this? He said, "With the staring OCD, well, I basically told myself, while I'm staring, well, I might as well stare anyway." And that clicked with me because I'm thinking he's basically saying that he just didn't give it value anymore. I'm like, "That's what I've been doing all this time. I've given so much value, so much importance. That's why it keeps happening to me." I'm like, "Okay, I can maybe try and work with this." Then I started connecting with Katie O'Dunne, who is also amazing. She was the first person I actually did hear about self-compassion. I'm like, "Yes, why didn't I learn about this early in my life? Self-compassion is amazing. I need to know all about this." It makes so much sense. Why'd I keep beating myself up when I treat a friend, like when I talked to myself about this? No, I wouldn't. I just watched Katie's streams and watched her videos and Instagram. It was just an eye-opener for me. I was like, "Wow, she's talking about, like, bring it on mindset as well with this." When you're about to face the brave thing, just say, "Bring it on. Just bring on," like The Rock says. "Just bring it. I just love that. That's what I did. That's what I started doing. I connected as well with my friend, Carol Edwards, who is also a former therapist and is the author of many books. One of them was Address Staring OCD . If anyone's going through this as well, I really recommend that book. Carol is an amazing, amazing person. Such an intelligent woman. When I met Carol, it was like the first time in my life. I was like, "Wow, I'm actually talking to someone who's got the same theme as me, and a lot of other themes I've gone through, she has as well." We just totally got each other. I was like, "Finally, I'm validated. I can talk to someone who gets it truly." And that really helped, let's say, when I started to learn about value-based exposures. I remember, again, Katie, Elizabeth McIngvale, Ethan, and Chris. I was like, "Yeah, I mean, I'm going to do it that way," because I just did ERP before I was white-knuckling. I never thought of doing it in a value-based way. So I thought, okay, well, what is OCD taking away that I enjoy most doing? That's what I did. I created a hierarchy, or like even in my mind. I thought, well, the cinema, restaurants, coffee shops, going to concerts, eventually going on holiday again, seeing my friends, family is most probably most important. I started doing baby steps. I remember as well, I asked Chris and Liz, how do I open up to this to my family? Because I've got to a point where I just can't hide behind a mask anymore. I need someone else to know who's really close to me. Chris gave me some amazing advice, and Liz, and they said that if you show documents, articles, videos about this, long as they have a great understanding of mental health and OCD, you should be okay. And that's what I did. They know I had OCD. I've told them I had OCD, but not the theme I had. When I showed them documents and videos, it was so nerve-racking, I won't lie. But it was the best thing I ever did because then, when they watched that, they came to me and said, "Why didn't you tell us about this before? I thought you wouldn't understand or grasp this." I know OCD awareness in the UK is not the best, especially with this theme. But they said, "No, after watching that, we're on your team; we will support you. We are here for you. We will do exposures with you." And they gave me a massive hug afterwards. I was like, "Oh my God, this is the best scenario for me ever," because then I can really amplify my recovery. This is where it started really kicking on for me now. Everything I've learned, again, from those videos, watching with the streams from IOCDF, I've incorporated. Basically, when I was going to go to the cinema at first, I know that the cinema is basically darkness. When you walk through there, no one's really going to notice you. Yeah, they might see you in their peripheral vision, but they're going to be more like concentrating on that movie than me. That was my mindset. I was like, "Well, if I was like the other person and I didn't have VTO and the other person did, would I be more concentrated on them or the movie?" And for me, it would be obviously the movie. Why would I else? Unless they were doing something really vigorous or dancing in front of me, I'm not going to look. And that's my mindset. The deep anxiety was there, I will be honest. It was about 80 percent. But I had my value because I was going to watch a film that I really wanted to watch. I'm a big Marvel fan. It was Black Panther Wakanda, and I really enjoyed that. It was a long movie as well. I went with my friend. We got on very, very well. For me as well, with this trigger, I get triggered when people can move as well next to me. I'm very hyper-vigilant with this. That can include me with the peripheral as well. But even though my eyes say they died, it was, okay, instead of beating myself up, I can tell myself this is OCD. I know what this is. It doesn't define me. I'm going to enjoy watching this movie as much as I can and give myself that compassion to do so. After that moment, I was like, "Wow, even though I was still triggered, I enjoyed it. I wasn't just wanting to get out of there. I enjoyed being there." And that was starting to be a turning point for me because then I went to places like KFC. I miss KFC. I love my chicken bucket. I won't lie with that. That was a big value. You got to love the chicken bucket folks. Oh, it was great. Well, I had my parents around me so that they know I was pretty anxious still. But I was there. I was enjoying my chicken again. I was like, "I miss this so much." And then the best thing is, as far as I remember, when I left that restaurant, they said to me, "We're so proud of you." And that helps so much because when you're hearing feedback like that, it just gives you a huge pat on the back. It's like, yeah, I've just done a big, scary thing. I could have been caught. I could have been ridiculed. I could have been made fun of. People may have gossiped about me, but I took that leap of faith because I knew it's better than keep isolating, where in my room, being in prison, not living a life. I deserve to live a life. I deserve to do that. I'm a human being. I deserve to be a part of human society. After that, my recovery started to progress. I went to my friend Carol to more coffee shops. We started talking about advocacy, powerful stuff, because when you have another reason on a why to recover, that's a huge one. When you can inspire and empower others to recover, it gives you so much more of a purpose to do it because you want to be like that role model, that champion for the people. It really gives you a great motive to keep going forward with that and that motivation. And then I went to restaurants with my family for the first time in years, instead of making excuses, instead of compulsion. People would still walk by me in my peripheral, but I had the mindset, like Kate said, "You know what? Just bring it on. Just bring it." I went in there. I know I was still pretty anxious, and I sat on my phone, and I'm going to tell myself using mindfulness this time that I'm going to enjoy the smell of the food coming in. I'm going to enjoy the conversation with my family instead of thinking of, let's say, the worst-case scenario. The same with a waiter or waitress coming by. I'm just going to have my order. And again, yeah, my eyes die, they spit in my food—who knows? But I'm going to take that leap of faith because, again, it's worth it to do this. It is my why to get my life back. That's why I did it. Again, I enjoyed that meal, and I enjoyed talking to my family. It was probably the first time in years where I wasn't proper triggered. I was like, that was my aha moment right there. The first time in years where my eyes didn't die or anything. I just enjoyed being in a normal situation. It was so great to feel that. So validating. Kimberley: So the more triggered you were, the harder it was to not stare? Is that how it was? Matthew: Yes. The more triggered I was going down that rabbit hole, the more, let's say, it would happen because my eyes would die, like up and down. It would be quite frantic, up and down, up and down. Everyone's not the same. Everyone's different with this. But that's what mine would be like. That's why I would call it a tick in that sense. But when we feel calm, obviously, and the rumination is not there, or let's say, the trigger, then it's got no reason to happen or be very rare when it does. It's like retraining. I learned to retrain my mind in that sense to incorporate that into doing these exposures. Again, that's what was great about opening up to my family. I could practice that at home because then, when I'm sitting with my family, I'd still be triggered to a degree, but they know what I have. They're not going to judge me or reject me, or anything like that. So my brain healed naturally. The more I sat next to my family, I could bring that with, say, the public again and not feel that trigger. I could feel at ease instead of feeling constantly on edge. Again, going to coffee shops late, looking around the room, like you say so amazingly, Kim, using your five senses. I did that, like looking around, looking at billboards, smelling the coffee again, enjoying the taste of it, enjoying the conversation, enjoying the surroundings where I am instead of focusing on the prime fear. And that's what really helped brought me back to the present. Being in the here and the now. And that was monumental. Such a huge tool, and I recommend that to everyone. Mindfulness is very, very powerful for doing, let's say, your exposures and to maintain recovery. It's just a game-changer. I can't recommend that enough. One of my biggest milestones with recovery when I hit it, the first time again in years, I went to a live rock concert full of 10,000 people. There would be no way a year prior that would I go. Kimberley: What rock concert? I have to know. Matthew: Oh, I went to Hollywood Vampires. Kimberley: Oh, how wonderful! That must have been such an efficient, like, it felt like you crossed a massive marathon finish line to get that thing done. Matthew: Oh, yeah, it was. It was huge to see, like I say, Alice Cooper, Johnny Depp, and I think—I can't remember this—Joe Perry from Aerosmith. I can't remember the drummer's name, I apologize, but it was great. You know what? I rocked out. I told myself, "I've come this far in my journey, I'm going to rock out. I'm going to enjoy myself. I don't care, let's say, where my eyes may go, and that's telling OCD, though. I'm just going to be there in the moment and enjoy rocking out." And that's exactly what I did. I rocked out big time. I remember even the lead singer from the prior band pointing at me and waving. I would have been so triggered by that before, but now we're back in the game, the rock on sign, and it was great. Kimberley: There's so much joy in that too, right? You were so willing to be triggered that you rocked out. That's how willing we were to do that work. It's so cool, this story. Matthew: Yeah. The funny part is, well, the guy next to me actually spilled beer all over himself. That would have been so triggering against me before, like somebody's embarrassing body part places. Whereas this time I just laughed it off and I had a joke with him, and he got the beer. It was like a normal situation—nothing weird or anything. His wife, I remember looking at my peripheral, was just cross-legged. But hey, that's just a relaxing position like anyone else would do. That's what I told myself. It's not because of me thinking, "Oh, he's a weirdo or a creep." It's because she's just being relaxed and comfortable. That's just retraining my mind out, and again, refocusing back to the concert and again, rocking out to Alice Cooper, which was amazing. I really enjoyed it. I just thought it's just incredible from where I was a year ago without seeing-- got to a point where I set myself, I heard the worst stigma imaginable to go to the other aspect, the whole end of the other tunnel, the light of the tunnel, and enjoy myself and being free. I love what Elizabeth McIngvale says about that, freedom over function. And that's exactly at that point where that's where I was. I'm very lucky to this day. That's why I've maintained it. Sometimes I still do get triggered, but it's okay because I know it's OCD. We all know there's no cure, but we can keep it in remission. We can live a happy life regardless. We just use the tools that we've learned. Again, for me, values-based exposure in that way was game-changing. Self-compassion was game-changing. I forgot to mention my intrusive thoughts with sexual images as well with this, which was very stressing. But when I had those images more and more, it's basically what I learned again from Katie. I was like, "Yeah, you know what? Bring it on. Bring it on. Let's see. Turn it up. Turn it up. Crank it up." Eventually, the images stopped because I wasn't giving fear factor to it. I was going to put the opposite of basically giving it the talk-to-the-hand analogy, and that worked so well. I see OCD as well from Harry Potter. I see OCD as the boggart, where when you come from the boggart, it's going to come to your most scariest thing. But you have that power of choice right there and then to cast the spell and say ridiculous, as it says in the Harry Potter movies, and it will transform into something silly or something that you can transform yourself with compassion and love. An OCD can't touch you with that. It can't. It becomes powerless. That's why I love that scene from that film. Patrick McGrath says it so well with the Pennywise analogy. The more fear we feed the beast or the monster, the more stronger it becomes. But when we learn to give ourselves self-compassion and love and, again, using mindfulness and value and knowing who we authentically are, truly, it can do nothing. It becomes powerless. It can stay in the backseat, it might try and rear its ugly head again, but you have the more and the power in the world to bring it back, and you can be firmly in that driver's wheel. Kimberley: So good. How long did it take you, this process? Was it a short period of time, or did these value-based exposures take some time? Matthew: Yeah, at first, it took some time to master it, if that makes sense. Again, I was going to start going to more coffee shops with my friend Carol or my family. It did take time. I was still feeling it to a degree, but probably about after a month, it started to really click. And then overall, it took me about-- I started really doing this in December, January time. I went to that concert in July. So about, yeah, six, seven months. Kimberley: Amazing. Were there any stages where there were blips in the road, bumps on the road? What were they like for you? Matthew: Yeah. I mean, my eyes did that sometimes. Also, like I said, when I started to do exposures, where I'd walk by myself around town places, it could be very nerve-wracking. I could think I'm walking behind someone that all the might think I'm a stalker and things like that because of the staring. That was hard. Again, I gave myself the compassion and told myself that it's just OCD. It doesn't define who I am. I know what this monster is, even though it's trying its very best to put me down that rabbit hole. Yeah, that person might turn around and say something, or even look. I have the choice again to smile back, or I can even wave at them if I wanted to do so. It just shows that you really have all the power or choice to just throw some back into OCD space every single time. Self-compassion was a huge thing that helped smooth out those bumps. Same with mindfulness. When I was getting dissociated, even when I was still getting dissociated, getting really triggered, I would use the mindfulness approach. For example, when I was sitting in pubs, and that was a value to me as well, sometimes that would happen. But I would then use the tools of mindfulness. And that really, really helped collect myself being present back in the here and the now and enjoying what's in front of me, like having a beer, having something to eat, talking to my friend, instead of thinking like, are they going to see me staring at them weirdly? Or my eyes met out someone, and I don't know, the waitress might kick me out or something like that. Instead of thinking all those thoughts, I just stay present. The thing is with this as well, it's like when you walk down places, people don't even look at you really anyway. They just go about their business, like we all do. It's just remembering that and keeping that mindfulness aspect. You can look around where you are, like buildings, trees, the ocean, whatever you like, and you can take that in and relearn. Feel the wind around you. If it's an ice wind, obviously, that's freezing right now. The smells—anything, anything if it's a nice smell, or even if it's a bad smell. Anything that use your senses that can just bring you back and feel again that peace, something you enjoy, surround yourself with. Again, when I was seeing my friend Carol, the town I went to called Beverley, it's a beautiful town, very English. It is just a nice place. That's what I was doing—looking at the scenery around where I was instead of focusing on my worst worries. Kimberley: This is so cool. It's all the tools that we talk about, right? And you've put them into practice. Maybe you can tell me if I'm wrong or right about this, but it sounds like you were all in with these skills too. You weren't messing around. You were ready for recovery. Is that true? Or did you have times where you weren't all in? Matthew: Yeah, there were times where I wasn't all in. I suppose when I was-- I also like to ask yourself with me if I feel unworthy. That is still, I know it's different to staring OCD and I'm still trying to tackle that sometimes, and that can be difficult. But again, I use the same tools. But with, like I say, doing exposures with VTO, I would say I was all in because I know that if I didn't, it's going to be hard to reclaim my life back. I have a choice to act and use the tools that I know that's going to work because I've seen Chris do it. It's like, "Well, I can do it. I've seen Carol do it. That means I can do it. So I'm going to do it." That's what gave me the belief and inspiration to go all in. Because again, reach out to the community with the support. If it was a hard time, I'd reach out. The community are massive. The connection they have and, again, the empowerment and the belief they can give you and the encouragement is just, oh, it's amazing. It's game-changing. It can just light you up straight off the bar when you need it most, and then you can go out and face that big scary thing. You can do it. You can overcome it because other people have. That means you can do it. It's absolutely possible. Having that warrior mindset, as some of my groups—the warrior badass mindset—like to call it, you absolutely go in there with that and you can do it. You can absolutely do it. Kimberley: I know you've shared with me a little bit privately, but can you tell us now what your big agenda is, what your big goal is right now, and the work you're doing? Because it's really exciting. Matthew: Sure, I'd be glad to do it. I am now officially a professional peer support worker. If anyone would love to reach out to me, I am here. It's my biggest passion. I love it. It's like the ultimate reward in a career. When you can help someone in their journey and recovery and even empower each other, inspire, motivate, and help with strategies that's worked for you, you can pass on them tools to someone else who really needs it or is still going through the process where it's quite sticky with OCD. There's nothing more rewarding than that. Because for me, when I was at my most severe, when I was in my darkest, darkest place, it felt like a void. I felt like just walking through a blizzard of nothing. Having someone there to speak to who gets it, who truly gets it, and who can be really authentically there for you to really say, "You can do this. I'm going to do it with you. Let's do it. Like really, let's do it. Bring it on, let's do it. Let's kick this thing's butt," it's huge. You really lay the smackdown on OCD. It's just massive. For me, if I had that when I was going through it, again, I had a great therapist, but if I had a peer support worker, if I was aware that they were around—I wasn't, unfortunately, at that time—I probably would have reached out because it's a huge tool. It's amazing. Even if you're just to connect with someone in general and just have a talk, it can make all the difference. One conversation, I believe, can change everything in that moment of what that person's darkness may be. So I'm super, super excited with that. Kimberley: Very, very exciting. Of course, at the end, I'll have everyone and you give us links on how to get to you. Just so people know what peer support counseling is or peer support is, do they need to have a therapist? Who's on the team? What is it that they need in order to start peer support? Matthew: Yeah. I mean, you could have a therapist. I mean, I know peer support workers do work with therapists. I know Chrissie Hodges. I've listened to her podcast, and she does that. I think it may be the same with Shannon Shy as well. I'm not too sure. I think as well to the person, what they're going through, if they would want to at first reach out to a peer support worker that they know truly understands them, that can be great. That peer support like myself can then help them find a therapist. That's going to really help them with their theme—or not just their theme—an OCD specialist who gets it, who's going to give them the right treatment. That can be really, really beneficial. Kimberley: I know that we've worked with a lot of peer support, well, some peer support providers, and it was really good because for the people, let's say, we have set them up with exposures and they're struggling to do it in their own time, the peer support counselor has been so helpful at encouraging them and reminding them of the tools that they had already learned in therapy. I think you're right. I think knowing you're not alone and knowing someone's done it, and I think it's also just nice to have someone who's just a few steps ahead of you, that can be very, very inspiring for somebody. Matthew: Absolutely. Again, having a peer support work with a therapist, that's amazing. Because again, for recovery, that's just going to amplify massively. It's like having an infinite gauntlet on your hand against OCD. It's got no chance down the long run. It's incredibly powerful. I love that. Again, like you said, Kim, it's like when someone, let's say, they know that has reached that mountain top of recovery, and that they look at that and thinking, "Well, I want to do the same thing. I know it would be great to connect with that person," even learn from them, or again, just to have that connection can make a huge, huge difference to know that they can open up to other people. Again, for me, it's climbing up that other mountain top with someone else from the start, but to know I've got the experience, I get to climb that mountain top with them. Kimberley: Yeah, so powerful. Before we finish up, will you tell us where people can get ahold of you if they want to learn more? And also, if there's anything that you feel we could have covered today that we didn't, like a main last point that you want to make. Matthew: Sure. People can reach out to me, and I'm going to try and remember my tags. My Instagram tag is matt_bannister27. I think my Facebook is Matthew.Bannister.92, if you just type in Matthew Bannister. It would be in the show notes as well. You can reach out to me on there. I am at the moment going to create a website, so I will fill more onto that later as well. My email is matt3ban@hotmail.com, which is probably the best way to reach out to me. Kimberley: Amazing. Anything else you want to mention before we finish up? Matthew: Everyone listening, no matter what darkness you're going through, no matter what OCD is putting in your way, you can overcome it. You can do it. As you say brilliantly as well, Kim, it's a beautiful day to do hard things. You can make that as every day because you can do the hard things. You can do it. You can overcome it, even though sometimes you might think it's impossible or that it's too much. You can do it, you can get there. Even if it takes baby steps, you're allowed to give yourself that compassion and grace to do so. It doesn't matter how long it takes. Like Keith Smith says so well: "It's not a sprint; it's a marathon." When you reach that finish line, and you will, it's the most premium feeling. You will all get there. You will all absolutely get there if you're going through it. Oh, Kim, I think you're on mute. Kimberley: I'm sorry. Thank you so much for being on. For the listeners, I actually haven't heard your story until right now too, so this is exciting for me to hear it, and I feel so inspired. I love the most that you've taken little bits of advice and encouragement from some of the people I love the most on this planet. Ethan Smith, Liz McIngvale, Chris Trondsen, Katie O'Dunne. These are people who I learn from because they're doing the work as well. I love that you've somehow bottled all of their wisdom in one thing and brought it today, which I'm just so grateful for. Thank you so much. Matthew: You're welcome. Again, they're just heroes to me, and yourself as well. Thank you for everything you do as well for the community. You're amazing. Kimberley: Thank you. Thank you so much for being here. Matthew: Anytime.

Jan 19, 2024

If you want to know the 5 Most Common Recovery Roadblocks with Chris Tronsdon (an incredible anxiety and OCD therapist), you are in the right place. Today Chris and I will go over the 5 Most common anxiety, depression, & OCD roadblocks and give you 6 highly effective treatment strategies you can use today. Kimberley: Welcome everybody. We have the amazing Chris Trondsen here with us today. Thank you for coming, Chris. Chris: Yes, Kim, thanks for having me. I'm super excited about being here today and just about this topic. Kimberley: Yes. So, for those of you who haven't attended one of the IOCDF Southern California conferences , we had them in Southern California. We have presented on this exact topic, and it was so well received that we wanted to make sure that we were spreading it out to all the folks that couldn't come. You and I spoke about the five most common anxiety & OCD treatment roadblocks, and then we gave six strategic solutions. But today, we're actually broadening it because it applies to so many people. We're talking about the five most common anxiety treatment roadblocks, with still six solutions and six strategies they can use. Thank you for coming on because it was such a powerful presentation. Chris: No, I agree. I mean, we had standing room only, and people really came up to us afterwards and just said how impactful it was. And then we actually redid it at the International OCD Foundation , and it was one of the best-attended talks at the event. And then we got a lot of good feedback, and people kept messaging me like, "I want to hear it. I couldn't go to the conference." I'd play clips for my group, and they're like, "When is it going to be a podcast?" I was like, "I'll ask Kim." I'm glad you said yes because I do believe for anybody going through any mental health condition, this list is bound, and I think the solutions will really be something that can be a game changer in their recovery. Kimberley: Absolutely, absolutely. I love it mostly because, and we're going to get straight into these five roadblocks, they're really about mindset and going into recovery. I think it's something we're not talking about a lot. We're talking about a lot of treatment, a lot of skills, and tools, but the strategies and understanding those roadblocks can be so important. Chris: Yeah. I did a talk for a support group. They had asked me to come and speak, and I just got this idea to talk about mindset. I did this presentation on mindset, and people were like, "Nobody's talking about it." In the back of my head, I'm like, "Kim and I did." But we're the only ones. Because I do think so many people get the tools, right? The CBT tools , they get the ERP tools, the mindfulness edition, and people really find the tools that work for them. But when I really think of my own personal recovery with multiple mental health diagnoses, it was always about mindset. And that's what I like about our talk today. It's universal for anyone going through any mental health condition, anxiety base, and it's that mindset that I think leads to recovery. It shouldn't be the other way around. The tools are great, but the mindset needs to be there. Kimberley: Yeah. We are specifically speaking to the folks who are burnt out, feeling overwhelmed, feeling a lack of hope of recovery. They really need a kickstart, because that was actually the big title of the presentation. It was really addressing those who are just exhausted with the process and need a little bit of a strategy and mindset shift. Chris: Yeah. I don't want to compare, but I broke my ankle when I was hiking in Hawaii, and I have two autoimmune diseases. Although those ailments have caused problems, especially the autoimmune, when I think back to my mental health journey, that always wore me out more because it's with you all the time, 24/7. It's your mental health. When my autoimmune diseases act up, I'm exhausted, I'm burnt out, but it's temporary. Or my ankle, when it acts up, I have heating pads, I have things I can do, but your brain is with you 24/7. I do believe that's why a lot of people resonate with this messaging—they are exhausted. They're busting their butt in treatment, but they're tired and hitting roadblocks. And that's why this talk really came about. Kimberley: Yeah, exactly. All right, let's get into it here in a second. I just want to give one metaphor with that. I once had a client many years ago give the metaphor. She said, "I feel like I'm running a marathon and my whole family are standing on the out, like on the sidelines, and they're all clapping, but I'm just like faceplant down in the middle of the road." She's like, "I'm trying to get up, I'm trying to get up, and everyone's telling me, 'Come on, you can do it.' It's so hard because you're so exhausted and you've already run a whole bunch of miles." And so I really think about that kind of metaphor for today. If people are feeling that way, hopefully they can take away some amazing nuggets of information. Chris: Absolutely. That's a good visual. Faceplant. Kimberley: It was such a great and powerful visual because then I understood this client's experience. Like, "Oh, okay. You're really tired. You're really exhausted." ROADBLOCK #1: YOU BEAT YOURSELF UP! Okay, let's get into it. So, I'm going to go first because the number one roadblock we talked about, not that these are in any particular order, but the one we came up first was that you beat yourself up. This is a major roadblock to recovery for so many disorders. You beat yourself up for having the disorder. You beat yourself up for not coping with it as well as you could. You beat yourself up if you have OCD for having these intrusive thoughts that you would never want to have. Or you're beating yourself up because you don't have motivation because you have, let's say, some coexisting depression. The important thing to know there is, while beating yourself up feels productive, it might feel like you're motivating yourself, or you may feel like you deserve it. It actually only makes it harder. It only makes it feel like you've got this additional thing. Again, a lot of my patients—let's use the marathon example—might yell at themselves the whole way through the marathon, but it's not a really great experience if you're doing that, and it takes a lot of energy. SOLUTION #1: SELF-COMPASSION So what we offered here as a strategic solution is self-compassion —trying to motivate and encourage yourself using kindness. If you're going through a hard day, maybe, just if you've never tried this before, trial what it would be like to encourage yourself with kind words or asking for support, asking for help so that you're not burning all that extra energy, making it so much harder on yourself, increasing your suffering. Because I often say to patients, the more you suffer, the more you actually deserve self-compassion. It's not the other way around. It's not that the more you suffer, the less you deserve it. Do you have any thoughts on that, Chris? Chris: Oh yeah. I would say I see that across the board with my clients, this harshness, and there's this good intention behind it, this idea that if I can just bully myself into recovery. I always try to remind clients that anxiety-based disorders, it's a part of our bodies as well. Our brain is a part of our body, just like our arm, our tibia, our leg, all these other bones, but there's a lack of self-empathy that we have for ourselves, as if it's something that we're choosing to do. Someone with a broken leg doesn't wake up in the morning and get mad at themselves that their leg is still broken. They have understanding, and they're working on their exercises to heal. It's the same with these disorders. So, the reason I love self-compassion is when we go and step in to help one of our friends, we use a certain tone, we use certain words, we tap into their strengths, we use encouragement because we know that method is going to be what boosts them up and helps them get through that rough patch. But for some reason, when it's ourselves, we completely abandon everything we know that's supportive, and we talk to ourselves in a way that I almost picture like a really negative boot camp instructor, like in the military, just yelling and screaming into submission. The other thing is when we're beating ourselves up like that, we're more likely to tap into our unhelpful habits. We're more likely to shut down and isolate, which we see a lot in BDD, social anxiety, et cetera. But that self-compassion isn't like a fake pop culture support. It's really tapping into meeting yourself where you're at, giving yourself some understanding, and tapping into the strategies that have worked in the past when you're in a low moment. I know sometimes people are like, "I don't know how to do that," but you're doing it to everybody else in your life. Now it's time to give yourself that same self-compassion that you've been giving to everybody important to you. Kimberley: Yeah, and we actually have a few episodes on Your Anxiety Toolkit on exactly how to embrace self-compassion, like how that might actually look. So, if people are really needing more information there, I can add in the show notes some links to some resources there as well. ROADBLOCK #2: THERE WILL BE HARD DAYS Okay. Now, Chris, can you tell us about the second most common or another common anxiety roadblock around this idea that there will be hard days? Chris: There's always these great images if you Google about what people think recovery will look like versus what recovery looks like. I love those images because there is this idea. We see a lot of perfectionism in anxiety disorders. In OCD, we see perfectionism . So, this idea of, like, I should be here and I should easily scoot to the end. It's not going to be like that; it's bumpy, it's ups and downs. We know so much factors into or impact how our mental health disorder shows up. We can't always control our triggers. Sometimes if we haven't slept well or there's a lot of change in our life, we could have more anxiety . So, it's going to ebb and flow. So, when we have this fixed mindset of like, it has to be perfect, there has to be absolutely no bumps on the road, no turbulence, we're going to set ourselves up for failure because the day we have a hard day, we want to completely shut down. So I really believe, in this case, the solution is thinking bigger. If you're thinking day to day, sometimes if you're too in it, you're dealing with depression, you're really feeling bad, you skipped school because you have a presentation, social anxiety is acting up. You think bigger picture. Why am I here? Why am I doing this? Why have I sought out treatment? Listen to this podcast. What am I trying to accomplish? SOLUTION #2: KNOW YOUR WHY I know for me in my own recovery, knowing my why was so important. There were certain things in my life that I found important to achieve, and I kept that as the figurative carrot in front of the mule to get me to go. So, that way, if I had a rough day, I thought bigger picture. What do I need to do today to make sure that I meet my goals? And so, I believe everybody needs to know their why. Now, it doesn't have to be grandiose. Some people want to build a school and teach kids in underprivileged countries. Amazing why. But other people are sometimes like, "I just want to be able to make my own choices today and not feel like I base them out of anxiety." There's no right or wrong why, but if you can know what beacon you're going to, it really helps you get through those hard days. What about for you? When we talk about this, what comes up for you? Kimberley: Well, I think that for me personally, the why is a really important mindset shift because often I can get to this sort of, like you said, perfectionistic why. Like, the goal is to have no anxiety, or the goal is to have no bad days. We see on social media these very relaxed people who just seem to go with the flow, and that's your goal. But I have to often with myself do a little reality check and go, "Okay, are you doing recovery to get there? Because that goal might be setting you up for constant disappointment and failure. That mightn't be your genetic makeup." I'm never going to be like the go-with-the-flow Kimberley. That's just not who I am. But if I can instead shift it to the why of like, what do I value? What are the things I want to be able to do despite having anxiety in my life? Or, despite having a hard day, like you said, how do I want that to look? And once I can get to that imagery, then I have a really clear picture. So, when I do have a bad day, it doesn't feel so defeating, like what's the point I give up, because the goal was realistic. Chris: For me, a big part of my why in recovery, once I started getting into a place where I was managing the disorders I was dealing with—OCD, body dysmorphic disorder, I had a lot of generalized anxiety, and major depressive disorder—I was like, "I need to give back. There's not people my age talking about this. There's not enough treatment providers." There was somewhere, like in the middle of my treatment, that I was like, "I don't know how I'm going to advocate. I don't know what that's going to look like, but I have to give back." And so, on those hard days when I would normally want to just like, "Well, I don't care that it's noon, I'm shutting it down, I'm going into my bed, I'm just going to sleep the rest of the day," reminding myself like there's people out there suffering that can't find providers, that can't find treatment, may not even know they have these disorders. I have to be one of the voices in the community that really advocates and gets people education and resources. And so, I didn't let myself get in bed. I looked at the day as quarters. Okay, the morning and the afternoon's a little rough, but I still have evening and night. Let me turn it around. I have to go because I have this big goal, this ambitious dream. I really want to do it. So that bigger why kept me just on track to push through hard days. ROADBLOCK #3: YOU RUN OUT OF STAMINA Kimberley: Amazing. I love that so much. All right. The third roadblock that we see is that people run out of stamina. I actually think this is one that really ties into what we were just talking about. Imagine we're running a marathon. If you're sprinting for the first 20 miles, you probably won't finish the race. Or even if you sprint the first two miles, you probably won't finish the marathon. One of the things is—and actually, I'll go straight to the strategy and the thing we want you to practice—we have to learn to pace ourselves throughout recovery. As I said, if you sprint the first few miles, you will fall flat on your face. You're already dealing with so much. As you said, having a mental health struggle is the most exhausting thing that I've ever been through. It requires such of your attention. It requires such restraint from not engaging in it and doing the treatment and using the tools. It's a lot of work, and I encourage and congratulate anyone who's trying. The fact that you're trying and you're experimenting with what works and what doesn't, and you're following your homework of your clinician or the workbook that you've used—that's huge. But pacing yourself is so important. So, what might that look like? Often, people, students of mine from CBT School , will say, "I go all out. I do a whole day of exposures and I practice response prevention, and I just go so hard that the next day I am wiped. I can't get out of bed. I don't want to do it anymore. It was way too much. I flooded myself with anxiety." So, that's one way I think that it shows up. I'll often say, "Okay, let's not beat yourself up for that." We'll just use that as data that that pace didn't work. We want to find a rhythm and a pace that allow you to recover. It's sort of like this teeter-totter. We call it in Australia a seesaw. You want to do the work, but not to the degree where you faceplant down on the concrete. We want to find that balance. I know for me, when I was recovering from postural orthostatic tachycardic syndrome, which is a chronic illness that I had, it was so hard because the steps to recovery was exercise, but it was like literally walking to the corner and back first, and then walking half a block, and then walking three-quarters of a block, and then having my husband pick me up, then walking one block. And that's all I was able to do without completely faceplanting the next day, literally and figuratively. My mind kept saying to me, "You should be able to go faster. Everybody else is going faster. Everyone else can walk a mile or a block. So you should be able to." And so, I would push myself too hard, and then I'd have to start all over again because I was comparing myself to someone who was not in my position. SOLUTION #3: PACE YOURSELF So, try to find a pace that works for you, and do not compare your pace with me or Chris or someone in your support group, or someone you see on social media. You have to find and test a pace that works for you. Do you have any thoughts, Chris? Chris: Yeah. I would say in this one, and you alluded to it, that comparison, that is going to get you in this roadblock because you're going to be looking to your left and your right. Why is that person my age working and I'm not? It's not always comparing yourself. Sometimes, like you said, it is people in your support group. It's people that you see advocating for the disorder you may have. But sometimes people even look at celebrities or they'll look at friends from college, and can I do that? The comparison never motivates you, it never boosts you; it just makes you feel less than. That's why one of my favorite quotes is, "Chase the dream, not the competition." It's really finding a timeline that works best for you. I get why people have this roadblock. As somebody who's lived through multiple mental health disorder diagnoses, it's like, once we find the treatment, we want to escalate to the finish line, and we'll push ourselves in treatment sometimes too much. And then we have one of those days where we can't even get out of bed because we're just beat up, we're exhausted, and it's counterproductive. I wanted to add one thing too. The recovery part may not even be what you're doing with your clinician in a session that you are not pacing yourself with. My biggest pacing problem was after recovery, not that the disorders magically went away, they were in remission, I was working on doing great, but it was like, I went to martial arts, tennis, learned Spanish, started volunteering at an animal shelter, went back to school, got a job, started dating. It was so much. Because I felt like I was behind, I needed to push myself. The problem that started to happen was I was focusing less on the enjoyable process of dating or getting a job, or going back to school. I was so fixated on the finish line. "I need to be there, I need to be there. What's next? What's next?" I got burnt out from that, and I was not enjoying anything I was doing. So, I would say even after you're managing your disorder, be careful about not pacing yourself, even in that recovery process of getting back into the lifestyle that you want. Kimberley: Yeah, absolutely. I would add too, just as a side point, anyone who is managing a mental health issue or an anxiety disorder, we do also have to fill our cup with the things that fill our hearts. I know that sounds very cliche and silly, but in order to pace ourselves and to have the motivation and to use the skills, we do have to find a balance of not just doing all the hard things, but making sure you schedule time to rest and eat and drink and see friends if that fills your cup, or read if that fills your cup. So, I think it's also finding a rhythm and a balance of the things that fill your cup and identifying that, yes, recovery is hard. It will deplete your stores of energy. So, finding things that fill that cup for you is important. Chris: Well, you just made a good point too. In my recovery, all those things you mentioned, I thought of those as like weakness, like I just wasted an hour reading. Sometimes even with friends. That one, not as much, because I saw value in friendship. But if I just watched a movie or relaxed, or even just hung out with friends, it felt like a waste. I'm like, "How dare I am behind everybody else? I should be working. I should be this. I should move up." A lot of should statements, a lot of perfectionist expectations of myself. So, the goal for me or the treatment for me wasn't to then go to the other extreme and just give up everything; it was really to ask myself, like you said, how can I fill my cup in ways that are important and see value and getting a breakfast burrito with a friend and talking for three hours and not thinking like, "Oh, I should have been this because I got to get my degree." I'm glad that you brought that up. I always think of like we're overflowing our cup with mental health conditions. We have to be able to have those offsets that drain the cup so we have a healthy balance. So, a great point. ROADBLOCK #4: NOT OWNING YOUR RECOVERY Kimberley: I agree. So important. Would you tell us about owning your recovery? Because you have a really great story with this. Chris: Yeah. People ask me all the time how I got better. A lot of people with body dysmorphic disorder struggle to get better. Obviously, we know that with obsessive-compulsive disorder, major depressive disorder, et cetera. So, a lot of people will ask sometimes, and I always say to them, if I had to come up with one thing, it was because I made my mental health recovery number one. I felt that it was like the platform that I was building my whole life on. I'm so bad with the-- what is it? The house, the-- I'm not a builder. Kimberley: Like the foundation. Chris: Thank you. Clearly, I'm not going to be making tools tomorrow or making things with tools. But yeah, like a house has to have a nice foundation. You would never build a house on a rocky side of the mountain. And so, I had to give up a lot, like most of us do, as we start to get worse. I became housebound and I dropped out of college, and I gave up a job. I was working in the entertainment industry, and I really enjoyed it. I was going to film school, and I was happy. I had to give all that up because I couldn't even leave my house because of the disorder. SOLUTION #5: MAKE YOUR RECOVERY THE MOST IMPORTANT THING So, when I was going to treatment and I was really starting to see it work, I was clear to that finish line of what I needed to do. So I made it the most important thing. It wasn't just me; it was my support system. My treatment was about a four-hour round trip from my house, so my mom and I would meet up every day. We drive up to LA. I go to my OCD therapist, and I'd go to my psychiatrist and then my BDD therapist and support group, and then come home. There's times I was exhausted, I wanted to give up, I was over it, but I never ever, ever put it to number two or three. I almost had this top three list in my head, and number one was always my recovery. My mom too, I mean, when she talks, she'll always say it's the most important thing. If my job was going to fire me because I couldn't come in because I had to take my kid on Wednesdays to treatment, I was going to get fired and find a new job. We just had to make this important. As I was getting better, there were certain opportunities that came back to me from my jobs or from school. My therapist and I and my mom just decided, "Let's hold off on this. Let's really, really put effort into the treatment. You're doing so well." One of the things that I see all the time, my mom and I run a very successful family and loved ones group. A lot of times, the parents aren't really making it the priority for their kids or the kids, or the people with the disorders aren't really making it a priority. It's totally understandable if there's things like finances and things, barriers. But that's not what I'm talking about. I'm talking about when people have access to those things, they're just not owning it. Sometimes they're not owning it because they're not taking it seriously or not making it important. Or other times, people are expecting someone else to get them better. I loved having a team. I didn't have a big team. I came from nothing. It was a very small team. I probably needed residential or something bigger. I only really had my mom's support, but we all leaned on each other. But I always knew it was me in the driver's seat. At the end of the day, my therapist couldn't save me, my mom couldn't save me, they couldn't come to my house and pull me out of bed or do an exposure for me, or have me go out in public during the daytime because of BDD. I had to be the one to do it. I could lean on them as support systems and therapists are there for, but at the end of the day, it was my choice. I had to do it. When my head hit the pillow, I had to make sure that I did everything I possibly could that day to recover. When I took ownership, it actually gave me freedom. I wasn't waiting for someone to come along. I wasn't focusing on other things. I made it priority number one. I truly believe that that was the thing that got me better. Once again, didn't have a lot of resources, leaned a lot on self-help books and stuff because I needed a higher level of care, but there was none and we couldn't afford it. I don't want anyone to hear this podcast and think, "Well, I can't find treatment in my area." That's not what I'm saying. I'm just saying, whatever you have access to, own it, make it a priority, and definitely be in that leader's seat because that's going to be what's going to get you better. Kimberley: Yeah, for sure. I think too when I used to work as a personal trainer, I would say to them, "You can come to training once a week, but that once a week isn't going to be what crosses you across that finish line." You know what I mean? It is the work you do in the other 23 hours of that day and the other seven days of the week. I think that is true. If you're doing and you're dabbling in treatment, but it's not the main priority, that is a big reason that can hold you back. I think it's hard because it's not fair that you have to make it priority number one, but it's so necessary that you do. I really want to be compassionate and empathize with how unfair it is that you have to make this thing a priority when you see other people, again, making their social life their priority or their hobby their priority. It sucks. But this mindset shift, this recalibration of this has to be at the top. When it gets to being at the top, I do notice, as a clinician, that's when people really soar in their recovery. Chris: Yeah. We had a very honest conversation with my BDD therapist, my OCD therapist , and my psychiatrist, and they're like, "You need a higher level of care. We understand you can't afford it. There's also a lot of waiting lists." They're like, "You're really going to have to put in the work in between sessions. You're supposed to be in therapy every day." We just couldn't. All we can afford is once a week. They said, "Look, when you're not in our session, you need to be the one." So, for instance, with depression, my psychiatrist is like, "Okay, you're obviously taking the medication, but you need to get up at the same time every day. Open up all your blinds, go upstairs, eat breakfast on the balcony, get ready, leave the house from nine to five." I didn't have a job. "But you need to be out of the house. You need to be in nature. You need to do all these things." I never wanted to, but I did it. Or with my OCD and BDD recovery, I didn't want to go out in public. I felt like it looked horrendous. I felt like people were judging me, but I did. Instead of going to the grocery store at 2:00 in the morning, I was going at noon. When everyone's there for OCD, it was like, I didn't want to sit in public places. I didn't want to be around people that I felt I could potentially harm. My point is like every single day, I was doing work, I was tracking it, I was keeping track, and I had to do that because I needed to do that in order to get better based on the setup that I had. I do want to also say a caveat. I always have the biggest empathy for people or sympathy for people that are a CEO of a company or like a parent and have a lot of children, or it's like you're busy working all day and you're trying to balance stuff. I mean, the only good thing that came from being housebound is I didn't have a lot of responsibilities. I didn't have a family. I wasn't running a company. I wasn't working. So, I did have the free time to do the treatment. So, I have such sympathy for people that are parents or working at a company, or trying to start their own small business and trying to do treatment too. But I promise you, you don't have to put your recovery first forever. Really dive into it, get to that place where you're really, really stable. It'll still be a priority, but then you will be a better parent, a better employee, a better friend once you've really got your mental health to a level that you can start to support others. You may need to support yourself first, like the analogy with a mask on the plane. ROADBLOCK #5: YOU HAVE A FIXED MINDSET Kimberley: Agreed. That's such an important point. All right, we're moving on to roadblock number five. This is yours again, Chris. Tell us about the importance of specific mindsets, particularly a fixed mindset being the biggest roadblock. Chris: One of the things that makes me the most sad about people having a mental health condition because of how insidious they are is it starts to have people lose their sense of identity. It has them start to almost re-identify who they are, and it becomes a very fixed mindset. So, if you have social anxiety or social phobia, it's like, "Oh, I'm somebody that's not good around people. I say embarrassing things. I never know what kind of conversation to lead with. I should probably just not be around people." Or, let's say generalized anxiety. "Deadlines really caused me too much strain. I can't really go back to school." BDD. "I'm an unattractive person. Nobody wants to date me. I'm unlovable." We get into these fixed mindsets and we start to identify with them, and inevitably, that person's life becomes smaller and smaller and smaller. So, the more they identify with it, the more that they become isolated from others, and they have this very fixed mindset. I think of like OCD, for instance, isn't really about guidelines; it's all about rules. This is how things are supposed to be. What happens is when I work with a client specifically, somebody that's pretty severe, it's trying to get them to see the value in treatment and to even tap into their own personal values is really difficult. It's like, "Treatment doesn't work. I've tried all the medications. I don't know what I'm going to do. I'm just not somebody that can get better." SOLUTION #5: GROWTH MINDSET What I tell clients instead is, "Let's be open. Let's be curious. Let's move into a growth mindset . Let's focus on learning, obtaining education, being open to new concepts. Look, when you were younger and the OCD didn't really attack you, or when you were younger and you didn't deal with social anxiety, you were having friends, you had birthday parties, you were going to school, and everything. Maybe that's the real you, and it's not that you lost it. You just have this disorder that's blocked you from it." And so, when clients become open and curious and willing to learn, willing to try new things, and to get out of their comfort zone, that's where the growth really happens. If you're listening to this podcast or watching it right now and you're determined like, "This isn't working; nothing can help me," that fixed mindset is never something that's going to get you from where you are to where you want to be. You have to have that growth, that learning, that trying new things, expanding. I always tell clients, "If you try something with your therapist and it doesn't work, awesome. That's one other thing that doesn't work. Move on to something else." That openness. What I always love after treatment is people are like, "I am social. I do love to be around people. I am somebody who likes animals. I just was avoiding animals because of harm thoughts." People start to get back into who they really are as soon as they start to be more open to recovery. Kimberley: Yeah, for sure. The biggest fixed mindset thought that I hear is, "I can't handle it." That thought alone gets in the way of recovery so many times. We go to do an exposure, "I can't handle this." Or, "What if I have a panic attack? I cannot handle panic attacks." It's so fixed. So I often agree with you. I will often say, this work, this mental health work, or this human work that we do is shifting the way we see ourselves and life as an experiment. We always have these black-and-white beliefs like "I can't handle this" or "I can't do this. I can't get in an elevator. I can't speak public speaking," or whatever it might be. But let's be curious. Like you said, let's use it as an experiment. Let's try, and we'll see. Maybe it doesn't go great. That's okay, like you said, but then we know we have data, and then we have information on what got in the way, and we have some information. I think that even just being able to identify when you're in a fixed mindset can be all you need just to be like, "Oh, okay, I'm having a very black-and-white fixed mindset." Learning how to laugh and giggle at the way our brain just gets so determined and black-and-white, like you can't do this, as you said, I think is so important because, like you said, once you get to recovery, then you go on to live your life and actually do the things that you dream, the dream that you're talking about. It might be you want to get a master's degree or you might want to go for a job, or you want to go on a date. You're going to be able to use that strong mindset for any situation in life. It applies to anything that you're going to conquer. I always say to clients, if you've done treatment for mental health, you are so much more prepared than every student in college because they haven't gone through, they haven't had to learn those skills. Chris: Yeah, no, exactly. I remember like my open mindset was one of the assets I had in recovery. I remember going to therapy and being like, "I'm just going to listen. These people clearly know what they're doing. They've helped people like me. Why would it be any different?" And I was open. I can see the difference with clients that have a more growth mindset. They come in, they're scared. They're worried. They've been doing something for 10, 15, 16 years, and they're like, "Why is this guy going to tell me to try to do different things or to think different or have different thinking patterns?" But they're open. I always see those people hit that finish line first. It's the clients that come and shut down. The family system has been supporting this like learned helplessness. Nobody really wants to rock the boat. Everything shut down and closed. It's like prying it open, as most of the work. And then we finally get to the work, but we could have gotten there quicker. Everybody's at their own pace, but I really hope that people hear this, though, are focused on that openness. You were talking about like people thinking they can't handle it. The other thing I hear sometimes is people just don't think they deserve it. "I just don't even deserve to get better." You do. You do. That's what I love about my job the most. Everybody that comes into my office, and I'm like, "You deserve a better life than you're living. Whatever it is you want to do. You want to be a vet. How many animals are you going to save just by getting into being a vet? You got to do it." My heart breaks a little bit when people have been dealing with mental health for long enough that they start to believe they don't even deserve to get better. SOLUTION #6: IT'S A BEAUTIFUL DAY TO DO HARD THINGS Kimberley: I love that. So, we had five roadblocks, and we've covered it, but we promised six strategies. I want to be the one to deliver the last one, which everyone who listens already knows what I'm going to say, but I'm going to say it for the sake that it's so important for your recovery, which is, it's a beautiful day to do hard things . It is so important that you shift, as we talked about in the roadblock number one, you shift your mindset away from "I can't do hard things" to "It's okay to do hard things." It doesn't mean you've failed. Life can be hard. I say to all my patients, life is 50/50 for everybody. It's 50% easy and 50% hard. I think some people have it harder than others. But the ones who seem to do really well and have that grit and that survivor's mindset are the ones who aren't destroyed by the day when it is hard. They're willing to do the hard thing. They're okay to march into uncertainty. They're willing to do the hard thing for the payoff. They're willing to take a short-term discomfort for the long-term relief or the long-term payout. I think that mindset can change the game for people, particularly if you think of it like a marathon. Like, I just have to be able to finish this marathon, I'm going to do the hard thing, and think of it that way. There'll be hills, there'll be valleys, there'll be times where you want to give up, but can I just do one hard thing and then the next hard thing, and then the next hard thing? Do you have any thoughts on that? Chris: I'm glad that this is the message that you put out there. I'd say, obviously, when I think of Kim Quinlan as a friend, I think of other things and all the fun we've had together. But as a colleague, I always think of both. Obviously, self-compassion. But this idea of it's a beautiful day to do hard things, I like it because we've always talked about doing hard things as this negative thing before you came along, and by adding this idea of it's a beautiful day. When I look at all the hard things I did in my own recovery, or I see clients do hard things, there's this feeling of accomplishment, there's this feeling of growth, there's this feeling of greatness that we get. Just like you were saying, beyond the mental health conditions that I dealt with, when I start getting into real life after the mental health conditions now are more in recovery, every time I choose to do hard things, there's always such a good payoff. I was convinced I would never be able to get through school and get a degree and become a licensed therapist because I struggled with school with my perfectionism. It was difficult for me to get back in there and to humble myself and say, "Hey, you may flop and fail." But now I'm a licensed therapist because of that willingness to do hard things. I could give a plethora of examples, but I want people to hear that doing hard things is your way of saying, "I believe in myself. I trust myself that I can accomplish things, and I'm going to tap into my support system if I need to, but I am determined, determined, determined to push myself to a level that I may not think I can." I love when clients do that, and they always come in, they're like, "I'm so proud of myself, I can't wait to tell you what I did this weekend." I love that. So, always remember hard things come with beautiful, beautiful, beautiful outcomes and accomplishments. Kimberley: Yeah. I think the empowerment piece, when clients do scary, hard things, or they feel their hard feelings, or they do an exposure, they'll often come in and be like, "I felt like I could do anything. I had no idea about the empowerment that comes from doing hard things." I think we've been trained to think that if we just avoid it, we then will feel confident and strong, but it's actually the opposite. The most empowered you'll ever feel is right after you've done a really, really hard thing, even if it doesn't go perfectly. Chris: Yeah, and so much learning comes out of it. That's why I always tell clients too, going back to one of our first roadblocks, beating yourself up prevents the learning. Let's say you try something and it doesn't go well. I was talking to a colleague of ours who I really, really like. She was telling me how her first treatment center failed. Now she's doing really well for herself down in San Diego. She's like, "I just didn't know things, and I just did things wrong, and I learned from it, and now I'm doing well." It's like, whenever we look at something not going the way we'd like as an opportunity to learn and collect data, it just makes us that much better when we try it the other time. A lot of times these anxiety disorders were originally before treatment, hopefully trying to find ways to avoid our way through life—tough words—and trying to figure out, like, how can I always be small and avoid and still get to where I want to be? When people hear this from your podcast—it's a beautiful day to do hard things—I hope that they recognize that you don't have to live an avoidant lifestyle, an isolated lifestyle anymore. Really challenging yourself and doing hard things is actually going to be so rewarding. It's incredible what outcomes come with it. Kimberley: Amazing. Well, Chris, thank you so much for doing this with me again. We finally stamped it into the podcast, which makes me so happy. Tell us where people can hear about you, get in contact with you, and learn more about what you do. Chris: I am really active in the International OCD Foundation. I'm one of their board members. I also am one of their lead advocates, just meeting as somebody with the disorder. I speak on it. Then I lead some of their special interest groups. The Body Dysmorphic Disorder Special Interest Group is one of them, but I lead about four of them. One of their affiliates, OCD Southern California, I am Vice President of OCD SoCal and a board member. We do a lot of events here locally that Kim is part of, but also some virtual events that you could be a part of. And then, as a clinician, I'm a licensed clinician in Costa Mesa, California. I currently work at The Gateway Institute . You can find me either by email at my name, which is never easy to spell. So, ChrisTrondsen@GatewayOCD.com, or the best thing is on social media, whether it's Instagram, Facebook, or X, I guess we're calling it now. Just @christrondsen . You could DM me. I always like to hear from people and get people's support, and anything I can do to support people. I always love it. Kimberley: Oh my gosh, you're such a light in the community, truly. A light of hope and a light of wisdom and knowledge. I want to say, because I don't tell you this enough as your friend and as your colleague, thank you, thank you for the hope that you put out there and the information you put out there. It is so incredibly helpful for people. So, thank you. Chris: I appreciate that. I forgot to say one thing real quick. Every first, third, and fourth Wednesday of the month at 9 a.m. Pacific Standard Time on the IOCDF , all of their platforms, including iocdf.org/live, I do a free live stream with Dr. Liz McIngvale from Texas, and we have great guests like Kim Quinlan on, so please listen. But thank you for saying that. I always try to put as much of myself in the community, and you never know if people are receiving it well. I want to throw the same thing to you. I mean, this podcast has been incredible for so many. I always play some of this stuff for my clients. A lot of clients are looking for podcasts. So, thanks for all that you do. I'm really excited about this episode because I think it's something that we touch so many people. So, now to share it on a bigger scale, I'm excited about it. But thank you for your kind words. You're amazing. It's all mutual. Kimberley: Thank you. You're welcome back anytime. Chris: And we're going to get Greek food soon. It's funny [inaudible] I'm telling you. It's life-changing. Thanks, Kim. Listen to other episodes. Kimberley: Thank you.

Jan 12, 2024

Welcome back, everybody. This is Part 2 of Your 2024 Mental Health Plan, and today we are going to talk about the specific tools that you need to supercharge your recovery. This podcast is called Your Anxiety Toolkit. Today, we are going to discuss all the tools that you are going to have in your tool belt to use and practice so that you can get to the recovery goals that you have. Let's go. For those of you who are here and you're ready to get your toolkit, what I encourage you to do first is go back to last week and listen to Part 1 of this two-part series, which is where we do a mental health recovery audi t. We go through line by line and look at a bunch of questions that you can ask yourself, journal them down, and find specifically what areas of recovery you want to work on this year. Now, even if you're listening to this as a replay and it's many years later, that's fine. You can pick this up at any point. This episode and last week's episode actually came from me sitting down a few weeks ago and actually going, "Okay, Kimberley, you need to catch up and get some things under control here." You can do this at any time in a month from now or a year from now. We're here today to talk about tools, so let's get going. First, we looked at, when we did our audit, the general category. The general question was, how much distress are you under? How much time is it taking up, and how do you feel or what are your thoughts about that distress? That is a very important question. Let's just start there. That is an incredibly important question because how you respond to your distress is a huge indicator of how much you will suffer. If you have anxiety and your response is to treat it like it's important, try to get it to go away, and spend your time ruminating and wrestling, you're going to double, triple, quadruple your suffering. You're already suffering by having the anxiety, but we don't want to make it worse. If you're having intrusive thoughts and you respond to them as if they're important and need to be solved, again, we're going to add to our suffering. If you have grief, shame, or depression and you're responding to that by adding fuel to the fire, by adding negative thoughts, or by saying unkind things to yourself, you're going to feel worse. How do you respond? WILLINGNESS Tool #1 you're going to need in this category is willingness . When you identify that you're having an emotion, how willing are you to make space for that emotion? I'm not saying give it your attention; I'm saying, are you willing to just allow it to be there without wrestling it, trying to make it go away? Are you willing to normalize the emotion? Yeah, it makes complete sense that I'm having a hard time, or that all humans have these emotions. How willing can you be? Often, what I will ask my patients is, out of 10, if 10 being the highest, how willing are you? We're looking for eights, nines, and tens here. If you're at like a six, seven, that's okay. Let's see if we can get it up to the eights, nines, and tens. VALUES OVER FEAR Another tool (Tool #2) is respond with values, not fear or emotion . We want to work at being very clear on what our values are, what is important to us. Because if we don't, emotions will show up. They will feel very, very real. When they feel very, very real, you're likely to respond to them as if they're real. Again, adding fuel to the fire, adding to the suffering. Instead, we want to respond with values. If you have fear, you're going to ask yourself, do I want to respond based on what fear is telling me, or my values, my beliefs, the principles, the things that are important to me? If you're depressed, do you want to respond based on what depression is telling you to do? Like, "Give up, it's hopeless, there's no point." Or do you want to get back in touch with what matters to you? What would you do if depression wasn't here? What would you do if anxiety was not here? The third tool I'm going to give you, and this is a huge one—I'm going to break it down into different categories—is mindfulness . Now, if you've been here on Your Anxiety Toolkit, you already know that I think mindfulness is the most important tool, one of the most important tools you will have in your tool belt. You should be using it in your tool belt every day. It's like if you actually had a tool belt, it'd be like the hammer, the thing you probably use the most. Mindfulness involves four things, and this is the way I want you to think about it. MINDFULNESS Number one, it's awareness. Mindfulness is being present and aware of what is happening to you internally. Being able to identify, I feel sad, I feel anxious, I notice uncertainty, I'm noticing I'm having thoughts about A, B, and C. That awareness can help you stay in line with your values, but stay present enough to respond wisely. Mindfulness is also presence. I've already given you that word. It's being in the here and now. Fear always wants us to look into the future; mindfulness is being in the here and now. Depression often always wants us to look at the past and ruminate on the past and what went wrong or what will potentially go wrong in the future; mindfulness is only tending to the here and now, what's actually happening. When I'm anxious and I become present in my body, I realize that the thing that I'm afraid of hasn't happened yet. If it is happening, if the thing that I'm afraid of is happening, then I can still go, "Okay, what's happening in the present? How can I relate to it?" As we've discussed in earlier tools, how can I relate to it in a way that doesn't add to my suffering? Can I make some space for it? Can I be willing to have it? Can I respond with values? Really getting present in this moment will give you some space to act very skillfully. NON-JUDGMENT The next mindfulness tool is non-judgment . We have to be non-judgmental. Often, when I'm with my patients or with my students, they will often say, "I'm having anxiety, and it is bad and wrong, and I'm wrong for having it, and it shouldn't be here." All of that is a judgment. I often bring them back to the fact that anxiety, while yes, it is uncomfortable, it is neutral. Let me say that again. Anxiety, while it is uncomfortable—it's not fun—it is neutral. It is neither good nor bad. It just is your present experience. This work becomes how willing are you to feel discomfort. How willing are you to widen your distress tolerance for this thing that you're experiencing, and how can you practice not judging it as bad? The thing to remember is, if you have an emotion, a sensation, or a thought, and you appraise it as bad, your brain will remember that for next time. So next time you have it, it will more likely send out a bunch of cortisol and adrenaline and a bunch of stress hormones when you have that emotion, that sensation, or that thought. And that's how we can break this cycle by practicing non-judgment. WISDOM AND INSIGHT The fourth piece of mindfulness that I want you to consider is wisdom and insight. This is not a typical mindfulness tool, I would say, but it's an important piece of our work. When we have mental struggles, when we have emotional struggles, it's very easy to fall into the trap of believing our thoughts and our feelings, going into that narrative, and getting into that story. When we do that, again, we make things worse. We tend to act on those emotions and that distress instead of our values. A lot of mindfulness, if you can practice being present, if you can practice being aware, if you can practice being non-judgmental, you then get to be steady in wisdom. You get to check the facts and respond according to the facts and the reality. You get to be level in how you respond. It doesn't mean your anxiety will go away. It just means that you're thinking in a way where you can make decisions. You're connected to your prefrontal cortex, where you can make good decisions for yourself, not just respond to the emotions that you're having. That's sort of like a bigger picture, but that's sort of more like the result of practicing mindfulness. When we last week went through the audit of your mental health recovery, we also addressed safety behaviors. Now these were avoidance, reassurance seeking, mental compulsions , physical compulsions, and there is a fifth one, but we'll talk about that later. We really went through and thoroughly investigated, did an audit, did an inventory of how many of these behaviors and what specific behaviors you do. Again, if you didn't listen to that episode, go back and look at that because it will help you put together a really good inventory of what's going on for you. Now, I want to address a couple of things when it comes to these. If you're someone who does a lot of avoidance, I'm going to strongly encourage you to use Tool #4, which is find ways to face your fear. Identify all the things that you are afraid of and you're avoiding, and find creative ways to face your fear and make it fun. If you're afraid of something, try to find ways to make it fun that line up with your values. If you're afraid of airplanes but love to travel, pick a place when you first start this that you're interested in going to. Have it be something that you have been wanting to go to for a long time. Do it with someone you enjoy doing it with. If it's something miscellaneous around the house, include the people around you, make it fun, put the music on that you want. You're not doing that to take the discomfort away; you're doing it so that it's so deeply based on your values, so deeply based on what's important to you, and purposely every day, find ways to face your fears. Now, if you have OCD specifically and you want help with this, we have a full, comprehensive course called ERP School. If you go to CBTSchool.com , you can get access to that, and it will take you step by step on how to do that for OCD. If you have generalized anxiety or panic disorder, we have a step-by-step process for how you can do that. It's called overcoming anxiety and panic. If you have depression, we actually have a whole comprehensive course for depression as well on how you can face the depression, how you can undo the way that depression has you avoiding things and procrastinating, and how it's demotivating you. That course is there for you as well at CBT School. If you're someone who struggles with mental compulsions, we actually have a free six-part mental compulsion series here on Your Anxiety Toolkit. It's completely free. I'll leave the links for that in the show notes below. But that will help you walk through it with six amazing clinicians from around the world, like the best ones that we can get, talking specifically about different ways to manage mental compulsions. But it does involve a lot of the tools we've already talked about—a lot of mindfulness, a lot of facing your fear, a lot of willingness, a lot of awareness. These are things that you can be using specifically to interrupt those safety behaviors. Now, another tool (Tool #5) is distress tolerance, because as you face your fear, you're going to have some uncomfortable feelings. Distress tolerance is an opportunity for you to lean into that discomfort a little more. It's very skill-based. Let me give you a couple of ideas. BEGINNERS MIND Number one would be this idea of a beginner's mind. Usually, when we're uncomfortable, our natural human instinct is to get out of here. Like, "Let's go. I don't want to be here. I don't want to feel it. Let's run away." Another instinct is to fight. Like, "Oh, I want to wrestle with it." Beginner's mind is the opposite of that. It's the practice of being curious. We actually have a whole podcast episode on beginner's mind. Think of it like you're a baby. I always say, imagine you're like one or two and you hand the baby a set of keys. Now, if you handed a set of keys to an adult, they'd be like, "Yeah, that's keys." They wouldn't really stop to look at the keys. But if you give it to the baby, they're so curious, they're so open-minded, and they look at the keys like I've never seen these. They're shiny, but they're hard, but they're bumpy. They have these round things. What do you do with them? I'll put them in my mouth. What do they taste like? What do they feel like? They're so willing to see these keys as if it's the first time they've ever seen them because it's the first time they've ever seen them. As adults, we have to practice being curious, just like that. When we're uncomfortable, we can be curious instead of nonjudgmental and go, "Okay, let's be curious about this. What does it feel like? I wonder what it's like if I'm willing to feel it. How long does it last? Can I let it be there? I wonder what will happen if I let it be there and go and do this or face the fear." Let's be curious instead of having a fixed mindset of, "I can't feel this. I can't handle it. I don't want to," and so forth. Beginner's mind is very important in helping you relearn the perceived stress or the perceived danger of a certain thing. Another really important distress tolerance skill is radical acceptance. Radical acceptance is a sort of badass response to fear and emotions by going, "Bring it. Let's have it. It's here. There's nothing I can do. Trying to stop it only makes things worse. And so I'm committed to radically accepting it being here." Then you can go on to use other tools like your values and willingness, ERP, CBT, and any of those. You can use any of those skills. But you're coming from a place of just radically accepting that it's there. UNCERTAINTY Another distress tolerance skill is to be uncertain on purpose. "Bring it on." If you have anxiety, you're going to have uncertainty anyway. Bring it on. Let's let it be there. Let's make another relationship with uncertainty—one that's not stressful and one where it's like, I'm allowing it to be there. I actually have some mastery over it because I've practiced letting it be there before, and I tolerated it then, and I'm sure I'll tolerate it again. Remember here, you have gotten through 100% of the hard things in your life. You can do it again, and each time we can make this 1% improvement in how skillful we are in response to it. SELF-KINDNESS AND SELF-COMPASSION The next category that we had in the audit was kindness. We talked about questions such as, how do you treat yourself throughout the day? How kind are you? Do you punish yourself for having emotional struggles? And of course, you guys know this is number six, which is self-compassion. We know that self-punishment doesn't work. In fact, it makes us feel worse. Self-compassion is the practice of making you a safe place to have any emotion, any discomfort, have any thought, have any anxiety. You're willing to have them all, and you're going to promise yourself and commit to yourself that you'll be gentle with yourself no matter what. That's the work. Truly, so many of you have said that you've been working on that, and you've actually made huge strides in that area. We have so much content on Your Anxiety Toolkit on self-compassion. I'd encourage you to go back and listen to any of those. This year I'm going to really heavily emphasize this work, but I really want you to really consider creating a safe place for you to have any emotion, any intrusive thought, any feeling, any discomfort at all, any pain, so that you know that you're always in a safe place to have those feelings. MINDSET The last category of the audit that we did last week was on mindset. We asked questions like, how willing are you to experience these emotional struggles? When you wake up, what's the thing you think? Do you think, "Oh no, I can't handle it, this is going to be terrible, I hope I don't have any anxiety today, I hope my emotions don't come or I hope I don't have any thoughts"? Or do you have a more positive outlook of the day? Now, we already talked about willingness. It was one of the first tools that we used. But here, I want you to consider the idea of being positive. Now, I'm not saying positive like, "Oh no, my bad things won't happen," or "No, I'm not a bad person, and my fears won't come true." That's not what I'm talking about being positive. I'm talking about remind yourself of your strengths. That is a tool. Being complementary and positive is a tool that we don't use enough. We spend all the time thinking about the worst-case scenario, and we very rarely take time to really think, "I'm actually pretty strong. I've actually handled a lot. I'm actually very, very resilient." Is it possible that you do that too? What can we do to get you to see yourself the way I see you? Often, I'll say to clients, "Oh my gosh, you're doing so well." And they'll be like, "Oh, I kind of am, you're right." Or I'll say, "Wow, look at how you got through that really hard thing." And they're like, "No, it's not a big deal; everyone can do it." But I'm like, "No, you did that." CELEBRATE YOUR WINS Please practice being positive towards yourself, having positive regard for yourself, celebrating your wins, thinking positive about your strengths, not just focusing on your weaknesses. Now Tool #8, we all know. I say it every single week, which is it's a beautiful day to do hard things. When we wake up and we think, "Oh no, I don't want bad things to happen," we become a victim. What we want to do is we want to stand up and say, "Today is a really beautiful day to do really freaking hard things, and I'm going to practice doing those." I want you to think of #8 as a motto, a mantra that you can take with you everywhere. "It is a beautiful day to do hard things." We don't need perfect conditions to do hard things either. We don't need motivation to do hard things. Sometimes we just have to do them, whether we're motivated or not. And then we see the benefit. We don't have to wait until you have the right thought, the right feeling, or the right situation. Often, I'll catch myself like, "Oh, I had a little bit of an argument with my husband. No, I'm not going to do hard things today." No, that's the day to go do the hard thing. Do it because it's what brings you closest to your recovery. It brings you closest to the goals that you have. TIME MANAGEMENT Now, Tool #9 is time management. When you wake up in the morning, if dread is the first thing on your mind, time management will help. We have a whole course on CBTSchool.com on time management, and what it is about is teaching you a few core things. Number one, schedule your recovery homework first because it has to be the priority. It has to be. Secondly, schedule fun time first. Don't schedule work. Don't schedule your chores. Make sure you're prioritizing these things because recovery requires rest, it requires fun, it requires lightness and brightness, and fulfillment. Doing these hard things takes up a lot of energy, so any way you can, even if it's for two minutes, manage your time so that you have set in your calendar, set a reminder, the time where you're going to do the things that you need to do to get your recovery on its way. Prioritize it. We have a whole course called Time Management for Optimum Mental Health . You can get it at CBTSchool.com, and it really outlines how you can do this and how you can practice prioritizing these things, which brings us to Tool #10, which is find a community of people who are doing the same things as you. I get it, everyone on Instagram looks like they're having a jolly time and their life is easy. The truth is, no, they're not. Find the people who are also struggling with similar adversity. You could go to CBT School Campus, which is a Facebook group we have. On social media, there are so many amazing advocates sharing what it's like to be doing this work. Come on over and follow me on Instagram at Your Anxiety Toolkit, where I talk a lot about this all the time. There is a community of people who make the most gorgeous comments and are so supportive and encouraging. FIND COMMUNITY Find a community, because if you feel like you're the only one who's struggling, it makes it really, really hard. Just know that you're not alone and that other people are going through hard things. They might not be going through exactly what you're going through, but this community is filled with millions of listeners. There are other people who are struggling too, so try to find them. Use them as accountability buddies. Touch base with them. My best friend and I meet once a week, fire the phone, and check in. How are you doing? What are you doing well with? How are you doing with the goals you set for last week? Try to find someone, if you can, who can be your accountability buddy. If not, maybe ask a loved one or a friend who might be willing to do that. There are the 10 tools that I want you to have in your toolkit. You're not going to use them all the time. You're not even going to be good at them. I'm even willing to say you're going to suck at using them, and that is okay. I suck at using these sometimes too. This is not about perfection; this is about pausing, looking at the problem, asking yourself, which of these tools would be most helpful right now? And be curious. Again, use your beginner's mind. Be curious about trying them, experimenting, giving yourself a lot of celebration in the fact that you tried. Again, this doesn't have to be perfect. We make 1% improvements over here. That's all I'm looking for—a 1% improvement. Is there something you can do today that will get you 1% closer to your recovery goal? If that is possible, go for it. Give it your best. You will not regret it. I've never once had someone regret moving towards their recovery. In fact, I've only seen people say, "I'm so grateful I did it." Even though it might have been late, it's never too late. All right. Have a wonderful day. I know you can do this. I cannot wait for this year. I have so many things I want to talk to you about. Have a wonderful day, and I'll see you next week.

Jan 5, 2024

f you need a mental health plan for 2024, you are in the right place. This is a two-part series where we will do a full recovery audit. And then next week, we're going to take a look at the key tools that you need for Your Anxiety Toolkit . We call it an anxiety toolkit here, so that's exactly what you're here to get. The first step of this mental health plan for 2024 is to look at what is working and what isn't working and do an inventory of the things that you're doing, the safety behaviors, the behaviors you're engaging in, and all the actions that you're engaging in that are getting in the way of your recovery. Now what we want to do here is, once we identify them, we can break the cycle. And then we can actually start to have you act and respond in a very effective way so that you can get back to your life and start doing the things that you really, really wanted to do in 2023 but didn't get to. If you're listening to this in many years to come, same thing. Every year, we have an opportunity to do an audit—maybe even every month—to look at what's working and what's not. Let's do it. Now, one thing I want you to also know here is this is mostly an episode for myself. A couple of weeks ago, I was not coping well. I consider myself as someone who has all the skills and all the tools, and I know what to do, and I'm usually very, very skilled at doing it. However, I was noticing that I was engaging in some behaviors that were very ineffective, that had not the best outcomes, and were creating more suffering for myself. Doing what I do, being an anxiety specialist, and knowing what I know as a therapist, I sat down and I just wrote it all out. What am I engaging in? What's the problem? Where am I getting stuck? And from there, naturally, I did a mental health audit. And I thought, to be honest with you, you guys probably need such a thing as well, so let's do it together. Here is what I did. Let's get started with this mental health audit that we're going to do today. FOUR RECOVERY AUDIT CATEGORIES General Perspective Safety Behaviors Safety Mindset What we're going to do is we're going to break it down into four main categories. The first category is your general perspective of your mental health, your recovery, and your internal emotional experience. The second category is the safety behaviors you're engaging in. A safety behavior is a behavior that you do to reduce or remove your discomfort, to get a sense of safety, or to get a sense of control. Sometimes they're effective, sometimes they're not, and we're going to go through that today. The third category is actually just safety—looking at how safe you are inside your body with your internal experience. And I'll explain a lot more of that here in a little bit, so let's just move on to section number four, which is mindset. What is your mindset about recovery? And we're going to go through this together. LET'S PROMISE TO DO THIS KINDLY As we move forward, I want you to promise me and vow to me as we do this. We are only doing it through the lens of being curious and non-judgmental. This audit should not be a disciplinary action where you wrap yourself over the knuckles and you beat yourself up, and you just criticize yourself for the fact that you're not coping well. That is not what we're doing here. WE ARE JUST GATHERING DATA We are ultimately just taking data. We're just looking at the data of what's working and what's not. And then we get to decide what we do differently. And we get to be honest with ourselves about what's actually happening from a place of compassion, from a place of understanding, knowing that we're doing the best we can with what we've got. Again, I could beat myself up and be like, "You're a therapist. You do this for a living. What is wrong with you?" But instead, I just recognize. Of course, you fell off the wagon. Things don't always work out perfectly when you're under a high amount of stress or when it's the holidays, when things feel out of your control. We naturally gravitate to safety behaviors that often aren't the most effective. That's just the facts. BE NON-JUDGMENTAL Let's do this from a non-judgmental standpoint. We are literally just gathering data. How we handle this is a big part of recovery. Okay? Let's do it. YOUR RECOVERY AUDIT Let's first look at the first section of your recovery audit. This is a general category. We're going to ask some questions. You can get a pen and notepad, or you could just listen and think about this, pause it, take some stock of what's been going on for you. But I do strongly encourage you to pause, sit down, write your answers on a piece of paper, on a Google Doc, or whatever you love to do. All right, here we go. GENERAL Number one, generally, how much of the day do you experience anxiety, hopelessness, or some kind of emotional distress, whatever it is that you experience? You could give a percentage, a grade, or an amount of hours. How much of the day do you experience emotions that are out of your control? We're only here to get data on how much this thing is impacting your life. You might say all day, every day. That's okay. You might say, "A couple of hours every day that I experience panic," or "A couple of hours every day I'm having intrusive thoughts." It doesn't matter; just put it down. If you're someone who has more depressive symptoms, you might say, "For six hours of the day, I experience pretty severe depression." Whatever you're experiencing, you can write it down. The second question in this category is, what are your thoughts about the emotional distress that you just documented? What are your thoughts about them? If you have anxiety, are your thoughts "I shouldn't have anxiety"? Because what we gather there is if for, let's say, two hours a day, you're having anxiety, but for four hours a day, you're saying, "I shouldn't have it. I'm bad for having it. What's wrong with me? Something is wrong. I'm terrible," and so forth, we want to understand, what are the specific thoughts you're having about the emotional distress? If you have OCD and you're having a lot of intrusive thoughts, what are your thoughts about that? "Oh, my thoughts make me a bad person. Oh, my intrusive thoughts mean I must want to do the thing that I'm having thoughts about." If you're having depression, what are your thoughts about that? "Oh, I'll never get better, that I'm weak for having this struggle, that I should be able to handle it better. I should be able to get out of bed and function normally." We want to really understand your general mindset and perspective of what you're going through. Often, we spend a lot of time thinking about why we have the problem. Why do I have this? What's wrong with me? What did I do wrong? Why is this happening? Was it my past? Was it something that happened to me? Spending a lot of time trying to figure out why. That's the general category. SAFETY BEHAVIORS The second category, safety behaviors, is probably one of the most important, but there is a good chance I'm going to say that about every category, so let's just go through them. The first question in safety behaviors is, how much of the day do you spend ruminating, thinking, going over and over the problem, trying to solve it? How many minutes, how many hours, or what percent of the day do you spend ruminating? We've already identified how much of the day you spend with the original, initial problem. But how much of the time do you actually spend engaging in the behavior of mental compulsions, mental rumination, sort of that real stressful solving practice? Write it down. Again, we're not judging here. Even if you wrote 100% of the day, all day, every day for a year or 10 years, it doesn't matter, okay? The next question in safety behaviors is, if you zoomed out and looked at your entire life, what is it that you are avoiding because of this internal emotional experience, whether it be anxiety, uncertainty, depression, grief, whatever it might be, panic? Whatever it is, what is it specifically that you're avoiding? Some people say, "I'm avoiding a certain street. I'm avoiding a certain person. I'm avoiding a certain event. I'm avoiding an emotion. I'm avoiding a feeling. I'm avoiding a thought. I'm avoiding a specific book on a specific bookshelf. I'm avoiding a specific movie on the internet or on TV. I'm avoiding a specific topic in every area of my life." Be as specific as you can. What is it that you are avoiding to try and reduce or remove your distress inside your body? Document all of it. I tell my patients, it doesn't matter if this takes 17 pages; just document it down. Don't judge yourself. Once we have the data, we can next week meet and work on a solution here. Or as you go through this, if you've already clearly identified that you have, let's say, OCD, generalized anxiety , panic, or depression , we have specific courses on CBTSchool.com that will walk you through these and give you specific solutions to specific problems. That is there for you as well. We will next week go through the main tools you're going to need. But if you really want to target a specific issue, we may have a course specifically in that area that will help you. If not, there are other areas where you can get resources and therapy as well. But this is going to help you get really clear on what specifically is going on for you. What is it that you're engaging in that's getting in the way? The next safety behavior category is, how do you carry your body throughout the day? Are you hypervigilant? Are you tense? Are you rushing around? That was me. That's when I was like, "Oh, Kimberley, you are going down the wrong channel." Because I noticed in many areas of my day, I was rushing, trying to avoid some emotions, trying to check boxes, rushing around, hypervigilant, looking around, what bad thing is going to happen next. How are you carrying this in your body? If you had an eating disorder, it might be, "I'm tensing my stomach and pulling it in and trying to not eat and trying to suppress hunger and thirst." If that's happening, okay, let's document. If you're having panic , are you squinting, pushing away thoughts, trying to avoid a sensation in your body? We want to get to know what is happening with our bodies. A patient of mine a couple of weeks ago said, "I just hold my breath all day. I really do. I probably take half the breath that someone without anxiety takes." Write it down if you notice that's what you're doing in your body. Again, not your fault; we're just here to look at the data. The next category of safety behaviors is, how often do you seek reassurance per day? How often do you consult with Google to reduce your anxiety? How often do you ask family and friends questions about your fear to get a sense of certainty or to reduce your anxiety? Sometimes this can be tricky. You might even just mention a topic to notice their facial expression to see how they respond, or you might report to them something that happened to see if they're alarmed so that you then know whether you should be alarmed and engage in some behavior, worrying, ruminating, and so forth. How often are you trying to get to the bottom of anxiety and you're noticing that it's repetitive, and over and over again, you're getting stuck in these rabbit holes of Googling or asking friends and families, often asking them questions they don't even know the answer to? Often, our family members, because they love us, will give us an answer based on probability, but they actually don't know. And therefore, your brain-- you're very smart. I know this because all my clients with anxiety often in depression are. You're very smart. You know they don't know the answer, so your brain doesn't compute it as a real certainty anyway. Your brain is going to immediately go, "Well, how do they know? They probably don't know any better than I do," and it's going to want more and more questions to be asked. How often do you seek reassurance per day, or how much of the day do you spend seeking reassurance? And then the last safety behavior here is physical behaviors. This is more common for folks with OCD, phobias, or health anxiety . What physical behaviors do you engage in? Meaning, do you rearrange things? Do you move things? Do you check things? Do you turn things on and off? Lock doors, unlock doors, lock them again. How much are you engaging in physical behaviors to reduce your anxiety? Again, I will also say this is very true for generalized anxiety . Often, people with generalized anxiety disorder spend a lot of time just engaging in this high-level functioning of checking boxes, getting things done, always being the busiest person in the room. And while yes, that does get rewarded by our society because, "Oh, look at them go, they're getting all the things done," they're doing it to avoid or remove discomfort or uncertainty. So we want to get a thorough documentation of all of those things. Again, do not beat yourself up if it's a long list. Those will help us next week when we talk about tools. KINDNESS AND SAFETY We move on now to the third category, which is kindness and safety. And now we're talking about how do you respond to yourself and your experience of anxiety. We also talked about this through the lens of safety. Safety is when you're feeling uncomfortable, you're having an emotion such as anxiety, grief, sadness, dread, anger. When you have those emotions, is your brain and body a safe place to allow those emotions to exist, or is it an unsafe place in that you push it away, judge yourself, tell it shouldn't be there, rid it out, get rid of it, banish it, avoid it, abandon it, all the things? Question #1: How do you treat yourself throughout the day? Out of 10, how kind are you to yourself? Really think about it. How do you treat yourself? If you thought objectively about yourself as a friend, would you want yourself as a friend around? Probably not. Maybe you've been listening to Your Anxiety Toolkit for some time and you've already really developed these skills, but really, really honestly, how kind are you to yourself? If you were another friend, would you invite yourself over? Probably not because you wouldn't invite a friend over who's like, "What is wrong with you? You're crazy. You shouldn't be doing that. You're so silly. Why are you spending all this time? You're lazy. You're dumb. You're stupid for asking these questions." So really think about that. The second question is, do you punish yourself for having these emotional struggles? And if so, how? Do you blame yourself? Do you shame yourself? Do you engage in a lot of guilt behavior, guilting yourself for these behaviors? Do you withhold pleasure from yourself? I've had so many clients tell me that they will not allow themselves to have the nice toilet paper, and they get themselves the scratchy, one-ply toilet paper because of their intrusive thoughts or because they're depressed and they don't check the boxes that their friends on Instagram have checked. Therefore, they don't deserve the nice shampoo, or they don't deserve nice sheets, or they don't deserve to rest. They basically punish themselves for their emotional struggles, and we don't want to do that. I know you know this already, but we want to know specifically. Do an inventory. Give yourself some days here to really do a thorough audit of what's going on in your life. You might find that you don't eat or you eat foods that aren't delicious. One thing in my eating disorder recovery was, let's really try to eat foods that are genuinely delicious. And if it's not delicious, don't eat it. Well, of course, if you need to eat and you need to function and you don't have great options, that's fine. Just eat for the sake of nourishment. But if you're at a restaurant, eat the thing that's delicious. Are you engaging in not allowing yourself to have those pleasurable things? The last question in the area of kindness and safety is, what specifically do you say to yourself when things get hard? What specifically do you say to yourself? Often, people say, "No, I'm really kind to myself. I'm really good. I work out." But then, when things get hard, everything goes down the drain. They start beating themselves up. When they don't win at work or they don't get a good grade or when they're having a bad anxiety or depression day, that's when they start beating themselves up. What do you say to yourself specifically when things get hard or when things get painful? Write it down. MINDSET All right. We're moving into the last section, which is mindset, because remember, we're looking at 2024. We're looking at the next six months, three months, or one month, and we're really looking at how can we supercharge your recovery. Here's the question: How willing are you to experience these emotional struggles in your body? Out of 10, how willing are you? Most of my patients report like a four, five, and a six, which is still great. I'm happy with that. It's better than one, two, and three. And if you're at a one, two, and three, it's okay. We can start somewhere. Okay? What I'm looking for when I'm with my patients or when I'm with myself is a solid eight, nine, and 10 of willingness. Of all the things that I push the most, how willing are you to actually have your emotional discomfort? Often, people are like, "I don't want it. I'm in too much pain. I've had too much pain, Kimberley. Don't even ask me to. You don't even understand. I've been in pain for years," and I get it. What we do resist persists. So we want to first ask ourselves, how willing are we to allow this discomfort to be in our body, this emotion to be in our body, or this thought to be present in our awareness? The last question here is, when you wake up, what is your mindset about tackling the day? Do you wake up and go, "Oh no, God, I don't want this," or do you wake up and go, "No, no, no, no. Please, no anxiety today. Please, no thoughts today. Please, no depression today. Please, let this be a good day," or do you wake up and say, "This will be a bad day"? Just take note of it. You're not wrong for any of them, but we want to get a little bit of a temperature check on how you start the day. Now, one thing to know, often these thoughts are automatic. You don't have control of them. Again, I'm not here to say they're wrong, but what we will talk about next week is ways in which you can change how you respond to some of those automatic negative thoughts, or even your intrusive thoughts, and really look at how we can create a mindset for you. Let me give you just a quick rundown before we move forward. Number one, we will be doing tools next week, and I'll be going deep into that. And that will be the focus of mine for 2024. My biggest focus for 2024 is really doubling down on making sure you guys know what the tools are in your toolkit and which ones work for you, and you get to work from that. Then I'm actually recording another podcast with Chris Trondsen, where we talk about common mindset roadblocks when it comes to recovery, and we will be giving you strategies there as well. Stick around for that. If you are listening to playbacks here, make sure you listen to all three episodes of this, because I think it will be so important now that you've done an inventory and you know what's going on. All right. That's that. That is your mental health audit. Write it all down. Give yourself plenty of love. Congratulate and celebrate the fact that you did this hard thing, and I will see you next week to talk about the tools you need—the specific tools in your anxiety toolbelt—to help you go and live a life where anxiety is not in charge, not in the driver's seat, and where you live according to your values, what is important to you. Anxiety and emotions do not get to make your decisions, and that's my goal for you. Have a great day. As always, I always say it's a beautiful day to do hard things. You did a hard thing today. Thank you for sticking with me. This is not fun work. I get it. But it is important work, and you do deserve to get this really out on paper so that we can get you going in the direction that you want to go. As always too, take what you need, leave the rest. If some of these questions don't really fly for you or they're very triggering, just do the best you can. I don't ever want people to feel like what I'm saying is the rule and you have to do it. Take what you need. Leave the rest, and I'll see you next week. Have a good one, everyone.

Dec 22, 2023

Kimberley: Could I have PTSD or trauma? This is a question that came up a lot following a recent episod e we had with Caitlin Pinciotti, and I'm so happy to have her back to talk about it deeper. Let's go deeper into PTSD , trauma, what it means, who has it, and why we develop it. I'm so happy to have you here, Caitlin. Caitlin: Yes, thank you for having me back. INTRODUCING CAITLIN PINCIOTTI Kimberley: Can you tell us a little bit about you and all the amazing things you do? Caitlin: Of course. I'm an assistant professor in the Psychiatry and Behavioral Sciences Department at Baylor College of Medicine. I also serve as the co-chair for the IOCDF Trauma and PTSD in OCD Special Interest Group. Generally speaking, a lot of my research and clinical work has specifically focused on OCD, PTSD, and trauma, in particular when those things intersect, what that can look like, and how that can impact treatment. I'm happy to be here to talk more specifically about PTSD. WHAT IS PTST VS TRAUMA? Kimberley: Absolutely. What is PTSD? If you want to give us an understanding of what that means, and then also, would you share the contrast of—now you hear more in social media—what PTSD is versus trauma ? Caitlin: Yeah, that's a great question. A lot of people use these words interchangeably in casual conversation, but they are actually referring to two different things. Trauma refers to the experience that someone has that can potentially lead to the development of a disorder called post-traumatic stress disorder. When we talk about these and the definitions we use, trauma can be sort of a controversial word, that depending on who you ask, they might use a different definition. It might be a little bit more liberal or more conservative. I'll just share with you the definition that we use clinically according to the DSM. Trauma would be any sort of experience that involves threatened or actual death, serious injury, or sexual violence, and there are a number of ways that people can experience it. We oftentimes think of directly experiencing trauma. Maybe I was the one who was in the car accident. But there are other ways that people can experience trauma that can have profound effects on them as well, such as witnessing the experience happening to someone else, learning that it happened to a really close loved one, or being exposed to the details of trauma through one's work, such as being a therapist, being a 911 telecommunicator, or anyone who works on the front lines. That's what we mean diagnostically when we talk about trauma. It's an event that fits that criteria. It can include motor vehicle accidents, serious injuries, sexual violence, physical violence, natural disasters, explosions, war, so on and so forth—anytime when the person feels as though their bodily integrity or safety is at risk or harmed in some way. Conversely, PTSD is a mental health condition. That's just one way that people might respond to experiencing trauma. In order to be diagnosed with trauma, the very first criterion is that you have to have experienced trauma. If a person hasn't experienced an event like what I described, then we would look into some other potential diagnoses that might explain what's going on for them, because there are lots of different ways that people can be impacted by trauma beyond just PTSD. PTSD SYMPTOMS AND PTSD DIAGNOSIS Kimberley: Right. What are some of the specific criteria for being diagnosed with PTSD? Caitlin: PTSD is comprised of 20 potential PTSD symptoms , which sounds like a lot, and it is. It can look really different from one person to the next. We break these symptoms down into different clusters to help us understand them a little bit better. There are four overarching clusters of PTSD symptoms. There's re-experiencing, which is the different ways that we might re-experience the trauma in the present moment, such as through really intrusive and vivid memories, flashbacks, nightmares, or feeling really emotionally upset by reminders of the trauma. The second cluster is avoidance. This includes both what we would call internal avoidance and external avoidance. Internal avoidance would be avoiding thinking about the trauma, but also avoiding any of the emotions that might remind someone of the trauma. If I felt extremely powerless at the time of my trauma, then I might go to extreme lengths to avoid ever feeling powerless again in my life. In terms of external avoidance, that's avoiding any cue in our environment that might remind us of the trauma. It could be people, places, different situations, smells, or anything involving the senses. That's avoidance. The third cluster of PTSD symptoms is called negative alterations, cognitions, and mood, which is such a mouthful, but it's basically a long way of saying that after we experience trauma, it's not uncommon for that experience to impact our mood and how we think about ourselves or other people in the world. You'll see some symptoms that can actually feel a little bit like depression, maybe feeling low mood, or an inability to experience positive emotions. But there's also this kind of impact on cognition—an impact on how I view myself and my capabilities, maybe to the extent that I can trust other people or feel that the world is dangerous. Blame is really big here as well. And then the last cluster of symptoms is called hyperarousal. This is basically a scientific word for your body—sort of kicking into that overdrive feeling of that fight, flight, freeze response. These include symptoms where your body is constantly in a state of feeling like there's danger or threat. This can impact our concentration. It can impact our sleep. We might have angry outbursts because we're feeling really on edge. We may feel as though we have to constantly watch our backs, survey the situation, and make sure that we are definitely going to be prepared and aware if another trauma were to happen. Those are the four overarching symptom clusters. But somebody only actually needs to have at least six of those symptoms to a clinically significant and impairing way. Kimberley: Right. Now, I remember early in my own treatment, a clinician using terms like little T trauma and big T trauma. The example that I was discussing is I grew up on a ranch, a very large ranch. My dad is and was a very successful rancher. Every eight to 10 years, we would have this massive drought where we would completely run out of water and we'd have to have trucks bring in water, and there were dead livestock everywhere. It was very financially stressful. I remember her bringing up this idea of what is a little T trauma and what is a big T trauma—not to say that that's what was assigned to me, but that was the beginning of when I heard this term. WHAT IS BIG T TRAUMA VS LITTLE T TRAUMA? What does it actually mean for someone to say big T trauma versus small T trauma ? Caitlin: Yeah, this is another common term that people are using. I'm glad that there is language to describe this because a lot of times, when I provide the definition that I gave a few minutes ago about what trauma is according to the DSM, people will hear that and think, "Wait a minute, my experience doesn't really fit into that criteria, but I still feel like I've been really impacted by something. Maybe it's even making me experience symptoms that really look and feel a lot like PTSD." Some people can find that really invalidating, like, "Wait a minute, you're saying that what I experienced wasn't traumatizing and it feels like it was traumatizing." Those terms can be used to separate out big T trauma, meaning something that meets the DSM definition that I provided—that really more strict definition of trauma. Whereas little T trauma is a word that we can use to describe these other experiences that don't quite fit that strict criteria but still subjectively felt traumatizing to us and have impacted us in some way. What's interesting is that there's some research that suggests that the extent to which somebody subjectively feels like something was traumatic is actually more predictive of their mental health outcomes than whether or not it meets this strict definition because we see people all the time who experience big T traumas and they might be totally fine afterwards. And then there are people who experience little T traumas and are really struggling. We can use little T trauma to describe things like racial trauma, discrimination, minority stress, the experiences that you described, and even just significant interpersonal losses and things like that. Kimberley: Yeah. Maybe even COVID. For some, it was a capital T trauma, would you say, because they did almost lose their lives or witness someone? Is that correct? Would you say that some others would have interpreted it as a smaller T and then some wouldn't have experienced it as a trauma at all? Caitlin: Yes, I think that's a great example because there are definitely a lot of folks who don't necessarily know someone who became really ill, lost their life, or didn't have that personally happen to them. But there was this looming stress, maybe even related to quarantine and isolation and things like that. WHO GETS PTSD AND TRAUMA? Kimberley: This is really fascinating. I wonder if you could share a little, like, of all the people, what are the factors that you mentioned that increase someone's chances of going on to have PTSD? Who goes on to get PTSD, and who doesn't? How can we predict that? What do we know from the research? Caitlin: This is an interesting question because I think that some people might intuitively think, "Well, somebody experienced this really horrible trauma. Of course, they're going to go on to develop PTSD." We actually know that people on the whole can be pretty resilient even in the face of experiencing pretty horrible tragedies. Our estimates of exposure to what we would call potentially traumatic experiences range from 70% to 90% of the population, and most of us will experience something at some point in our lives that would need that definition—that strict definition of a trauma. Yet, only about 6 to 7% of people will be diagnosed with PTSD at some point in their lives. So there's this huge discrepancy here. There are lots of factors, and of course, we don't have this perfectly nailed down where we can exactly predict, "Okay, this person is going to be fine. This person is going to have PTSD." It's really an interaction of lots of factors. But we know that there are some things that can either provide a buffering effect against PTSD or have the opposite effect, where they might put somebody at greater risk. One of the biggest things that's come up in research is social support or the lack thereof, so that when people have really great social support after their trauma, whether it's after a sexual assault or they've come home from combat, that can really buffer against the likelihood of developing PTSD. The reverse is true as well when people don't have social support. We saw this, for example, after the Vietnam War, where a lot of veterans came home and really were mistreated by a lot of people. Unfortunately, that's a risk factor for developing PTSD. But there are other things too, like coping. Not necessarily using one particular coping skill, but rather having a variety of coping strategies that somebody can use flexibly, even something like humor. We see this as a resilience factor. Obviously, there are times when using humor can serve as a distraction or avoidance, and there are times when it can be really adaptive too. Obviously, of course, genetics that people may have a predisposition in general towards having mental health concerns. Sex, we know that people assigned female at birth have a higher likelihood of developing PTSD after trauma. And then there are things that may be specific to the experience itself, so the type of trauma. Sexual assault is unfortunately a really big risk factor for developing PTSD, whereas there are other trauma types where fewer people go on to develop PTSD from those. And then there's something that we call peritraumatic fear, and that just means the fear that you were experiencing at the time that the event was happening. In the moment that the trauma was happening to me, how scared was I? How much did I feel like I might lose my life? People who experience more of that fear at the time of the event are more likely to go on and develop PTSD. But it's pretty interesting too, because, as with everything, there isn't just this binary, like you either have it or you don't have it. I want to normalize this too for anyone who might be listening and maybe has recently experienced something really horrible and is struggling with some of these symptoms that we talked about. It doesn't necessarily mean that you have PTSD or that you're going to continue to have PTSD. Most people, about 50 to 65%, will experience mild to moderate post-traumatic stress symptoms after the event that will just gradually go away on their own. We call that a resilience trajectory. We also have about 10 to 15% of people who have what we call a recovery trajectory, where maybe right away they did have a spike in post-traumatic stress symptoms, right away in that first month or so. But after a year, again, it's resolved itself. And then we have two trajectories that go on to describe people who will have PTSD. That would be a chronic trajectory where somebody would have this elevation in symptoms after the trauma that persists. That's usually about 15 to 20% of people. And then less likely is what we call a delayed trajectory. This is about only 5 to 10% of people who may have had really mild symptoms right away or perhaps no symptoms at all. And then, after about six to 12 months, it might just all of a sudden skyrocket for whatever reason. IT IS OCD OR AM I IN DENIAL? Kimberley: Right. So interesting. I was actually wondering what you often hear about people who, especially as someone who treats OCD and anxiety disorders, often questioning whether there was a trauma they had forgotten. Like, did I repress or am I in denial of a trauma? What can you share statistically about that? Caitlin: Yeah, that's a really great question. It's definitely more of a controversial topic in the field, not because people don't have the experience of having these recovered memories, but rather because of what we know about how memory works and how fragile it can be, that as clinicians, we have to be really careful that we're not, in our efforts to help someone, inadvertently constructing a false memory. I would say that most of the time, this delayed trajectory of PTSD symptoms is less so about the person not remembering the event, but more so like they just have continued on with their life and are probably suppressing, avoiding, and doing all sorts of things that are maybe keeping it at bay temporarily. And then there may be, in a lot of cases, some big life event that may bring it up, or perhaps another traumatic experience or something like that. WHAT IF I HAVE REPEATED TRAUMAS? Kimberley: Yeah. I was going to ask that as well, as I was wondering. Let's say you've been through a trauma. You recovered on that trajectory you talked about. Are you more likely to then go on to have PTSD if you repeat different events, or do we not have research to back that up? Caitlin: That's a great question. I'm not sure specifically about, depending on which trajectory you were initially on, how that increases the likelihood later on. I can say that repeated exposure to trauma in general is associated with a greater likelihood of PTSD. I would say that, probably regardless of how quickly your symptoms onset, if at all initially, experiencing more and more trauma is going to increase the likelihood of PTSD. WHO CAN DIAGNOSE PTSD AND TRAUMA? Kimberley: Right. Amazing. Thank you for sharing that. I know that was very in-depth, but I think it helps us to really understand the complexity and the way that it can play out. Who can make these diagnoses? I know, as I mentioned to you before, even my daughter has said she found herself on some magazine website that was having her do some online tests to determine whether there was trauma. It seems to be everywhere, these online tests. Can you get diagnosed through an online test? Would you recommend that or not? Who can we trust to make these diagnoses? Caitlin: That's a great question. I would not recommend using something like an online test or even a self-report questionnaire to help you figure out if you have PTSD. Now, it can give you a sense of the specific areas that I might be struggling with that I could then share with a licensed provider, who can then make the diagnosis . But if you were to just find a quiz online and take it, and it says you have PTSD, that would not be something that we would consider to be valid or reliable in any way. I would recommend talking with a psychologist, a psychiatrist, any sort of general practitioner, an MD, or maybe even someone's primary care physician. Definitely, if you can get in touch with a licensed provider who specializes in PTSD and can really be sure that that's what's going on for you. Now, TikTok and all these things exist out there. As with anything on the internet, it can be used for good and it can also be very harmful. I think it just comes down to gathering information that may be helpful but then passing it on to someone who can sift through the misinformation and give you a clearer answer. Kimberley: Yeah. Thank you for that. I think, as someone myself who's had their own mental journey, I do remember during different phases of my own recovery where our brains just don't make sense. I had an eating disorder—a very bad eating disorder—and my brain just couldn't see clearly in some areas, and me being so frustrated with that. I know lots of people with, let's say, panic disorder feel the same way or health anxiety, their condition feels so confusing and makes no sense that in the moment of being grief-stricken by this and also very confused, it's pretty easy to start wondering, "Could this have been a trauma or is this PTSD? This doesn't make sense. Why am I having this mental health issue?" Especially if it's not something that was genetically set up in your family. I'm wondering if you can speak to the listeners who may have dabbled in thinking maybe there is a trauma, a big T, a little T, or PTSD. Can you speak to how someone might navigate that? Caitlin: Most definitely. I'll validate too that it's really complex. We use the DSM to help us understand these different diagnoses, but there's so much overlap. Panic disorder—obviously, panic attacks are the hallmark feature of panic disorder, but people can have panic attacks in PTSD as well. People with eating disorders might have issues with their self-image and their self-esteem. That can happen in PTSD as well, as I mentioned, even with mood disorders. There are symptoms in PTSD that sure look and sound a lot like depression. If it feels confusing, "Well, wait a minute, I have this symptom. What does it belong to? What does it mean?" We do really have this very imperfect and overlapping classification system that we use. That being said, it's a legit question to ask if somebody feels like, as you were saying, "I've been struggling with these symptoms, but it really feels like there's something more here." When we diagnose PTSD, we go through all of the 20 symptoms, some of which I referenced earlier. For each symptom, we'll ask about when that symptom started for the person relative to trauma and whether or not it's related to trauma in some sort of way, if there's some content there to work with. For example, somebody maybe wasn't having any issues with their mood whatsoever, and then they experienced trauma, and all of a sudden, it was just really hard for them to get out of bed. Well, that could potentially be a symptom of PTSD because it started after the trauma. One thing that I hear a lot, because unfortunately, childhood trauma is really common, when I ask folks about this, they'll say, "I don't know. The trauma happened when I was so young that I don't even remember who I was before this person that I am now, who's really struggling." In that case, people usually have a pretty good insight into this. Like, do you think that this is related in any way? Or maybe, if you have any recollection, you had a little bit of this experience and this symptom initially, and it got worse after the trauma. That, again, could potentially indicate that that's a symptom of PTSD. I would say for those folks who are listening, who are struggling with things like panic attacks, difficulty with eating, mood, whatever it might be, even OCD, which we talked about recently, really checking in with yourself about how and if those symptoms are related to your trauma. If they are, then find someone that you trust that you can talk to about it. Hopefully, a therapist who can help you piece this apart. It could still be maybe the disorder you thought it was, maybe it is panic disorder, maybe it is OCD, maybe it is an eating disorder that's still informed by trauma in some way or impacted in some way, which would be important to be able to process in treatment. Or it could just be PTSD entirely. And then that would be really important to know because that would significantly change what the treatment approach would be. Kimberley: Yeah. It's so true of so many disorders. You could have social anxiety and panic attacks because of social anxiety, and a mental health professional will help you to determine what's the primary, like, "Oh, you have social anxiety and social interactions are causing you to have panic," and that can sort of help. I think as clinicians, we're constantly ruling out disorders using our professional hat to do that. I think you're right. Speak to a professional and have them do our assessment to help you pass that apart. Because I think in general, any mental health disorder will make you feel like something doesn't feel right, and that's the nature of any disorder. Caitlin: Right. The good news, too, is that, within reason, some of the treatment techniques that we have can be used more broadly. Interoceptive exposures, we can use that for people who have panic disorder, just people who struggle with panic attacks, or maybe people who have OCD or GAD and just feel really sensitive to those sensations in their body that suggest that they might be anxious. Same thing with behavioral activation. We use that for depression, and that can really easily be added to any treatment, whether it's treatment for PTSD or something else. You're exactly right, getting clarity on what's going on for folks, and then what are some of these techniques that might be most helpful for these symptoms? PTSD AND TRAUMA TREATMENT Kimberley: Yeah. Thank you. You perfectly segue this into the next question, which is, can you describe the treatment or give us names of the treatment for this comparison of trauma versus PTSD? Are they the same treatments? Does it matter whether it's a big T trauma or a little T trauma? Can you give us some idea of the treatments for these struggles? Caitlin: Definitely. Most of the evidence-based treatments that exist are specifically for PTSD. Obviously, they touch on trauma, of course, as the reason why somebody has PTSD and where all of these symptoms stem from. But there aren't as many treatments that are, let's say, specifically for trauma, at least not in terms of a standardized way of working through that. If somebody's experienced trauma and they don't have PTSD, and let's say they don't have any diagnoses, but they are still impacted by this experience, just doing behavioral therapy or whatever treatment feels like a good fit for what somebody is trying to work through might be sufficient. And then we have these evidence-based treatments that have been shown to really target PTSD symptoms and help reduce them. A few years back, I think it was 2017, the American Psychological Association reviewed all of the research on PTSD treatments. They reviewed it using lots of different criteria for what it means to feel better after treatment beyond just reducing PTSD symptoms, but also looking at other things too, like mood and suicidality and things like that. They essentially created this list of treatments that they rank orders in different tiers, depending on how effective they were shown to be. In the top tier are four treatments. There's cognitive behavioral therapy just broadly, cognitive therapy also broadly, and then the two specialized treatments are prolonged exposure (PE) and cognitive processing therapy or CPT. I can talk a little bit more about those two if you'd like. In the second tier are things like acceptance and commitment therapy, EMDR—these treatments that people may have used themselves and have found really effective, and they are effective. They're just maybe a little bit less effective for fewer people, if that makes any sense. It's not to say that EMDR doesn't work, but rather that there's just more of an evidence base for things like PE and CPT. DIFFERENCE BETWEEN PTSD AND TRAUMA TREATMENTS Kimberley: Great. To speak to those two top-tier treatments, can you compare and contrast them for someone just so that they feel they understand the difference? Caitlin: Yeah. If I had a whiteboard, I would just draw out the CBT triangle, but hopefully, folks listening know that in the CBT triangle, you have your emotions, your behaviors, and your thoughts, and all these things are constantly interacting with one another. We could say, just on a really simplified level, that when we are seeking treatment for PTSD, we want our emotions to be different. We want to feel less emotionally impacted by the trauma that we've experienced. PE and CPT are both under the umbrella of cognitive behavioral therapy, so they both use that triangle. They just get at it a different way. PE starts with the behaviors, knowing that the thoughts and emotions come along for the ride. CPT starts with the thoughts, knowing that the behaviors and the emotions come along for the ride. Now, they're both extremely effective at reducing PTSD symptoms. They've done head-to-head comparisons. They're both great. You're not going to find one that's significantly better than another, but you might find one that feels like a better fit for what you're currently struggling with. Cognitive processing therapy , again, starting with the thoughts, cognitive processing, basically involves-- I almost think of this as looking at our thoughts and our beliefs about things and examining them from different lenses. I always picture plucking an apple from a tree. Like, okay, this is a belief that I developed from my trauma. This was really adaptive for me at the time because this belief told me that I can't trust anyone and I have to always watch my back. Boy, did that help me when I was in combat and I was always watching my back and making sure I was safe. But as I look at it from these different angles, I might realize, well, I'm not in combat anymore, and I'm living in a pretty safe environment with safe people. So maybe this belief doesn't really serve me anymore. You work with your therapist to identify what we call stuck points, which are these really deep-seated beliefs that somebody has about themselves, other people, or the world that either developed from trauma or were reinforced by trauma, because sometimes people will say, "Well, I've never trusted people. I've always been in an environment where things weren't safe." And then there we go, the trauma happened, and it just proved me right. Cognitive processing therapy helps people work through these stuck points and come up with alternative perspectives on these thoughts. Prolonged exposure is a lot more similar to what I imagine lots of the folks listening may have done with exposure therapy generally, or exposure and response prevention for OCD. Again, we're starting with the behavior, knowing that if we target the behavior first, that's going to change our cognitions, and it's going to change our emotions. PE involves two different types of exposure. The first one being in vivo exposure, which is really similar to just any sort of ERP exposure where you expose yourself to something in the environment that triggers a thought about the trauma or some sort of emotional reaction. You do those over and over again until they feel like no big deal to you, you feel really awesome about yourself, and you can conquer the world because you can. And with your therapist, you do an imaginal exposure, which is where, in a really safe environment, you talk through the experience of your trauma and what happened to you. You do this actually in a unique way to really engage with that memory because, as we talked about, that internal avoidance is so common in people with PTSD. This imaginal exposure would be describing the experience in the present tense, painting a picture as though it was a film that was playing out right in front of our eyes, and really digging into the details of, what am I feeling in the moment that this trauma is happening? What am I hearing? What am I sensing? And doing that imaginal exposure, again, with your therapist in a really safe space until it doesn't have an impact on you anymore. I always say this to people when they start PE with me: I know that this may sound nuts right now. But a lot of people who do PE will get to a point where they'll look at me and say, "I'm so bored telling this story again. I've told this story so many times. It doesn't even bring up this emotional response for me anymore." That feels really unlikely for people who are just starting out in treatment and are so impacted by this memory, and they do everything in their power to avoid it. But people can and very much do get to a place where they feel like they've conquered this memory and it doesn't control them anymore. That's how PE and CPT work. Again, they both eventually target the same thing. It's just sort of, which route do you go? COMPLIMENTARY PTSD TREATMENTS Kimberley: Right. Amazing. Thank you. From my experience too, and actually, this is a question, not a statement—my experience, some people who I'm close with or clients who have been through PTSD treatment also then had to develop some coping skills, mindfulness skills, compassion skills, or maybe sometimes even DBT skills to get them across the finish line. Has that been your experience? What is your feedback from a more scientific perspective? Caitlin: Yeah, it really depends on the person. There are also combinations of these treatments. There's a combined DBT and PE protocol out there for folks who do need a little bit more of those skills. Some people do feel like they would benefit from having some of these coping skills, maybe upfront or throughout the course of treatment. But they've also done research where they've started with that skill-building before they go into PE or CPT, compared to people who go right in. Actually, what they often find is that starting with skill building, sometimes it's just colluding with avoidance, and it just lengthens the amount of time that somebody needs before they start to feel better. I'm glad you asked this question because it's so common for people with PTSD to feel like, "I can't. I can't do this thing. I can't feel this thing. I can't talk about this thing." And they really can. Sometimes if we allow people to really challenge those "I can't" beliefs, then they'll realize, "I really thought that I was going to need all this extra support or I was going to need this or this, and I was able to just move right through this treatment." Now, of course, again, that's not the case for everyone. There are some folks who maybe have much more severe PTSD, maybe have some different comorbidities like personality disorders or something else where it might be helpful to involve some of that, or people who had really chronic exposure to, say, childhood trauma. But far and away, people are often much better able to jump right into some of these treatments than they think they are. HOW TO FIND A PTSD TRAUMA THERAPIST Kimberley: Thank you for sharing that. I think that's super helpful for us to feel hopeful at the end. One more question before you tell us about you and some of the amazing things that you're doing. Where might people go? As we know, with OCD and health anxiety, we want a specialist to be helping us, ideally. I've noticed as a consumer that everybody and their Psychology Today platform says they treat trauma. I'm wondering how we might pass through that and find treatment providers who are skilled in this area. How might they find a trained professional? Caitlin: I'm glad you mentioned that about Psychology Today. That's the advice that I give people when they're using Psychology Today, or really any sort of platform. If this person is saying that they treat everything under the sun, then it's probably not a person that you want to link up with for something really specialized because it's-- what is the saying? "Jack of all trades, master of none." And I start to get suspicious even that this person even does evidence-based treatment for trauma and PTSD when they've listed a thousand things. It's definitely a red flag to consider for those who are listening and maybe have had this experience. In terms of finding a therapist, if folks are interested in PE or CPT, there's actually directories of therapists who've been trained and certified in those modalities. You can find them on-- I'm trying to think of the exact website. If you Google "Prolonged Exposure providers," something will come up, I believe it's through Penn. You can do the same for cognitive processing therapy. If you Google, I think it's like "CPT provider roster," you'll get a whole list of providers as well. Now, just because somebody isn't on there doesn't mean that they haven't been trained in these things. There's just a certification process that some people go through, and then they can get added to this list. If your provider says, "I'm trained in PE, I'm trained in CPT," I would probably trust that person that, for one thing, they even know what those things are, and I'd be willing to give them a shot. Also, and I know we mentioned this on the last episode too, for anyone listening who might have PTSD and OCD , I've compiled a list of providers on my website—providers who are trained to treat both OCD and PTSD. I have that broken down by state and then a couple of international providers as well. My website is www.cmpinciotti.com. In terms of broad resources beyond finding a provider, there are lots of organizations that have put out some really great content about PTSD—videos, handouts, blogs, articles, all sorts of things. I think the biggest place that I send people is the National Center for PTSD. This is technically run through the Veterans Administration, but anyone can use these resources. They're not only for veterans. It's very, very helpful. I'd recommend people who want more information to go there. You can also find things on the Anxiety and Depression Association of America, the National Institute of Mental Health, the National Alliance on Mental Illness, and so on. And then, of course, I mentioned the Trauma and PTSD in OCD Special Interest Group that I co-chair, that folks can sign up for that too, and we send out materials through there as well. Kimberley: Amazing. I am so grateful for you because I think we've covered so much in a way that feels pretty easily digestible, helps put things in perspective, and hopefully answers a lot of questions that people may be having but didn't feel brave enough to ask. Where can people find out more about you? You've already listed your website. Is there any other thing you want to tell us about the work that you're doing so that we can support you? Caitlin: On my website, in addition to the treatment provider directory, I also have some handouts and worksheets. Again, these are specific to co-occurring OCD and PTSD. That might be helpful for some folks. I also usually list on there different studies that are ongoing. I have two right now that are ongoing that I can-- oh, actually, I have three—I lied to you when I said two—that people can participate in if they're interested. There's one study that we'll be wrapping up at the end of December. That's about OCD and trauma. People can email OCDTraumaStudy@bcm.edu for more information. We also have a study that's specific to LGBTQIA+ people with OCD that also covers some things related to trauma and minority stress in that study. If folks are interested in participating in that, they can email me at PrideOCD@bcm.edu. And the last one, and I'll plug this one the most, that if folks are like, "Well, I want to participate in a study, but I don't know which of those," or "I only really have a few minutes of my time," we have a really, really brief survey, and we're trying to get a representation of folks with OCD from all over the country. For anyone who's listening and who has OCD and is willing to participate, it's a 10-minute survey. You can email me at NationalOCDSurvey@bcm.edu. All of these cover the topic of trauma and PTSD within them as well. Kimberley: Thank you. I'm so grateful for you. You've come on twice in one month, and I can't thank you enough. I do value your time, but I so value as well your expertise in this area and your kindness in discussing some really difficult topics. Thank you. Caitlin: No, I appreciate it. Thanks for having me on. I hope that folks who are listening can feel a little bit more hopeful about what the future can hold for them. PTSD & TRAUMA LINKS AND RESOURCES Find a PE provider: https://www.med.upenn.edu/ctsa/find_pe_therapist.html Find a CPT provider: https://cptforptsd.com/cpt-provider-roster/ For educational resources on PTSD: https://www.ptsd.va.gov/ To participate in a brief, 10-minute national survey on OCD: NationalOCDSurvey@bcm.edu To participate in the OCD/Trauma Overlap Study (closing at the end of December): OCDTraumaStudy@bcm.eduTo participate in a study for LGBTQIA+ people with OCD: PrideOCD@bcm.edu

Dec 15, 2023

Radical acceptance when things get hard can be a very difficult practice. In fact, it can be almost impossible. When things get hard, one of the things we often do is we spend a lot of time ruminating about why it's so hard and what we could have done to prevent it from being so hard. And, instead of using radical acceptance , we often go into beating ourselves up, telling ourselves, "We should have done this; we could have done that. If only we had looked at it this way or treated it this way." I want us to really zoom in on these safety behaviors that you're probably doing. Hopefully, today, you leave here committing to reducing or eliminating those behaviors. Now, I get it. When things are hard, we don't want to feel the suffering that goes with it. I get it. I don't want to feel it either. You're not alone. But when things are hard, often, instead of letting it be hard and feeling our feelings and being kind to ourselves so that we can move into effective behaviors, we get stuck resisting the emotions and doing these other behaviors that increase the shrapnel of the event. I call it 'shrapnel' because it does look like that. It creates more damage around us. Let's look at how we might prevent this. HUMANS SUFFER You're suffering. The reason I know this is because you're a human being, and all human beings have sufferings in their lives. Some of us, more than others. If you're in a season where the suffering is high, I would basically say, the higher the level of suffering, the more you need to listen in. Maybe listen to this multiple times, get your notepad out, and let's really go to work. SOLVING DOESN'T ALWAYS WORK When you're suffering and your suffering is high, again, it's very normal to want to solve why you're suffering, thinking that yes, that may prevent it from happening in the future, prevent us from having more pain, or prevent us from having to feel our feelings. That's effective behavior, except... if you're relying on that and you're spending too much time doing that, chances are, you're increasing your shrapnel. If that's the case, let's talk about other alternatives. When we're going through difficult things, there is a strong pull toward figuring out why. But my guess is, if you haven't solved it yet, chances are you won't. I know this is true for me. It might be true for you, but you've probably already identified the problem of one of the things that may be if, in 20/20 hindsight, you could have done differently. And that's okay, right? There's many times I've looked back and been like, "Yeah, it didn't handle that well," or "That didn't go as well. Maybe now, knowing what I know, I could have done something different." But often, we spend too much time resisting the fact that it is hard right now. If you're someone who's spending a lot of time going over and over on repetition, all the things you could have done, chances are, you're not radically accepting what is. What we want to do first is move to radical acceptance as fast as we can. We're not saying that you can't go back and do some effective addressing of what went wrong and what went right. You can do that for short periods of time. But if you're someone who's doing it repetitively, catch yourself. We want to move into radical acceptance that yes, things are hard right now. WHY DOES RADICAL ACCEPTANCE SUCK? Often, we resist practicing radical acceptance because of one core reason, and that's because we don't want to feel bad. We don't want to feel the guilt. We don't want to feel shame. We don't want to feel the uncertainty. We don't want to feel sad. We don't want to feel angry, grief, or panic, whatever it might be. It might be physical pain. We don't want to feel it. And so hand in hand goes this work of radically accepting the suffering that you're experiencing in whatever form, whether it be emotional, physical, spiritual, or other, and then really being willing and creating a safe place to feel those feelings. I'm not saying ruminate on those feelings, make them worse, or agree with everything you're thinking and feeling. No. I'm just saying, being able to observe that yes, sadness is here, or grief is here, or anxiety is here. It's showing up in these ways in my chest, in my head, in my shoulders, in my neck, in my hips, in my tummy, wherever it's showing up for you. First radically accepting it and then being willing to feel those experiences and those sensations. We alternate between those two. We radically accept, then be willing and open. Then we have to go back and radically accept, be willing, and be open. RADICAL ACCEPTANCE IS REPETITIVE I want to remind you that it's okay that you have to do this on repeat. Often, with my patients—and I do this too, I have to admit—we practice radical acceptance , we practice self-compassion, we practice willingness for a little while, and then we get frustrated because it's not making it go away. It's not fixing it. It's not making it disappear. So we go back to trying to solve, "Why is this happening? Why shouldn't it be this way? What did I do wrong?" instead of knowing that this is a repetitive practice that we commit to over and over again. It's like brushing our teeth. We don't do it once and go, "Great, it should be done." No, we go back, and we've accepted that we'll do it every morning and we'll do it every night. For some of you, at lunchtime too. I really want you guys to catch this deep urge and urgency to resist what really is and resist the feelings that go ahead and accompany that experience. We want to move back as fast as we can into radically accepting that it is what it is. RESISTING RADICAL ACCEPTANCE Now, if you're anything like me, a part of your brain is going to go, "But it's not fair. This is not fair. It is too much. Other people don't seem to be having these problems. It's not fair that I have this problem. It's not fair that mine is so big right now and theirs is not." I get that too. Also just acknowledge, you may even want to just validate and go, "Yeah, this is my season. They'll have theirs." I promise you, they'll have theirs. Hopefully not. We don't want to spread more pain around. But with being a human, it's 50/50. It's 50% hard and 50% wonderful, and that's a part of being human. They'll have their season; you're in yours. It is temporary. Again, resist the urge to stay in the rumination of "It's not fair." You can validate that by going, "Yes, it is not fair. This is a hard deck of cards that I've been dealt right now. I'm going to again try to reduce the shrapnel by not engaging in the why me and why did this happen and it shouldn't have, and it's not fair." I want to also say it's okay that you land there. That is a normal part of the grief process to land in that bargaining phase of grief. What we're really speaking to today is when you get caught in that. I NEED RADICAL ACCEPTANCE TOO Now, I am speaking to you about this because I needed to hear this message more than any of you today. This is actually as much for me as it is for you. I think that as I go through very difficult seasons in my life, I find them incredibly humbling because it helps me to see the story that I have told myself, the story that things should go well for me, that things shouldn't be hard, that I shouldn't suffer as much as I do in certain areas, that I should somehow magically be able to solve this or control this, and that other people want me to be able to handle this, so therefore, I should be able to. I forget my humanness. I keep getting humbled by my humanness. I feel like the world keeps coming to show me, "Kimberley, you're just like everybody else." Everybody suffers. How can you lean in and have this be an opportunity to deepen your self-compassion practice, deepen your mindfulness practice, and deepen your ability to feel any emotion that shows up? Because they will, many times in my lifetime. They will continue to show up in different ways because I'm a human, not because I'm a faulty person. All humans have these feelings. For you, you also have to remember, these are normal human feelings. You didn't do anything wrong. It's not your fault that you're having them so strong right now. Resist the urge to go into self-punishment for the fact that you're suffering. Again, radically accept that it is painful right now, and then move into willingness and openness to feel those feelings and create the safest, softest, gentlest landing for you as you navigate these really difficult emotions. As you do it, not to replace it, not to make them go away, but to help guide you through them. YOU CANNOT BYPASS EMOTIONS You can't bypass emotions. I have learned that one the hard way. You can't bypass them. If you do, you're probably increasing your problems. If you're doing compulsions to get your uncertainty and your anxiety to go away, you're going to have more of that obsession. If you're avoiding the thing that's hard, you're probably going to feel disempowered, and it's going to be a bigger problem. If you're resisting your emotions and you're resisting your experience, at some point, they will probably blow up and explode, and you'll feel them a lot. Our job, again—and this is my goal for myself, and I hope it's your goal too—is I want to be a place, a container. I want to be able to experience the full range of emotional experiences safely so that in the future, when hard days come, when I lose loved ones, when I go through hard times, when I witness difficult things, I already know that I have the ability to wade through this. WHEN YOU FEEL LIKE YOU CANNOT HANDLE IT ANYMORE The people who are struggling with "I can't handle this," they're the ones who have done everything they can to avoid feeling their feelings, and they haven't gotten much experience with learning to master emotions. When we do learn that we can have emotions and we do learn that we can tolerate them, then we do learn that we can ride them out. There's a sense of empowerment, like, "I can do really, really hard things." As I'm navigating a tough season, I'm actually blown away and in awe of myself, knowing that I can handle a lot. I've handled a lot in other difficult seasons in my life, and I come out of it usually being like, "Wow." Actually pretty impressed. I feel that way, especially when I stay out of that sort of rumination. I call it the inner tantrum. I have a tantrum like, "It's not fair, and it shouldn't be." RADICAL ACCEPTANCE SUMMARY I wanted to make this a very quick episode. Hopefully, it's exactly what you needed to hear. Number one, if you're in a difficult season, that doesn't mean there's anything wrong with you. That's just a human thing. Number two, if you're in a difficult season, let's back off from trying to solve what you could have done better because, coulda, woulda, shoulda, it's all 20/20 hindsight. You had no idea. Let's just leave that alone. Be very aware of that and work towards catching it and moving towards radical acceptance , willingness, and self-compassion. If you're somebody who really needs to improve your self-compassion, we have a whole mindfulness vault called The Meditation Vault. You can go to CBTSchool.com, and it will guide you through self-compassion practices that were led by me. It's all audio. It's all there. I'll teach you how to do it, and that hopefully will help you have my voice in your head so that you can start to practice self-compassion no matter what shows up for you, no matter what emotion you're experiencing, no matter what hardship you're experiencing. I hope that's helpful. Have a wonderful day. I'm sending you all the love, and I will talk to you next week.

Dec 8, 2023

Kimberley: Is ERP traumatizing? This is a question I have been seeing on social media or coming up in different groups in the OCD and OCD-related disorders field. Today, I have Amy Mariaskin, PhD , here to talk with us about this idea of "Is ERP traumatizing" and how we might work with this very delicate but yet so important topic. Thank you, Amy, for being here. WHY MIGHT PEOPLE THINK ERP IS TRAUMATIC? Kimberley: Let's just go straight to it. Why might people be saying that ERP is traumatic or traumatizing? In any of those kinds of terms, why do you think people might be saying this? Amy: I think there's a number of reasons. One of which is that a therapy like ERP, which necessitates that people work through discomfort by moving through it and not moving around it or sidestepping it, is different than a lot of other therapies which are based more on support, validation, et cetera, as the sole method. It's not to say that ERP doesn't have that. I think all good therapy has support and validation. However, I think that's part of it. The fact that's baked into the treatment, you're looking at facing discomfort and really changing your relationship with discomfort. I think when people hear about that, that's one reason that it comes up. And then another reason, I think, is that there are people who have had really negative experiences with ERP . I think that while that could be true in a number of different therapeutic modalities and with a number of different clinicians and so forth, it is something that has gained traction because it dovetails with this idea of, well, if people are being asked to do difficult things, then isn't that actually going to deepen their pain or worsen their condition rather than alleviate it? That's my take. Kimberley: When I first heard this idea or this experience, my first response was actual shock because, as an ERP therapist and someone who treats OCD, I have seen it be the biggest gift to so many people. I've heard even Chris Trondsen, who often will say that this gave him his life back, or—he's been on the show—Ethan Smith, or anyone really who's been on the show talk about how it's the most, in their opinion, like the most effective way to get your life back and get back to life and live your life and face fear and all of those things. DO PEOPLE FEEL ERP IS A DIFFICULT TREATMENT? I had that first feeling of surprise and shock, but also then asked more questions and asked about their experience of ERP being very pressured or feeling too scared or too soon, too much too soon, and so forth. Do you have any other ideas as to why people might be experiencing this difficult treatment? Amy: I do. I think that sometimes, like any other therapy, if you're approaching therapy as a technician and not as a clinician, and you're not as a therapist really being aware of the cues that you're getting from the very brave people sitting in front of you, entrusting their care to you—if we're not being clinicians rather than technicians, we can sometimes just follow a protocol indiscriminately and without respect to really important interpersonal dynamics like consent and context, personal history, if there's not an awareness of the power dynamic in the room that a therapist has a lot of power. We work with a lot of people as well who might have people pleasing that if you're going to be quite prescriptive about a certain treatment, you do this, and then you do this, and then you do this without taking care to either lay the foundation to really help somebody understand the science of how ERP works or get buy-in from the front end. I know we'll talk a little bit more about that, as well as there's a difference between exposure and flooding. There's a difference between exposure that serves to reconnect people with the parts of their lives that they've been missing, or, as I always call it, reclaims. We want to have exposures that are reclaims, as opposed to just having exposures that generate negative emotion in and of itself. Now, sometimes there are exposures that just generate negative emotions, because sometimes that's the thing to practice. There are some people who feel quite empowered by these over-the-top exposures that are above and beyond what you would do to really have a reclaim. I'm going to go above and beyond for an exposure, and I'm going to do something that is off the wall. I am eating the thing off of the toilet, or I have intrusive thoughts about harming myself, and I'm going to go to the top of the parking garage, and I'm really going to lean all the way over. Would I do that in my everyday life? No. There are some clients for whom that is not something that they're willing to do or it's not something that's important for them to do to reconnect with the life that they want to live, and there are others who are quite empowered. If you're a therapist and you don't take care to listen to the feedback from clients and let their voice be a part of that conversation, then you may end up, again, as a technician, prescribing things that aren't going to land right, and that could result in some harm. My heart goes out to anyone who's had that experience, because I think that's valid. Kimberley: I will be completely honest. I think that my early training as an ERP therapy clinician, because I was new, meant that I was showing up as a technician. When I heard this, again, I said my first thought was a little bit of shock, but then went, "Oh, no, that does make sense." When I was an intern, I was following protocols and I was learning. We all, as humans, make mistakes. Not mistakes so much as if I feel like I did anything wrong, but maybe went too fast with a patient or pushed too hard with a patient or gave an exposure because another person in supervision was saying that that worked for their client, but I was learning this skill of being attuned to my client, and that was a learning process. I can understand that some people may have had that experience, even me. I'm happy to admit to that early in my training, many years ago. Amy: That's a great point. I think if we're all being honest with ourselves, whether it be within the context of ERP or otherwise, there is a learning curve for therapists as well. I think going back to the basic skills and tenets of what it means to have a positive therapeutic relationship is that so much of that has to do with the repair as well. If there are times, because there will be times when you misjudge something or a client says, "I really think that I'm ready to try this," then we say things like when exposures go awry, when the worst-case scenario happens, or what have you. That's another philosophical question because I think in doing exposures, we're not necessarily, at least my style, saying the bad thing's not going to happen. It's about accepting the risk and uncertainty, which is a reasonable amount. However, I think when those things happen where it does feel like, "Hey, this felt like too much too soon," or this felt like, "Wow, I wasn't ready for this," or "I don't feel like that's exactly what I consented to. You said we were going to do this, and then you took an extra step"—I think being able to create an environment where you can have those conversations with clients and they feel comfortable bringing it up with you and you can do repair work is also important. That it's not just black or white like, "This happened and I feel traumatized." Again, I don't want to sound like I'm blaming anybody who's had that experience, but I'm just saying that I think that happens on a micro level, probably to all of us at some point. I think it's also important to acknowledge, and later we're going to talk about it, but the notion of the word 'traumatizing' is a little bit difficult for me to hear as well because I think from the perspective of an evidence-based practitioner, the treatments that we have, even for so-called big T trauma, many of them integrate in exposure. All of my first-line treatments, including ones that maybe come at it a little bit more obliquely like EMDR or something like that, which is not something that I personally use, are certainly out there as like a second-line trauma treatment. But things like prolonged exposure and cognitive processing therapy, they all have this exposure component to them. Even the notion that if there's trauma, you can't go there or that talking about hard things is traumatizing. I don't know. Can we talk a little bit about that? Because I don't know if that's something you've thought about too, that it's hard to reconcile. Kimberley: Yeah. Let me give a personal experience as somebody who had a pretty severe eating disorder. I was doing exposure therapy, but I didn't get called that, and I didn't know what to be that at the time. But I had to go and eat the thing that I was terrified to eat. While some people might think, "Well, that's not a hard exposure," for me, it was a 10 out of 10. I wanted to punch my therapist in the face at the idea that she would suggest that I eat these things. I'm not saying this is true for other people; I'm just giving a personal experience. I'm actually really glad that she held me to these things because now I can have full freedom over the things that used to run my life. I know that there is nothing on any menu I can't eat. If I had to eat on any plane, whatever they served me, I knew I was able to nourish my body with what was served to me, which I didn't have before I did that. The other piece is somebody who has also been through trauma therapy . A lot of it required me to go back and relive that event over and over. Even though I again wanted to run away and it felt like my brain was on fire, that too was very helpful. But what was really helpful was how I reframed that event. If I was doing it and, as I was doing it, I was saying, "This is re-traumatizing me," it was a very bad experience. But if I was saying, "This is an opportunity for me to learn how to have our full range of emotions, even the darker stuff," that ended up being a very important therapeutic experience for me. That's just my personal experience. Do you want to speak to that? Amy: Yeah. I wasn't planning on speaking to this part of it, but I will say as well that having had a traumatic event—a single event, big T trauma—that happened at my place of employment years ago. This is over 10 years ago now, which involved being held at gunpoint, which involved a hostage-type situation. It's interesting when you talk about trauma, that you want to tell the whole story, but I'm like, "Oh, we don't have enough time," which is interesting because our brains first don't want to tell the stories or we want to bury them. But suffice to say that after this very painful, very terrifying experience, after which all the hallmark symptoms of hypervigilance and quick to startle and images in my head and avoidance of individuals who looked like this particular individual and what have you. The most powerful thing for me in knowing this as somebody who works in exposure protocols, going back to work and being so kind to myself as I was, again, I come back to this word reclaim. It doesn't happen overnight. It's not something I wish there were. I do wish there's, "Oh yeah, we just push this button in our brains, and then that's just where we feel resilient again." But the process of building resilience for me was confronting this environment, reclaiming this environment. I think any exposure protocol has the ability to have that same effect if the framing is there and if it resonates with the person. Being somebody who's such a believer in exposure therapy for my clients, I was able to step into a role where I came out of that situation feeling so empowered and the ability to hold all of my experience gently and with compassion, as opposed to sweeping it under the rug and then having it come out sideways. Kimberley: I really appreciate you bringing that up because, similarly, I stowed mine down for many years because I refused to look at it until I was forced by another event to have to look at it. I think that's a piece of this work too. You have to want to face it as part of treatment. In my case, I either avoid the things that are so important to me or I am going to have to face this; I am going to have to. I showed up and made that choice. I think that's also a piece of it, knowing that that's an opportunity for you to go and be kind and to train your brain in different ways. HOW TO MAKE ERP ETHICAL AND RESPECTFUL We're speaking directly now about some ideas and solutions to making ERP ethical and respectful. Are there other ways that someone who's undergoing ERP, considering ERP, or has been through it—other things we might want to encourage them to do moving forward that might make this a more empowering and validating experience for them? Amy: That's a great question because I think we can talk about it both from the perspective of clients who are looking for a new therapist as well as what therapists can do. But if we start first with clients and maybe you're out there, and it's been something you've either been hesitant to engage with because of some of these ideas about it being harmful or you've had a negative experience in the past, I do think that there is a mindset shift into feeling really empowered and really willing. The empowerment part is coming in and bringing in-- your fears about ERP are also fears that can be worked on. If you're white-knuckling from the first moment of like, "Okay, I'm in here, I know I'm supposed to do this. I already hate it and it hasn't started," sharing that with a clinician. I know I'm used to hearing that. I'm very used to hearing that. I've had folks come in who have been in supportive therapy, talk therapy, or other modalities that haven't been effective for many, many years. There is a part of me-- I'm sorry, this is a tangent, but it's a little soapboxy tangent. I feel like when I think about my clients who've had therapy for sometimes 10, 20 years and it hasn't been effective, I don't think we talk enough about how harmful that is for people, like putting your life on hold for 10 or 20 years. I don't hear the word necessarily 'traumatizing,' but that can be harmful as well. People will go through that. BE OPEN WITH YOUR ERP THERAPIST After these contortions to maybe even avoid ERP because it's scary, they'll come in, and I welcome them, saying, "I'm really nervous about this," because guess what? Saying that aloud is a step in the direction of exposure. You're owning it. And then having a therapist who can say, "I'm so proud of you for being here." This is exposure number one. Sitting down on this couch, here we are. Well done, check and check. Because I think that a therapist who's looking at exposure, not just as what's on a strict hierarchy, or even from an inhibitory learning perspective, like a menu—exposure is what you're doing day to day to help yourself get closer to the life that you want and the values you have. When you said, "I can eat anything because I want to nourish my body," that's a value. When I say 'empowerment,' like empowerment to discuss that with your therapist. And then that shift into willingness versus motivation or comfort or like, "Oh, I want to wait till the right moment," or "Things are tough now. I don't want to add an extra tough thing." I know you're not here to tell anybody, "Well, this is the way you should think." But if there's any room to cultivate even a nugget of willingness to say, "I can do something difficult, and I am willing to do difficult things on the path toward the life that I want," those would be two things that come to mind right away. Kimberley: Yeah, I agree. It takes me to the second piece for a client. I think a huge piece of it is transparency with your therapist or clinician. There have been several times where we've discussed an exposure—again, this was more in my earlier days—agreed that that would be helpful for them, gone to do it, and then midway through it, them saying, "I felt like I had to please you, but I'm so not ready for this," or "I was too embarrassed because this is such a simple daily task and I should be able to do it." I think it's okay to really speak to your therapist and share like, "I don't know how I feel about this. Can we first just talk about if I'm ready?" We don't want to do that to the degree of it becoming compulsive, but I want to really encourage people who are undergoing treatment of any kind to be as completely honest as you can. Amy: Right. I think that, again, it's an interesting dynamic because people are coming to specialists because we do have the knowledge and awareness of protocols and so forth. But again, I think mental health is-- well, I wish all medical health folks were a little bit more open to these kinds of conversations too. But that being said, I think having that honesty and knowing that-- if you go in and you say, "Oh, I'm a little bit nervous," and you're getting pushback of, "Well, I'm the doc, this is what you do. Here's step one, here's step two," frankly, there are going to be therapists who are like that regardless of modality. It was interesting because I was talking to somebody about this and about—I think if we frame it as a question—"Is ERP inherently harmful" is a really different question than " Can ERP be harmful? " I think any modality implemented without that clinical touch can be potentially harmful. I know your motto is, "You can do hard things." That kind of shift as well is so powerful at the beginning of ERP. You've been transparent. You've said, "Look, here are my fears about this." And then often, what I will do as a clinician if people don't get to that place of like, I" can do things through the discomfort, there's no going around it," is ask them about things. If they're adults, it could even be like, "When you were a little kid, did you have any fears, and how did you get over those? What was that like?" Not always, of course, but 9 nine times out of 10, it is some kind of like, "Well, I did the thing." Or sometimes it's more complicated, "Well, I did the thing and then I got support from others, and then I learned more." But I think people have this innate capacity to learn by changing behavior and to do things that are outside of their comfort zone, and that doesn't have to mean way outside of their comfort zone. Often, that notion of these hard experiences or these difficult thoughts that you need to-- people will come in and feel like, "Well, I need not to be thinking about them." That's not really an option. Being a human with a full life, there are going to be things that are provocative. But I think I've heard you talk about this notion of shifting from wanting protection from negative thoughts or discomfort to almost willingness and acceptance. I love that as well. Kimberley: I agree. I want to also maybe back up a little bit and speak to that just a little bit. I do hear the majority of people saying this, coming from those who are seeking treatment from unspecialized people. Even this morning, people are emailing me saying, "I'm following this OCD coach online, and they're saying, 'Follow my six-month program and you will be OCD-free.'" That sounds good. I'll do whatever you say if that's what I can give you. There is a power dynamic. But then you're in the program and being told that you have literally two months to go and you better double down or you will fail my program. I think that urgency to get better can cause you to sometimes agree to things or seek out treatment from people who aren't super trained and who aren't taking an approach of, "Let's practice being uncomfortable, let's practice having every single emotion kindly and compassionately so that there is no emotion you can't ever have in your lifetime through the darkest ages." They're more coming from a, "I'm on a timeline here and I have to get this done, so I'm going to do these things that are absolutely terrifying." I think a lot of people are speaking to this. Amy: I think that's right. A lot of times, people have been-- I think we, as a field, like mental health professionals, there's this delicate balance of wanting to instill hope and really talk about like this works and to not overpromise or not simplify the circuitous way that we get there together as a therapist and client, because there are a lot of sound bites out there. I know you and I have talked about this. It's like these "better in 12 weeks" or "better in with these five tips" or what have you. I think even looking at research, and I have a strong research background, I was training to be a researcher when I was in grad school. I think it's important as well to remember that even with research, we are looking at-- if we say like, "Hey, this is a 12-week protocol that's been effective." Okay, what does effective mean? Does effective mean that you get to pick up your baby again? Or does it mean, oh no, it probably means an X amount reduction in the Y box? Does effective mean it was that amount of reduction for everyone? Well, no, it's averages and things like that. I can wear both hats and say, this is an incredibly empirically validated treatment that works for many people. It's not going to work the same way for every person, so why would we as clinicians go in and be like, "Here's a timeline?" You can't do that. Kimberley: Yeah. Let's speak to the therapist now. What can therapists be doing to make this a more effective, compassionate, and respectful practice? Do you have anything that you want to speak to first? Amy: Yes. I think that if we start at the beginning of therapy itself and the steps that you go through, the very first step is assessment because exposure is something that we know is very effective for anxiety, to a lesser degree, disgust, and not quite right feelings as well, and some sensory issues, to a lesser extent. But exposure is effective for certain things. We want to make sure that those are the things that are occurring. So, making sure because somebody can have OCD, or can have anxiety, or something like that and also have other things going on. I think sometimes when exposure is treated-- exposure and response prevention. I know we talk a lot about exposure, but even response prevention, that side of things, it's just this one size fits all. Okay, something you don't like doing, we're going to expose you to it, and something that alleviates your distress, we're going to eliminate those. If you're doing that outside of the context of where it's clinically indicated for OCD, i.e., areas that provoke obsessions and compulsive behaviors, then you're really missing the target. I know there's been a lot of discussion about neurodiversity and for autistic people who may have routines and things like that or may have stereotypies or stimming behaviors, things that are pleasant for them or self-regulatory to really get a good assessment in there. Again, you're not having people do exposures or engage in response prevention in places where it's not clinically indicated. I think even if somebody has a trauma history, for something like PTSD, exposure is often, as I mentioned, a part of treatment protocols. The way in which we are doing those kinds of exposures and really centering the sense of agency in the client who's had that sense of agency taken away by prior experiences is really important. I think assessment is the first thing that comes to mind, followed-- Kimberley: I would add-- sorry, I didn't mean to cut you off, but I would add even assessment for depression. A lot of what we teach in ERP school for therapists and what I teach my staff is, if a client has depression, I might do more exposures around uncertainty and not around their worst-case scenario happening because sometimes that can make the depression come in so strong that they can't get out of bed the next day. We can tailor exposure even to make depression, and so forth. I think it is so important that we do get that assessment and really understand the big picture before we proceed. Even understanding other anxiety disorders, health anxiety, the history of trauma with health, and so forth, or even the things you were taught as a child, can be really important to understand before we proceed with exposure. Amy: I love that you added that in—the things that we were taught as a child—because I love this story. I mean, I love it and hate it, and you'll understand why in a moment. But when I was on my internship—this was back in 2008, 2009—there was a fellow intern. He and I were co-presenting on a case, and we had the other interns. They were asking questions, and this was a makeshift IOP case. We were both doing a little bit of individual therapy, and people in the audience were asking questions, and somebody asked about childhood. This was an adult. The other intern said, "We don't care about that stuff." I said, "Time out, I care about it," and we all laughed. I get where he was coming from in the sense that he was like, "Hey, here are the symptoms, here's the protocol for the symptoms, and it is important." Like you said, I mean, even from a CBT, this is very consistent with CBT and how we form core beliefs and schemas and our ideas about the world and fairness and justice, and all of that is a part of it. We don't want to lose the C part, the cognitive part as well in ERP. But I love that you said that about depression as well, because even something co-occurring can just nudge. It just nudges the way that we do exposure and so forth. Kimberley: Yeah. I think culturally too. Think about the different traditions that come with different cultures or religions. Sometimes some of their rituals can seem compulsive. If I didn't know that that's why they're doing these, I could easily, as an untrained or ineffective therapist, be like, "Just expose yourself." We've got to break this ritual, without actually understanding, like, is this actually a value-based ritual that you're doing because of a religion or a culture or tradition that is in line with your values? I think that's very, very important. After assessment, what would you say the next steps are? Amy: I think that-- and this is the part where I'm really going to own that. I get really excited, and I just want to jump into treatment. This is me, I'm calling myself out. But I think psychoeducation, that not only very clearly lays out the evidence and the why, like here's the process, here's why we're asking you to do these things that are really difficult, here are the underlying patterns, and here's what we're looking out for, and so forth. I think not only that, but also laying out very clearly what the expectations are. "This is how this is going to look," and maybe at that point as well, clinicians saying—this is very collaborative—"I am here to provide this information, and then together we are going to formulate a treatment plan and formulate these exposures." I have heard so many people who do a lot of ERPs say how proud they are by the end of therapy when clients come in and they say, "I was thinking I need to do this as my exposure." They're really taking that ownership. I think not only again talking about the science and all the charts and things like that, but really talking about this as a collaborative, consensual process, that it's like, "I'm handing this off to you, and this is going to be something you have for the rest of your life." Kimberley: Yeah. I'll tell a similar story. I had a patient who-- I'll even be honest, I don't think this was in my internship. This was in my career as an OCD therapist. But my client was just doing the exposures that he and I had agreed to. He would come back and be very frustrated with this process until he came to me and said, "I need you to actually stop and explain to me why I'm doing this." I thought I had done a thorough job of that. I truly, really, honestly did. But he needed me to slow down and explain. We got out the PET scans of the brain, and I had a model of the brain. I showed him what part of the brain was being triggered and where the different parts of why-- from that moment, he was like, "I got you. I know what we're doing. I'm on board now. I got this." I think that I was so grateful that he was like, "Hold up, you need to actually slow down and help me to understand because this still doesn't make sense to me." This was a very important conversation. In my case, I think it's checking in and saying, "Do you understand why we're doing this? Do you understand the science of this?" I think it's so important. What else might a therapist do? Amy: I love that. I was just going to say, I love that you create that culture because that's what I was talking about earlier. Sometimes we don't quite get it right. And then it's like, "What can I do better?" It's such a powerful question. Knowing the why of ERP and then also the why, like, why is it worth it for you? Why is this? ACT has these wonderful metaphors about it. We've heard the monsters on the bus analogy. You're driving the bus, and all your symptoms are the passengers yelling out or different fears you might have. But so often we don't talk about, where are you driving the bus toward? Where are you going? I get misty when I think about this. I get almost a little teary because I think that people with OCD have such incredible imaginations, and yet, having OCD can make it so hard to dream and dream about what you truly want. Especially if it's quite entrenched, it can just feel like, "Well, that's a life that other people have. I don't get to have that." On the one hand, there's this expansive imagination about illnesses, danger, harming others, or what have you. These things that are just dystonic—you don't want to be thinking about them. I love to see people exercise that other part of their imagination and really encourage them to dream because if you have that roadmap, or rather that end destination of what you want your life to be, those very concrete moments that you want-- for some people, it's like, "I want to have a family," or "I want to travel," or "I want to have the freedom to be around whomever I want to be around, regardless of the thoughts that come up," whatever it is. Sometimes it can feel scary to even dream and envision that, either through values work or if it's somebody who had a later onset thinking about where were you heading before. How did this derail you? What were you heading toward? I think that's really important as well. If we don't do that-- I mean, frankly, I wouldn't want to do anything if I didn't know my why. Kimberley: No, agreed. I think that another thing—I often talk about this with my therapists in supervision—is one thing that I personally do-- and this is just me personally. Every therapist has their own way of doing it, but I often will ask my patients, "What kind of Kimberley do you need today?" I have the question as an opening where they can be like, "No, we're good. Let's just get to work." We knew what we were going to do and so forth. My patients now know to say, "I need you to actually push me a little today." They're coming to me saying, "I want you to push you." Or they'll say, "I'm feeling very vulnerable today. I'm on my period," or "It's been a hard week," or "I haven't slept." I don't consider that me accommodating them. I consider that me being attuned to them. It might be that I might go, "Okay, but there's been several weeks in a row that you've said that. Can we have a conversation?" It's not that I'm going to absolutely let them off with avoidant compulsions, but I love offering them the opportunity to ask, what kind of Kimberley do you need? Sometimes they'll say, "I need you to push me today, but I also need you to really encourage me because I have run out of motivation and I don't have a lot." I think that as clinicians, the more we can offer an opening of, what is it that you're ready for? What do you want to expose yourself today? Is there something coming up that you really need to be working on? I think those conversations create this collaborative experience instead of like, "I'm the master of treatment, and you're my follower" kind of model. Amy: Right. I love that, and I love the idea that we can be motivational, encouraging, and celebratory in the face of exposure. Like exposures, I do feel like there has been a shift, and perhaps with the shift away from the strict habituation paradigm in the field, where it's not like you have to just do the thing and be scared, be scared, be scared, be scared, be scared, and then it goes down. You can explore, "Hey, are you feeling stronger now? Are you feeling like I'm nervous, but I'm also curious?" Again, some of this is just personal style, but I use a lot of humor. There are often a lot of inside jokes with clients and things like that. I don't see that as incompatible with really good exposure work because you're learning that you can be scared and laughing. You're learning that you can feel discomfort and empowerment. These kinds of things are huge. But again, I think when I was newer to ERP, there was a little bit of like, "Nope, we're not cracking a joke, because that would be avoiding negative emotion." Kimberley: Yes. I remember that. Or being like, "I hope I don't trigger them. I'm not going to [unintelligible]." The joke is what created an attunement and a collaboration between the two of us, which I think can be so beautiful. Another question I ask during exposure is, would you like to keep going? Would you like to make it a little harder? How could we? Even if we don't, how might we? No pressure, but how might we make it so that they're practicing this idea of being curious about making decisions on their own? Because the truth is, I'm only seeing you for 50 minutes a week. You have to then go and do this on your own. We want the clients, us as therapists, to model to them a curiosity of like, "Oh, it's here." Am I going to tell myself this is terrible and I can't handle it? Or am I going to be curious about what else I could introduce? Would I like to send them a text to a loved one while I do this exposure? How would I like to show up? What values do I want to show up with? Those questions can take the terror out of it. Amy: Yes. I think that all of this is hitting on something. I've noticed that oftentimes this notion of ERP is traumatizing. Again, not to discount anybody's personal experiences with it if that has been negative, but it's often based on this caricature of ERP that all those things that we're saying don't need to have that element of consent. It needs to have that collaborative nature, really good assessment, really good psycho-ed. I think that's something I just realized because I don't like feeling defensive about things. If I feel defensive, I'm like, "Uh-oh, this is a me thing." I think in this case, it's because I'm seeing a lot of misinformation about ERP, or perhaps just poorly applied ERP. Kimberley: Yeah, for sure. I want to be respectful of time. We could make this into a whole training easily, but let's end here on the healing because we've talked about everything today—ideas, concepts, mindsets, conceptualizations. But I also want to really make sure we are slowing down and creating a safe place where some people may actually, like you said, have had not great experiences. What might we do, and what might patients do in terms of healing moving forward? Amy: It's a good question. There's a couple of things. I think if it's something that we were talking about with the transparency and the talking, number one, finding support and finding support from, ideally, somebody who's going to understand ERP enough that they can speak to. That doesn't have to be the type of therapy that you're getting with them, but understands it well enough to have a conversation like this. Just knowing it should never feel disrespectful, it should never feel non-consensual, and if that was your experience, then—I mean, I hate to say this, but I do think it's true—I know I would want to know if somebody felt that way. If somebody was working with me and they felt that way, I know that can be quite a burden for people to reach out to someone with whom they've had a negative experience. But I think if you're able to do that, that can be really helpful and really restorative, even if you're not looking for a response, even if it's just something that you're letting them know. If you still have a relationship with that therapist, or let's say it's a clinic where you saw a therapist and you ended up moving to a different therapist, consider sharing it with them directly. I think we live in a very contentious culture of, "Well, I've made my mind up. That's bad, and I'm moving on." But truly, I think validation also starts with self-validation. My hope is that even though we're both clearly ERP therapists who believe very strongly in its positive application for many people, we want to validate that if you've felt any harm, that's valid. I think that also starts with self-validation as a first means of healing and then seeking support. Kimberley: Yeah. What I think too, if you're not wanting to do that, which I totally understand, sharing with your new clinician. One of the questions we have about our intake is what therapy was helpful and why, and what therapy wasn't helpful and why. As you go with a new therapist, share with them, "This was my experience. This is what I found to be very effective. This is what I am very good at, but these are the things that I struggled with, and here's why." And then giving them the education of your process so they can help you with that, I think, is really important. I think you hit the nail on the head—also being very, very gentle. The administering of therapy is not a perfect science; it's a relationship. It's not always going to go well. I wish it could. I truly wish there was a way we could, but that doesn't mean that you're bad, that therapy won't work for you in the future, or that all therapists are similar to what your experience was. I think it's important to know that there are many therapists who want to create a safe place for you. Amy: That's so well said. Kimberley: Anything else you want to add before we finish up? Amy: No, no, I think this has been great. Again, anybody out there, I don't know. I feel like, as therapists, sometimes we're the holders of hope. If this could give you any hope, and again, ERP may not be the route that you choose, but just anyone who's felt like therapy hasn't been what you wanted, you deserve to find what's going to feel like the best, most helpful fit. Kimberley: Amy, I have wanted to do this episode for months now, and there is no one with whom I would feel as comfortable doing it as much as you. Thank you for creating a place for me to have this very hard conversation and a conversation I think we need to have. I'm again so grateful for you, your expertise, your kind heart, and your wisdom. Amy: Thank you.

Dec 1, 2023

Kimberley: Welcome back, Ethan Smith. I love you. Tell me how you are. First, tell me who you are. For those who haven't heard of your brilliance, tell us who you are. Ethan: I love you. My name is Ethan Smith , and I'm a national advocate for the International OCD Foundation and just an all-around warrior for OCD , letting people know that there's help and there's hope. That's what I've dedicated my life to doing. Kimberley: You have done a very good job. I'm very, very impressed. Ethan: I appreciate that. It's a work in progress. Kimberley: Well, that's the whole point of today, right? It is a work in progress. For those of you who don't know, we have several episodes with Ethan. This is a part two, almost part three, episode, just catching up on where you're at. The last time we spoke, you were sharing about the journey of self-compassion that you're on and your recovery in many areas. Do you want to briefly catch us up on where you're at and what it's been like since we met last? Ethan: Yeah, for sure. We'll do a quick recap, like the first three minutes of a TV show where they're like, "So, you're here, and what happened before?" Kimberley: Previously on. Ethan: Yeah, previously, on real Ethans of Coweta County, which sounds super country and rural. The last time we spoke, I was actually really vulnerable. I don't mean that as touting myself, but I said for the first time publicly about a diagnosis of bipolar. At that time, when we spoke, I had really hit a low—a new low that came from a very hypomanic episode, and it was not related to OCD. I found myself in a really icky spot. Part of the reason for coming or reaching that bottom was when I got better from OCD into recovery and maintenance, navigating life for the first time, really for the first time as an adult man in Los Angeles, which isn't an easy city, navigating the industry, which isn't the nicest place, and having been born with OCD and really that comprising the majority of my life. The next 10 years were really about me growing and learning how to live. But I don't know that I knew that at the time. I really thought it was about, okay, now we're going to succeed, and I'm going to make money, live all my dreams, meet my partner, and stuff's going to happen because OCD is not in the way. That isn't to say that that can't happen, and that wasn't necessary. I had some amazing life experiences. It wasn't like I had a horrible nine years. There were some wonderful things. But one of the things that I learned coming to this diagnosis and this conclusion was how hard I was being on myself by not "achieving" all the goals and the dreams that I set out to do for myself. It was the first time in a long time, really in my entire life, that I saw myself as a failure and that I didn't have a mental illness to blame for that failure. I looked at the past nine years, and I went, "Okay, I worked so hard to get here, and I didn't do it. I worked so hard to get here in a personal relationship, and I didn't get there. I worked so hard to get here financially, and I didn't even come close." In the past, I could always say, "Oh, OCD anxiety." I couldn't do it. I couldn't finish it. I dropped out. That was always in the way. It was the first time I went, "Oh wow, okay, this is on Ethan. This is on me. I must not be creative enough, smart enough, good enough, strong enough, or brave enough." That line of thinking really sent me down a really dark rabbit hole into a really tough state of depression and hypomania and just engaging in unhealthy activities and things like that until I just came crashing down. When we connected, I think I had just moved from Los Angeles to Atlanta and was resetting in a way. At that time, it very much felt like I was taking a step back. I had left Los Angeles. It just wasn't a healthy place for me at that time. My living situation was difficult because of my upstairs neighbor, and it was just very complicated. So, I ended up moving back to Georgia for work, and I ended up moving back in with my parents. I don't remember if we talked about that or not, but it was a good opportunity to reset. At that time, it very much looked and felt like I was going backwards. I just lived for 10 years on my own in Los Angeles, pursuing my dreams and goals. I was living at home when I was sick. What does this mean? I'm not ready to move. I'm not ready to leave. I haven't given up on my dream. What am I doing? I think if we skip the next three years from 2019 on, in retrospect, it wasn't taking a step back; it was taking a step forward. It was just choosing a different path that I didn't realize because that decision led to some of the healthiest, most profound experiences in my life that I'm currently living. I can look back at that moment and see, "Oh, I failed. I've given up." This is backwards. In reality, it was such a beautiful stepping stone, and I was willing to step back to move forward, to remove myself from a situation, and then reinsert myself in something. Where I am now is I'm engaged, to be married. I guess that's what engaged means. I guess I'm not engaged with a lawyer. I'm engaged, and that's really exciting. Kimberley: Your phone isn't engaged. Ethan: Yeah, for sure, to an amazing human being. I have a thriving business. I'm legitimately doing so many things that I never thought I would do in life ever, whether it had to do with bipolar or more prominently in my life, OCD, where I spent age 20 to 31, accepting that I was home-ish bound and that was going to be my life forever and that I'm "disabled" or "handicapped," and that's just my normal. I had that conversation with my parents. That was just something that I was going to have to live with and accept. I'm doing lots of things that I never expected to do. But what I've noticed with OCD is, as the stakes seem raised because you're engaging yourself in so many things that are value-driven and that you care about, the stakes seem higher. You have more to lose. When you're at the bottom, it's like, okay, so what? I'm already like all these things. Nothing can go wrong now because I'm about to get married to my soulmate, and my business is doing really well. I have amazing friends, and I love my OCD community. The thoughts and the feelings are much more intense again because I feel like I have a lot more to lose. Whereas I was dismissing thoughts before, now they carry a little bit more weight and importance to me because I'm afraid of losing the things that I care about more. There's other people in my life. It's not just about me. With that mindset came not a disregard but almost forgetting how to be self-compassionate with myself. One of the things that came out of that bipolar diagnosis in my moving forward was the implementation of active work around self-compassion. I did workbooks, I worked very closely with my therapist, and we proactively did tons and tons of work in self-compassion. You can interrupt me at any time, because I'll keep babbling. So, please feel free to interrupt. I realized that I was not practicing self-compassion in my life at all. I don't know that I ever had. Learning self-compassion was like learning Japanese backwards. It was the most confusing thing in the world. The analogy that I always said: my therapist, who I've been with for 13 years, would say to me, "You just need to accept where you are and embrace where you are right now. It's okay to be there. Give yourself grace." She would say all these things. I always subscribe to the likes of, "You have to work harder. You can't lift yourself off the hook. Drive, drive, drive, drive." That was what I knew. I tried to fight her on her logic. I said, "If there's a basketball team and they're in the finals and it's halftime and they're down by 10, does the coach go to the basketball team and say, 'Hey guys, let's just appreciate where we are right now; let's just be in this moment and recognize that we're down by 10 and be okay with that.'" I'm like, "No, of course not. He doesn't go in there and say that. He goes, 'You better get it together and all this stuff.'" I remember my therapist goes, "Yeah, but they're getting out of bed." I'm like, "Oh, okay, that's the difference." They're actually living their life. I'm completely paralyzed because I'm just beating myself down. But what I've learned in the last three or four years is that self-compassion is a continuous work in progress for me and has to be like a conscious, intentional practice. I found myself in the last year really not giving myself a lot of self-compassion. There's a myriad of reasons why, but I really wanted to come on and talk about it with you and just share some of my own experiences, pitfalls, and things that I've been dealing with. I will say the last two years have probably been the hardest couple of years and the most beautiful simultaneously, but hard in terms of OCD, thoughts and triggers, anxiety, and just my overall baseline comfort level being raised because, again, there's so many beautiful things happening. That terrifies me. I mean, we know OCD is triggered by good stress or bad stress. So, this is definitely one of those circumstances where the stakes seem higher. They seem raised, so I need more certainty. I need it. I have to have more certainty. I don't, really. I'm okay with uncertainty, but part of that component is the amount of self-compassion that I give myself. I haven't been the best at it the last couple of years, especially in the last six months. I haven't been so good. Kimberley: I think this is very validating for people, myself included, in that when you are functioning, it doesn't seem like it's needed. But when we're not functioning, it also doesn't feel like it's needed. So, I want to catch myself on that. What are some roadblocks that you faced in the implementation of this journey of self-compassion or the practice of self-compassion? What gets in the way for you? Ethan: I will give you a specific example. It's part of my two-year journey. In the last year and a half, I started working with a nutritionist. Physical health has become more important to me. It may not look like that, but getting there, a work in progress. But the reality of it is, and this is just true, I'm marrying a woman who's 12 years younger than me. I want to be a dad. I can't wait to have children. The reality of my life—which I'm very accepting of my current reality, which was something I wasn't, and we were probably talking about that before—was like, I wanted to be younger. I hated that everything was happening now. I wasn't embracing where I was and who I was in that reality. I'm very at peace with where I am, but the reality of my reality is that I will be an older father. So, a value-driven thing for me to do is get healthier physically because I want to be able to run around and play catch in 10 years with my kid. I would be 55 or 60 and be able to be in their lives for as long as I possibly could. I started working with a nutritionist, and for me, weight has always been an issue. Always. It has been a lifelong struggle for me. I've always yo-yoed. It's always been about emotional eating. It's always been a coping mechanism for me. I started working with a nutritionist. She's become a really good friend, an influence in my life, and an accountability partner. I'm not on a diet or lifestyle change. There's no food off the table. I track and I journal. But in doing this, I told her from the beginning, "In the first three months, I will be the best client you've ever had," because that's what I do—I start perfectly. Then something happens, and I get derailed. I was like, my goal is to come back on when I get derailed. That is the goal for me. And that's exactly what happened. I was the star student for three months. I didn't miss a beat. I lost 15 pounds. The goal wasn't weight loss, mind you; it was just eating healthier and making more intentional choices. Then I had some OCD pipe up, my emotions were dysregulated, and I really struggled with the nutrition piece. I did get back on track. Over the last year, I gained about seven pounds doing this nutrition. Over the last six months, I was so angry at myself for looking at my year's journey. This is just an example of multiple things with self-compassion, but this is the most concrete and tangible I can think of at the moment. But looking at my year and looking at it with that black-and-white OCD brain and saying, "I failed. I'm a piece of crap. I'm not where I want to be on my journey. I've had all of the support I could possibly have. I have all the impetus. I want to be thinner for my wedding. I want to look my best at my wedding. What is wrong with me? In these vulnerable emotional states or these moments of struggle, why did I give in?" In the last couple of months, I literally refused to give myself any compassion or grace around food, screw-ups, mess-ups, and any of that. I refused. My partner Katie would tell me, "Ethan, you have to love--" I'm like, "No, I do not deserve it." I'm squandering this opportunity. I just wholeheartedly refused to give myself compassion. Because it's always been an issue, I'm like, "What's it going to take?" Well, compassion can't be the answer. I need tough love for myself. I think I did this in a lot of areas of my life because, for me, I don't know, there's a stigma around self-compassion. Sometimes, even though I understand what it is on paper-- and I've read your workbook and studied a lot of Kristin Neff, who's an amazing self-compassion expert. On paper, I can know what it is, which is simply embracing where you are in the moment without judgment and still wanting better for yourself and giving yourself that grace and compassion, regardless of where it is. I felt like I couldn't do that anymore because I wasn't supposed to. I wasn't allowed. I suddenly reframed self-compassion as a weakness and as an excuse rather than-- it was very much how I thought about it before I even learned anything about self-compassion, and I found myself just not a very loving person myself. My internal self-talk was really horrible and probably the worst. If somebody was talking to me like this, you always try to make it external and be like, "Oh, if somebody talked to you like this, would they be your friend? Would you listen to them?" I was calling myself names. I gave myself a room. It was almost in every facet of my life, and it was really, really eating at me. It took a significant-- yeah, go ahead. Kimberley: When I'm with clients and we're talking about behaviors, we always talk about the complex outcomes of them, like the consequences that you were being hard on yourself, that it still wasn't working, and so forth. But then we always spend some time looking at, let's say, somebody is drinking excessively or doing any behavior that's not helpful to them. We also look at why it was helping them, because we don't do things unless we think they're helping. What was the reason you engaged in the criticism piece? How did that serve you in those moments? Ethan: It didn't, in retrospect. In the moment, I think behaving in that way feels much like grabbing a spear and putting on armor. I don't know if it's stigma or male stigma. I mean, I've always had no problem being sensitive, being open to sensitivity, and being who I am as an individual. But with all of this good in my life, my emotions are more intense. My thoughts are more intense. My OCD is more intense. I felt like I needed to put on-- I basically defaulted to my original state of thinking before I even learned about self-compassion, which is head down, bull horns out, and I'm just going to charge through all of this because it's the only way. It's just like losing insight. When you're struggling with OCD, it's like you lose insight, you lose objectivity. It's like there's only one way through this. I think it's important to note, in addition to the self-compassion piece, this year especially, there's been some physical things and some somatic symptoms that I've gotten really stuck on. I'm really grateful that-- and I love to talk about it with advocacy. It's like, advocates, all of us, just because we're speaking doesn't mean that we have an OCD-free life or a struggle-free life. That's just not it. I always live by the mantra: more good days than bad. That is my jam. I'm pleased to report that in the last 13 years, I've still had more good days than bad, but it doesn't mean that I don't have a tough month. I think that in the last couple of years, I've definitely been challenged in a new way because there's been some things that have come up that are valid. I have a lot of health anxiety, and they've been actual physical things that have manifested, that are legitimate things. Of course, my catastrophic brain grabs onto them. You Google once, and it's over. I have three and a half minutes to live for a brown toenail, and-- Kimberley: You died already. Ethan: I'm already dead. I think it all comes back around to this idea of self-stigma, that even if you know all this stuff like, I'm not allowed to struggle, I'm not allowed to suffer, I have to be a rock, I have to be all things to all people—it's all these very black and white rules that are impossible for a human being to live by because that's just not reality. I mean, I think that's why the tough exterior came back because it was like, "All right, life is more challenging." The beautiful thing about recovery is, for the most part, it didn't affect my functioning, which was amazing. I could still look at every day and go, "I was 70% present," or "I was 60% present and 40% in my head, but still being mindful and still doing work and still showing up and still traveling." From somebody that was completely shut down, different people respond in different ways to OCD. From somebody who came from completely shutting down and being bedridden, this was a huge win. But for me, it wasn't a huge win in my head. It was a massive failing on my part. What was I doing wrong? How was it? Just as much as I would talk every week on my live streams and talk about, it's a disease, not a decision, it's a disorder. I can say that all day long, but there are times when it tricks me, and I stigmatize myself around it. It's been very much that in the last year, for sure. It's been extremely challenging facing this new baseline for myself. Because, let's face it, I'm engaging in things that I've never experienced before. I've never been in a three-year relationship with a woman. I've never been engaged. I've never bought a house. Outside of acting, I've never owned a business or been a businessperson. I mean, these are all really big commitments in life, and I'm doing them for the first time. If I have insight now and it's like, I can have this conversation and say, "Yeah, I have every reason to be self-compassionate with myself." These are all brand new things with no instruction manual. But it's very easy to lose sight of that insight and objectivity and to sit there and say-- we do a lot of comparing, so it's very easy to go, "Well, these are normal human things. Everybody gets married. Everybody works. This should be easy." You talk about, like, never compare struggles, ever. If somebody walks to the mailbox and you can't, never compare struggles. But that's me going, "Well, this is normal life stuff. It's hard. Well, what's wrong with me?" Kimberley: Right. I think, for me, when I'm thinking about when you're talking, I go in and out of beating myself up for my parenting, because, gosh, I can't seem to perfect this parenting gig. I just can't. I have to figure it out. What's so interesting is when I start beating myself up and if I catch myself, I often ask myself, what would I have to feel if I had to accept that I'm not great at this? I actually suck at this. It's usually that I don't want to feel that. I will beat myself up to avoid having to feel the feelings that I'm not doing it right. That has been a gateway for me, like a little way to access the self-compassion piece. It's usually because I don't want to feel something. And that, for me, has been really helpful. I think that when you're talking about this perceived failure—because that's what it is. It's a perceived failure, like we're all a failure compared to the person who's a little bit further ahead of us—what is it that you don't want to feel? Ethan: It's a tough question. You've caught me speechless, which is rare for me. I'm glad you're doing video because otherwise, this would be a very boring section of the podcast. For me, the failing piece isn't as much of an issue. It was before. I don't feel like I've failed. In fact, I feel like I'm living more into where I'm supposed to be in my values. I think for me, the discomfort falls around being vulnerable and not in control. I think those are two areas that I really struggle with. I always say, sometimes I feel like I'm naked in a sandstorm. That's how I feel. That's the last thing you want to be. Well, you don't want to be in a sandstorm—not naked, but naked in a sandstorm—you don't want to see me naked at all. That's the bottom line. No nudity from Ethan. But regardless, you're probably alone in the sandstorm. You feel the stinging and all of that. No, I'm just saying that's what I picture it feels like. Kimberley: Yeah, it's an ouch. That feels like an ouch. Ethan: It feels like a big ouch. I think that vulnerability, for me, is scary. I'm not good at showing vulnerability. Meaning, I have no problem within our community. I'll talk about it all day long. I'll talk about what happened yesterday or the day before. I'll be vulnerable. But for people who don't know me, I struggle with it. Kimberley: Me too. Ethan: Yeah. We all have our public faces. But vulnerability scares me in terms of being a human being, being fallible, and not being able to live up to expectations. What if I have to say I can't today? Or I'm just not there right now and not in control of things that scare me. Those feelings, I think, have really thrown me a bit more than usual, again. I keep saying this because things feel more at stake, and they're not, but I feel like I have so much more to live for. That's not saying that I didn't feel like I didn't have a reason to live before. That's not what I'm saying at all. I'm simply saying, dreams come true, and how lucky am I? But when dreams come true with OCD, it latches onto the things we care about most and then says, "That's going to be taken away from you. Here are all the things you have to do to protect that thing." I think it'd been a long time since I'd really faced that. To answer your question in short, I think, for me, vulnerability and uncertainty around what I can't control, impacting the things that I care about most, are scary. Kimberley: I resonate so much with what you're saying. I always explain to my eating disorder clients, "When you have an eating disorder and you hit your goal weight, you would think we would celebrate and be like, 'Okay, I hit it. I'm good now.'" But now there's the anxiety that you're going to go backwards. Even though you've hit this ridiculous goal, this unhealthy goal, the anxiety is as high as it ever was because the fear of losing what you've got is terrifying. I think that's so true for so many people. And I do agree with you. I think that we do engage in a lot of self-criticism because it feels safer than the vulnerability, the loss of control, or whatever that we have to feel. What has been helpful for you in moving back towards compassion? I know you said it's like an up-and-down journey, and we're all figuring this out as we go. What's been helpful for you? Ethan: A couple of things. I think it's worth talking about, or at least bringing up this idea of core fear. I've done some recent core fear work, just trying to determine, at the root of everything, what is my core fear? For me, it comes down to suffering. I'm afraid of suffering. I'm not afraid of dying; I'm afraid of suffering. I'm afraid of my entire life having to be focused on health and disease because that's what living with OCD when I was really sick was about. It's all I focused on. So, I'm so terrified of my life suddenly being refocused on that. Even if I did come down with something awful, it doesn't mean that my life has to solely focus on that thing. But in my mind, my core fear is, what if I have to move away from these values that I'm looking at right now and face something different? That scares the crap out of me. The first thing around that core fear is the willingness to let that be there and give myself compassion and grace, and what does that look like, which is a lot of things. This fear—this new fear and anxiety—hasn't stopped me from moving forward in any way, but it sure has made it a little bit more uncomfortable and taken a little bit of the joy out of it. That's where I felt like I needed to put on a second warrior helmet and fight instead of not resisting, opening myself up, and being willing to be naked in a sandstorm. One of the things that I've learned most about is, as a business owner yourself, and if you're a workaholic, setting boundaries in self-care is really hard. I didn't really connect until this year the connection, the correlation between self-care and self-compassion. If I don't have self-compassion, I won't allow myself to give myself self-care. I won't. I won't do it because I don't deserve it. There's a very big difference between time off, not working, sleeping, but then actually taking care of yourself. It's three different things. There's working, there's not working, and then there's self-care. I didn't know that either. It was like, "Well, I didn't work tonight." Well, that's not necessarily self-care. You just weren't in a meeting, or you weren't working on something. Self-care is proactive. It's purposeful. It's intentional. Giving myself permission to say no to things, even at the risk of my own reputation, because I feel like saying no is a big bad word, because that shows that I can't handle everything at once, Kim. I can't do it all. And that is a no-no for me. Like, no, no, no, everybody needs to believe that you can do everything everywhere all at once, which was a movie. That's the biggest piece of it. Recently, I was able to employ some self-care where it was needed at the risk of the optic seeming. I felt like, "Here I am, world. I'm weak, and I can't handle it anymore." That's what I feel like is on the other end. I was sick, and I had been traveling every week since the end of March. I don't sleep very well. I just don't. When I'm going from bed to bed, I really don't sleep well. I had been in seven or eight cities in seven or eight weeks. I had been home for 24 hours. This was only three weeks ago, and I was about to head out on my last trip, and the meeting that I was going for, the primary reason, got canceled, not by me. I was still going to meet with people that I love and enjoy. I woke up the day before I was traveling, and I was sick. I was like, "Oh man, do I still go?" The big reason was off the table, but there were still many important reasons to go, but I was exhausted. I was tired. I was sick. My body was saying, "Enough." I had enough insight to say, I'm not avoiding this. This isn't anxiety. This is like straight up. When I texted the team—this is around work and things that I value—I was like, "I'm not coming." I said, "I'm not coming." They responded, "We totally understand. Take care of yourself." And what I read was, "You weak ass bastard. You should suck it up and come here, because that's what I would have done. Why are you being so lame and lazy?" That is what I read. This is just an instance of what I generally feel if I can't live up to an expectation. I always put these non-human pressures on myself. But making this choice, within two days, I was able to reset intentionally. This doesn't mean I'm going to go to bed and avoid life. I rested for a day because I needed to sleep to get better. But the next few days were filled with value-driven decisions and choices and walks and exercising and getting back on nutrition and drinking lots of water and spending quality time with people that I care about, and my body and brain just saying, "You need a moment." Within a couple of days, everything changed. My OCD quickly dropped back down to baseline. My anxiety quickly dropped back down. I had insight and objectivity. When I went back to work later that week—I work from home—I was way more effective and efficient. But I wouldn't have been able to do that. It was very, very hard to give myself self-compassion around making that simple decision that everybody was okay with. Kimberley: I always say my favorite saying is, "I'm sorry, but I'm at capacity right now." That has changed my life because it's true. It's not even a lie. I'm constantly at capacity, and I find that people do really get it. But for me to say that once upon a time, I feel this. When I was sick, the same thing. I'm going to think I'm a total nutcase if I keep saying no to these people. But that is my go-to sentence, "I'm at capacity right now," and it's been so helpful. Ethan: In max bandwidth. Kimberley: Yes. What I think is interesting too is I think for those who have been through recovery and have learned not to do avoidant behaviors and have learned not to do compulsions, saying "I need a break" feels like you've broken the rules of ERP. They're different things. Ethan: You hit them down. I was literally going to say that. It also felt when I made that decision that it felt old history to me, like old Ethan, pre-getting better. I make the joke. It was true. I killed my grandfather like 20 times while he was still alive. Grandpa died. I can't come to the thing. I can't travel. I can't do the thing. This was early 2000s, but I had a fake obituary that I put into Photoshop. I would just change the date so I can email it to them later and be like, it really happened. I would do this. It's like, here was a reason. It was 100% valid. Nobody questioned it. It was not based on OCD. It was a value-driven decision, and it felt so icky. My body felt like I might as well have sent a fake obituary to these people about the fake death of my grandfather. It felt like that. So, I wholeheartedly agree with you. Kimberley: I think it's so important that we acknowledge that post-recovery or during recovery is that saying acts of compassion sometimes will feel like and sound like they're compulsions when they're actually not. Ethan: That's such a great point. I totally agree with you. Kimberley: They're actually like, I am actually at capacity. Or the expectation was so large, which for you, it sounds like it is for me too—the expectation was so large, I can't meet that either. That sucks. It's not fun. Ethan: No, it's not. It's not because, I mean, there's just these scales that we weigh ourselves on and what we think we can account for. I mean, the pressure that we put on ourselves. And that's why, like the constant practice of self-compassion, the constant practice of being mindful and mindfulness, this constant idea of-- I mean, I always forget the exact thing, but you always say, I strive to be a B- or C+. I can never remember if it's a B- or C+, but-- Kimberley: B-. Ethan: B-. Okay, cool. Kimberley: C+ if you really need it. Ethan: Yeah. To this day, I heard that 10 years ago, and I still struggle with that saying because I'm like, I don't even know that I can verbally say it. Like, I want to be a B... okay, that's good enough. Because it sounds terrifying. It's like, "No, I want to be an A+ at everything I do." I know we're closing in on time. One of the things I just wanted to say is thank you not only for being an amazing human being, an amazing advocate, an amazing clinician, and an okay mom, as we talked about. Kimberley: Facts. #facts. Ethan: But part of the reason I love advocating is I really didn't come on here to share a specific point or get something across that I felt was important. I think it's important as an advocate figure for somebody who doesn't like transparency or vulnerability to be as transparent and vulnerable as possible and let people see a window into somebody that they may look at and go, "That person doesn't struggle ever. I want to be like that. I see him every week on whatever, and he's got it taken care of. Even when it's hard, it isn't that hard." For me, being able to come on and give a window into Ethan in the last six months is so crucial and important. I want to thank you for letting me be here and share a little bit about my own life and where I met the goods and the bads. I wouldn't trade any of it, but I appreciate you. Kimberley: No, thank you. I so appreciate that because it is an up-and-down journey and we're all figuring it out, myself included. You could have interviewed me and I could have done similar things. Like here are the ways that I suck and really struggle with self-compassion. Here are the times where I've completely forgotten about it as a skill until my therapist is like, "Uh, you wrote this book about this thing that you might want to practice a little more of." I think that it's validating to hear that learning it once is not all you need; it is a constant practice. Ethan: Yeah, it definitely is. Self-compassion is, to me, one of the most important skills and tools that we have at our disposal. It doesn't matter if you have a mental health issue or not. It's just an amazing way of life. I think I'll always be a student of it. It still feels like Japanese backwards sometimes. But I'm a lot better at putting my hand-- well, my heart's on that side, but putting my hand in my heart, and letting myself feel and be there for myself. I never mind. I'm a huge, staunch advocate of silver linings. I've said this a million times, and I'll always say, having been on the sidelines of life and not being able to participate, when life gets hard and stressful, deep down, I still have gratitude toward it because that means I'm actually living and participating. Even when things feel crappy or whatever, I know there'll be a lesson from it. I know good things will come of it. I try to think of those things as they're happening. It's meaningful to me because it gives me insight and lets me know that there'll be a lesson down the road. I don't know if it'll pay itself back tomorrow or in 10 years, but someday I'll be able to look at that and be like, "Well, I got to reintroduce myself to self-compassion. I got to go on Kim Quinlan's podcast, Your Anxiety Toolkit, and be able to talk to folks about my experience." While I didn't quite enjoy it, it was a life experience, and it was totally worth it for these reasons. Now I get to turn my pain into my purpose. I think that's really cool. Kimberley: Yeah, I do too. I loved how you said before that moving home felt like it was going backwards, but it was actually going completely forward. I think that is the reality of life. You just don't know until later what it's all about. I'm so grateful for you being on the show. Thank you so much for coming on again. Ethan: Well, thanks for having me, and we'll do one in another 200 episodes. Kimberley: Yes, let's do it. Ethan: Okay.

Nov 24, 2023

Today, we are going to talk about what to do when feeling hopeless. Today's episode was actually inspired by one of our amazing Your Anxiety Toolkit podcast listeners. They wrote in and asked a question about hopelessness , and I thought it was so important and so relevant in today's day, with the news being scary and everybody struggling and still readjusting to COVID, mental health, and mental illnesses at an all-time high. I really felt that this was important for us to talk about. So, let's do this together. We're going to take it step by step, and we're going to do it with a whole lot of self-compassion. So let's talk about what to do when feeling hopeless. Alright folks, here is the question that was posed to me. It goes like this: "I have been really struggling with hopelessness lately. It feels like my life has no real meaning, and I feel pretty aimless. The things in my life that I want to improve need so much work to improve, such as career, relationship, family stuff. And I have large parts that are out of my control, which feels pretty discouraging despite lots of effort to improve them. I'm working to accept these feelings and trying to stay out of rumination, but it does feel hopeless a lot of the time. What are you telling folks who are in a similar position?" Now, number one, I so resonate with this question. As a clinician, a human, a mom, and someone with a chronic illness, I hear you in this question, and I don't think you're alone. In fact, I am a member of a pretty large online group of therapists, and I wanted to do my homework for today. So I left the question, saying, when you have clients who are experiencing hopelessness and they're feeling stuck, what do you say? A lot of them were coming with these such humble responses of saying, "To be honest, I tell them the truth, which is I don't know the answer. I too struggle with this." Or they'll say, "I often let them know that they're not alone in this and that this is such something that collectively we're all going through." And I loved that they were so real and dropped into reality on the truth of this, the pain of this, and the confusion of this topic. Now, in addition to that, there were also some amazing pieces of advice, and some of them I really agreed with. I'm going to include them here when we go through specifically some tools that you can use to help you when you're struggling with this feeling of hopelessness or feeling like what's the point and feeling like there's no meaning to life. Let's talk about it. Number one—let me just be real with you—is I too have struggled with this. In fact, it wasn't that long ago that I actually sought out therapy for this specific issue. I looked around my life, and I have these two beautiful children, I have two businesses and a career that I love, and I still felt hopeless. I still felt like this sense of what's the point? What's the meaning of all this? I'm working my butt off, trying to manage all the things. What is the real point? It felt a little like an existential crisis, to be honest. I love that this person reached out to ask this question. I do encourage you all, if you're struggling with this and navigating this, do go and seek therapy. I'm going to be giving you some tools on how to manage this today, but in no way do I think that my solutions are going to be exactly what you need to hear. There may be some of them that are super helpful for you, but I strongly encourage you to go and navigate them on your own. Through exploring this, I found that there were some unmet needs that I was not paying attention to. I found that I was grieving living in a country that's not my home country. So many parts of it were also related to my chronic illness. And so it was very personal work, and I encourage you too to do that personal work. But, given that we're here today, I also want to give you some strategies, skills, and direction if you too are wondering what to do when feeling hopeless. Let's do this together. THERAPY FOR HOPELESSNESS The first thing here is I love that the person who wrote this said, "I'm working at accepting the feelings." I think that that is probably the biggest key here, which is not accepting that they'll be there forever but instead accepting that they're here right now and reminding yourself that they're temporary. HOPELESSNESS IS A TEMPORARY EMOTION Hopelessness, like any other emotion, is a temporary emotion. It will rise and fall, rise and fall, and rise and fall. It doesn't mean that you'll always feel this way. What we can do is, while we're accepting it, I often ask my patients, "As you accept it, let's also be very curious about any resistance you have in your body as you practice accepting." I've had clients who've sat on the couch of my office and said, "No, no, I'm accepting it." But every part of their body is clenched up. Every part of their face is resistant. They're obviously accepting that it is here, but also trying to push against it, also trying not to feel it. Yes, accepting feelings is important, but are you creating a safe place for that emotion to rise and fall within you? Here, we can check in with our bodies. Where is this discomfort in my body? Where am I holding tension around it? Is there a way I can soften around this experience of hopelessness first? And that can be so important as we're navigating hopelessness and finding meaning in our lives. HONOR THAT THIS IS HARD FOR YOU The next thing I'm going to encourage you to do is first honor just how hard things are for you. Often, that might be just a moment of saying, "This is really hard for me. Absolutely. This is very hard for me." OFFER SELF-COMPASSION WHEN YOU FEEL HOPELESS The next piece here is we want to offer as much compassion as we can. We want to nurture the fact that you're going through an incredibly hard thing or things. You're trying so hard. You're exhausted. You're feeling lost. You might even be feeling like, "I don't even know which direction I'm going. I'm just going and getting through the day." We want to create as much compassion as we can for that. Now, if you are new to the work of self-compassion, there are so many resources online. We have a meditation vault with tons of different meditations for self-compassion at CBT School. They're there for you if you're really wanting to embark on this practice. We've also got tons of other episodes of Your Anxiety Toolkit on self-compassion as well. KEEP AN EYE OUT FOR CATASTROPHIZATION The next thing I want you to think about here is keep an eye on how you're doing things throughout the day. I'll tell you a story. Actually, as I did this work for myself when I went into therapy, I looked at my schedule every morning, and all I could see was just a whole bunch of things I had to do. It was just like a list of things that I had to do. It felt like trash things I had to do, even though many of them were joyful things that I love doing and that I've signed up to do. But what I noticed was I was looking at the day as if it was just a mountain of chores instead of staying very present and mindful, doing one thing at a time, and practicing non-judgment, curiosity, and kindness as I do those things. BREAK THINGS DOWN INTO SMALL, DOABLE STEPS What I'm going to encourage you to do is break things down into small, doable steps. When you look at your life and you think, oh my goodness, in the case of this question of relationships, career, work—when you look at all of that, it can become so overwhelming. Maybe sit down, get a notepad, and just pick one thing you want to work on right now, one thing that you can do from a place of wisdom and being effective and kind, and just focus on seeing if you can achieve and accomplish that one thing. Chances are, you might already be doing that, but there's a piece that you've missed, and I can guarantee you've missed it—you've forgotten to celebrate the fact that you got a small step done. Often, when things feel so huge, we finish something, and then we just move on to the next thing that we have to do. And that's when things do feel like there's no meaning, there's no point to this life. We're just in the motions, going with the cycles. We forget to celebrate, validate, and recognize the accomplishments that we've made. We forget to go, "Yeah, that's a big deal. Good for you, you did that," and take that time to celebrate it. Because again, as I said to you, I was looking at my life going, "Everything looks mostly pretty good. I've got this pretty severe chronic illness, but otherwise, things are going well." But I realized I was just doing thing after thing after thing and after thing and not stopping to go, "Wow, good job. You're taking care of your kids. Great job, you did something for yourself today," or "Wow, you accomplished that one thing, and that was really hard." We've got to celebrate our wins. STOP COMPARING YOURSELF TO OTHERS The next piece of that is, often, people who get stuck in the day-to-day feeling like it's Groundhog's Day and there's no real point, that's because they're comparing their experience to somebody else's. They're comparing their day-to-day with someone on social media who has made it look beautiful, they've got beautiful filters on, and everything looks really great. We're making a lot of comparisons between how they're doing and how we're doing. I want to encourage you, please do not compare your wins and struggles to other people's wins and struggles. That is a recipe for feeling hopeless, it's a recipe for feeling depressed, and it's a recipe for feeling like you're never going to be enough. It's so important. THREE THEMES OF DEPRESSION The next thing I want you to do is catch yourself in the distorted thinking. Now, here is something you must take away from today—depression commonly has three themes. The first one is hopelessness—feeling like there is no hope. The second one is helplessness, feeling like no one can help you, that there's no point, there's no one can help you with your problem. And the last one is worthlessness, which is "I have no value." These three themes show up in our thinking and in our cognitions. I've done episodes in the past where I'd say depression is a liar . It tells lies all day. If you aren't able to detect and correct those lies, you're going to start believing them. Thoughts that are just depressive thoughts will start to become beliefs. Once they become beliefs, you start acting them out in many ways in your life. What we want to do when we're treating depression in therapy is actually slow down and be very mindful of your thoughts about the world, your thoughts about yourself, and your thoughts about your future. Look at where the distorted thoughts are and correct them. We have a course on CBTSchool.com called Overcoming Depression , and the whole middle section of that course is teaching you how to identify cognitive distortions or errors in thinking and how to correct them. And that is a crucial part of managing depression. Because depression tells us lies all day. It tells us, "There's no hope. You're not doing good enough. You're not good. There's no hope for you. No one can help you. You're just a piece of trash. You're a loser. It should be easy. Why is it so hard for you?" It might even say, "Look at you, you've got A, B, and C, and other people have it so much worse than you. So, what's your problem?" It just tells you all of these judgmental, horrible, mean things that are not true. What we can do and what we do in the course, Overcoming Depression, is we identify those thoughts. We understand and acknowledge the presence of them. We maybe take a little look into what they're trying to get to, what they're trying to say. And then we work at coming up with alternative thoughts that feel helpful, compassionate, effective, and true. One of the tools we use in overcoming depression is we pretend that we're in a court of law, and we have this scene where we say, "Okay, if you were to bring your depressive thoughts to a court of law, would the jury agree or disagree? Would the judge throw your case out?" Often, what happens is we have thoughts. Like, minimizing the positive is one kind of distorted thought we go through. There are many different types of distorted thoughts, but let's say minimizing the positive. Let's say you did something positive and you say, "No. I know I completed that, but it should have been easier," or "I should have done it faster," or "It shouldn't have been that difficult." That's minimizing the positive. We would go, "Okay, if we were to take that to court, if we were to take that claim to court, what would the jury and what would the judge say?" The judge would not agree with that. They would say, "No, you completed the thing, and it's okay that it's hard. I'm tossing this out of the court. You're wasting my time." And so we want to be able to identify that and look at another example being a labeling distorted thought, like, "You're a loser. You should be doing better." In a court of law, the jury would look at the evidence and go, "No, it looks like you're handling a lot right now. It looks like you're handling many things. It makes sense that you feel that way, but it looks like you have many pieces of evidence to show that you're not a loser. Let's throw the case out. Case dismissed." We want to make sure you're doing that because the chances are, as you're going through these hard things, as you're navigating the day, you're forgetting to check the facts. We've got to check the facts in depression. It's so important. REMEMBER, YOU CAN DO HARD THINGS The next thing we have to do is remind yourself that you can do hard things. When the world feels like it's a mountain of just chores and things in check boxes and to-do's, we often just get overwhelmed with it, and it's like, "I can't do this." I will say to you, when I actually was struggling the most with my chronic illness and I did get therapy for this, the thought we identified the most was this repetitive, consistent, nagging thought, "I can't do this." I probably thought "I can't do this" about 150 times a day, minimum. Even as I was doing things, I was having the thought, "I can't do these things." As I was taking an MRI or helping my kids or working on my business—even as I was doing them, I was telling myself, "You can't do this," as I was doing them, which again shows how our thinking can really distort and make things so much worse if we don't catch them. We have to remind ourselves we can do hard things. We're already doing hard things. That baby steps at a time can make small progress. There's no race. There's no finish line. We're not here to beat other people or compare ourselves to other people's timelines. This is our timeline, and we're going to let it take as long as it needs. We're going to be gentle. We're just going to do one hard thing at a time. FIND SUPPORT Another thing I want you to remember here when you're struggling with hopelessness is to find support. When we feel hopeless, we feel alone. When we feel hopeless, we feel isolated. We feel like we're the only one going through this. But there are so many people who are experiencing this. Sometimes it's just saying, "This is a hard season for me." You'd be shocked at how many other people come out and go, "Yeah, me too." So find support in others who are in the thick of it, who are also trying to work on hopelessness, what's the real meaning, and so forth. FIND PLEASURABLE ACTIVITIES And then the last piece here that I think is the foundation of this work is, make sure you're implementing pleasurable activities in your day. When somebody has depression and hopelessness , what we often do in therapy, and we do this in Overcoming Depression, the course as well, is we look at your day, and often people with depression do not schedule pleasure. They do not input pleasurable, value-driven exercises into their day because depression often will say, "What's the point? Don't even bother. You used to like doing painting, but what's the point? You're not going to enjoy it, so don't do it," or "You're not good. You're never going to be good at it, so don't do it." As we take pleasure out of our lives, it adds to this feeling of what is the meaning because the truth is, the meaning of life, who knows what it truly is? It's different for every person. But a big piece of you finding what's meaningful to you is acting according to your values and doing the things that feel lovely, nourishing, and yummy to you. My guess is, you're not doing a lot of that. You're not doing a lot of yummy, nourishing, pleasurable, fun activities. I get it, depression isn't going to let you have all the fun. It's not going to let you have a 10 out of 10 fun. But even if we get a 2 out of 10 pleasure or 4 out of 10 pleasure, let's take it. Let's do it even just to get the 4 out of 10 pleasure, 10 being the highest level of pleasure. Try not to rid yourself of activities that used to bring you joy. It's also a big piece here when we find meaning. This is a really big topic in the field of therapy and psychotherapy. There is a beautiful book, which I would encourage you to read, called Man's Search for Meaning. It's by Viktor Frankl. It was one of the first books that were recommended in my master's degree as I was training to become a therapist. It will bring a beautiful sense of understanding of making meaning in your life, and hopefully would be a beautiful supplement to the work that we're doing here, and a compliment to you, finding what's meaningful to you. Sometimes it means we have to reshuffle our lives a little bit. When I did this work personally, I had to really go, "Okay, you're working too much. I know it's scary to slow down, but you're lost. You've lost yourself. You're going to have to slow down." Or it might be, "Wow, your schedule is too full with just appointments and soccer practice and swim lessons and all the things. We're going to have to slow down and have a little more fun. Play a little more. Sit a little more. Read a little more. Be with your family. Actually, be with them instead of just going through the motions." We can't get caught up in the day-to-day and not implement that pleasurable thing. And then the last part of that is, I'm going to offer to you one sort of final idea for what to do when feeling hopeless, and it is, please try to stop fixing yourself all the time. In my experience as a clinician, the people who often do get hopeless and helpless and feel depressed are the ones who constantly tell themselves they need to be more, need to be better, that something has to change, that there's something fundamentally wrong with them. I want to offer to you that there is nothing wrong with you, even if you're struggling with a mental illness right now. Try to catch your constant need to fix yourself. Try to just live. Identify what your values are and see if you can get your behaviors and life to line up with those. This striving that we have today in our pop culture of constantly having to be better, constantly having to have self-help books and being better, that is exhausting, and that is not the meaning of life. The meaning of life for me now that I've done the work isn't the grand things and achievements. The meaning of life is actually quite silly and simple. In comparison, it's sitting in the sunlight and letting the sun hit my face. It's just hearing a laugh of my child. Nothing huge, doesn't need to require massive wins. It might be just holding space for my emotions, honoring my needs, identifying my unmet needs, and doing what I can to meet those. I'm not here to tell you in any way that I know what the meaning of your life is. I'm just telling you what the meaning of mine is. But I encourage you to enter this practice, to leave today, doing this as kindly, as gently, and as respectfully and compassionately as you can. You're going through a hard season. These are hard times. These are confusing times. I hope that with little baby steps, you changing your perspective and giving yourself the opportunity to just do one thing at a time and slow it all down will be helpful for you. Have a wonderful day. If you're wanting any of the resources that we have listed today, you can check the show notes, or you can also go to CBTSchool.com and learn more about our online resources there. Have a wonderful day, everybody.

Nov 17, 2023

Kimberley: Welcome, everybody. This is a very exciting episode. I know I'm going to learn so much. Today, we have Caitlin Pinciotti and Shala Nicely , and we're talking about when OCD and PTSD collide and intertwine and how that plays out. This is actually a topic I think we need to talk about more. Welcome, Caitlin, and welcome, Shala. Caitlin: Thank you. Shala: Thanks. Kimberley: Okay. Let's first do a little introduction. Caitlin, would you like to go first introducing yourself? Caitlin: Sure thing. I'm Caitlin Pinciotti. I'm a licensed clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. I also serve as a co-chair for the IOCDF Trauma and PTSD and OCD SIG. If people are interested in that special interest group as well, that's something that's available and up and running now. Most of my research specifically focuses on OCD, trauma, and PTSD, and particularly the overlap of these things. That's been sort of my focus for the last several years. I'm excited to be here and talk more about this topic. Kimberley: Thank you. You're doing amazing work. I've loved being a part of just watching all of this great research that you're doing. Shala, would you like to introduce yourself? Shala: Yes. I'm Shala Nicely. I am a licensed professional counselor, and I specialize in the treatment of OCD and related disorders. I am the author of Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life , which is my story, and then co-author with Jon Hershfield of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully . I also produce the Shoulders Back! newsletter . It has tips and resources for taming OCD. Kimberley: Shoulders Back! was actually the inspiration for this episode. Shala, you recently wrote an article about post-traumatic OCD or how PTSD and OCD collide . Can you tell us about your story, particularly going back to, I think you mentioned, May 2020, and what brought you to write that article? Shala: Sure, and thank you very much for having Caitlin and me on today because I really appreciate the opportunity to talk about this and to get more information out in the world about this intertwined combination of PTSD and OCD. In May of 2020, I moved to a new house, the house that I'm in now. Of course, we had just started the pandemic, and so everybody was working at home, including me. The house that I moved into was in a brand new neighborhood. While the houses on this side of me were completed, the houses behind me and on that side were not completed. I didn't think anything of that when I moved in. But what I moved into was a situation where I was in a construction zone all the time. I was working at home, so there was no escape from it. One day I was walking behind my house, where most of the houses were in the process of being built and there were no sidewalks. As I was walking down the street, I saw, down at the end of the street, a big forklift come down the street where I was walking with my two little dogs backwards at a really high rate of speed, and the forklift driver seemed to be looking that way, and he was going that way. It happened so fast because he was going so quickly that all of a sudden I realized he was going to hit us, my dogs and me, and there was no place for us to go because we were on the road because there was nowhere else for us to be. I screamed bloody murder, and he heard me. I mean, that's how loud I screamed, and he stopped. That was not all that pleasant. I was upset. He was not happy. But we moved on. But my brain didn't move on. After that incident, what I noticed was I was becoming really hypervigilant in my own house and finding the construction equipment. If I go outside, I tense up just knowing that construction equipment is there. Over time, my sleep started becoming disturbed. I started to have flashbacks and what I call flash-forwards, where I would think about all these horrible things that could happen to me that hadn't happened to me yet but could. I'd get lost in these violent fantasies of what might happen and what I need to do to prevent that. I realized that I seemed to be developing symptoms of PTSD . This is where being a therapist was actually quite helpful because I pulled the DSM open one night and I started going through symptoms of PTSD. I'm like, "Oh my gosh, I think I have PTSD." I think what happened, because having a forklift driver almost hit you, doesn't seem like that could possibly cause PTSD. But if you look at my history, I think that created a link in my brain to an accident I was in when I was four where I did almost die, which is when my mom and I were standing on the side of a road, about to cross. We were going to go between two parked cars. My mom and I stepped between two parked cars, and there was a man driving down the road who was legally blind, and he mistook the line of parked cars where we were standing as moving traffic. He plowed into the end of all the parked cars, which of course made them accordion in, and my mom and I were in the middle of that. I was very seriously injured and probably almost died. My mom was, too. Several months in the hospital, all of that. Of course, at that point—that was 1975—there was no PTSD, because I think— Caitlin, you can correct me—it didn't become a diagnosis until 1980. I have had symptoms—small, low-level symptoms of PTSD probably on and off most of my life, but so low-level, not diagnosable, and not really causing any sort of problems. But I think what happened in my head was that when that forklift almost hit me, it made my brain think, "Oh my gosh, we're in that situation again," because the forklift was huge. It was the same scale to me as an adult as that car that I was crushed between was when I was four. I think my brain just got confused. Because I was stuck with this construction equipment all day long and I didn't get any break from it, it just made my brain think more and more and more, "Boy, we are really in danger." Our lives are basically threatened all the time. That began my journey of figuring out what was going on with me and then also trying to understand why my OCD seemed to be getting worse and jumping in to help because I seemed to get all these compulsions that were designed to keep me safe from this construction equipment. It created a process where I was trying to figure out, "What is this? I've got both PTSD now, I've got OCD flaring up, how do I deal with this? What do I do?" The reason why I wanted to write the article for Shoulders Back! and why I asked Caitlin to write it with me was because there just isn't a lot of information out there about this combination where people have PTSD or some sort of trauma, and then the OCD jumps in to help. Now you've got a combination of disorders where you've got trauma or PTSD and OCD, and they're merging together to try to protect you. That's what they think they're doing. They're trying to help you stay safe, but really, what they're doing is they're making your life smaller and smaller and smaller. I wanted to write this article for Shoulders Back! to let people know about my experience so that other people going through this aren't alone. I wanted to ask Caitlin to write it with me because I wanted an expert in this to talk about what it is, how we treat it, what hope do we have for people who are experiencing this going forward. THE DIFFERENCE BETWEEN OCD AND PTSD (AND POST-TRAUMATIC OCD) Kimberley: Thank you for sharing that. I do encourage people; I'll link in the show notes if they want to go and read the article as well. Caitlin, from a clinical perspective, what was going on for Shala? Can you break down the differences between OCD and PTSD and what's happening to her? Caitlin: Sure. First, I want to start by thanking Shala again for sharing that story. I know you and I talked about this one-on-one, but I think really sharing personal stories like that obviously involves a lot of courage and vulnerability. It's just so helpful for people to hear examples and to really resonate with, "Wow, maybe I'm not so different or so alone. I thought I was the only one who had experiences like this." I just want to publicly thank you again for writing that blog and being willing to share these really horrible experiences that you had. In terms of how we would look at this clinically, it's not uncommon for people to, like Shala described, experience trauma and have these low-level symptoms for a while that don't really emerge or don't really reach the threshold of being diagnosable. This can happen, for example, with veterans who return home from war, and it might not be until decades later that they have some sort of significant life event or change. Maybe they've retired, or they're experiencing more stress, or maybe, like Shala, they're experiencing another trauma, and it just brings everything up. This kind of delayed onset of PTSD is, for sure, not abnormal. In this case, it sounds like, just like Shala described, that her OCD really latched onto the trauma, that she had these experiences that reinforced each other. Right now, I've had two experiences where being around moving vehicles has been really dangerous for me. Just like you said, I think you did such a beautiful job of saying that the OCD and PTSD colluded in a way to keep you "safe." That's the function of it. But of course, we know that those things go to the extreme and can make our lives very small and very distressing. What Shala described about using these compulsions to try to prevent future trauma is something that we see a lot in people who have comorbid OCD and PTSD. We're doing some research now on the different ways that OCD and trauma can intersect. And that's something that keeps coming up as people say, "I engaged in these compulsions as a way to try to prevent the trauma from happening to me again or happening to someone else. Or maybe my compulsions gave me a sense of control, predictability, or certainty about something related to the trauma." This kind of presentation of OCD sort of functioning as protection against trauma or coping with past trauma as well is really common. STATISTICS OF OCD AND PTSD Kimberley: Would you share a little bit about the statistics between OCD and PTSD and the overlap? Caitlin: Absolutely. I'm excited to share this too, because so much of this work is so recent, and I'm hopeful that it's really going to transform the way that we see the relationships between OCD and PTSD. We know that around 60% of people who have comorbid OCD and PTSD tend to have an experience where PTSD comes first or at the same time, and the OCD comes later. This is sort of that post-traumatic OCD presentation that we're talking about and that Shala talked about in her article. For folks who have this presentation where the PTSD comes first and then the OCD comes along afterwards, unfortunately, we see that those folks tend to have more severe obsessions, more severe compulsions. They're more likely to struggle with suicidality or to have comorbid agoraphobia or panic disorders. Generally speaking, we see a more severe presentation when the OCD comes after the PTSD and trauma, which is likely indicative of what we're discussing, which is that when the OCD develops as a way to cope with trauma, it takes on a mind of its own and can be really severe because it's serving multiple functions in that way. What we've been finding in our recent research—and if folks want to participate, the study will still be active for the next month; we're going to end it at the end of the year, the OCD and Trauma Overlap Study—what we're finding is that of the folks who've participated in the study, 85% of them feel like there's some sort of overlap between their OCD and trauma . Of course, there are lots of different ways that OCD and trauma can overlap. I published a paper previously where we found that about 45% of people with severe OCD in a residential program felt that a traumatic or stressful event was the direct cause of their OCD on setting. But beyond that, we know that OCD and trauma can intersect in terms of the content of obsessions, the function of compulsions, as we've been talking about here, core fears. Some folks describe this, and Shala described this to this, like cyclical relationship where when one thing gets triggered, the other thing gets triggered too. This is really where a lot of the research is focusing on now, is how do these things intersect, how often do they intersect, and what does that really look like for people? Kimberley: Thanks. I found in my practice, for people who have had a traumatic event, as exactly what happened to Shala, and I actually would love for both of you maybe to give some other examples of how this looks for people and how it may be experienced, is let's say the person that was involved in the traumatic event or that place that the traumatic event was recent that recently was revisited just like Shala. Some of them go to doing safety behaviors around that person, place, or event, or they might just notice an uptick in their compulsions that may have completely nothing to do with that. Shala, can you explain a little bit about how you differentiated between what are PTSD symptoms versus OCD, or do you consider them very, very similar? Can you give some insight into that? SYMPTOMS OF OCD & PTSD Shala: Sure. I'll give some examples of the symptoms of OCD that developed after this PTSD developed, but it's all post-traumatic OCDs. I consider it to be different from PTSD, but it is merged with PTSD because it's only there because the PTSD is there. For instance, I developed a lot of checking behaviors around the doors to my house—staring, touching, not able to just look once before I go to bed, had to be positively sure the doors were locked, which, as somebody who does this for a living, who helps people stop doing these compulsions, created a decent amount of shame for me too, as I'm doing these compulsions and saying, "Why am I not taking my own advice here? Why am I getting stuck doing this?" But my OCD thought that the construction equipment was outside; we're inside. We need to make sure it stays outside. The only way we do that is to make sure the door stays locked, which is ridiculous. It's not as if a forklift is going to drive through my front door. As typical with OCD, the compulsions don't make a lot of sense, but there's a loose link there. Another compulsion that I realized after a time was probably linked with PTSD is my people-pleasing, which I've always struggled with. In fact, Kimberley, you and I have done another podcast about people-pleasing, something I've worked really hard on over the years, but it really accelerated after this. I eventually figured out that that was a compulsion to keep people liking me so that they wouldn't attack me. That can be an OCD compulsion all by itself, but it was functioning to help the PTSD. Those would be two examples of compulsions that could be OCD compulsions on their own, but they would not have been there had the PTSD not been there. Kimberley: Caitlin, do you want to add anything about that from symptoms or how it might look and be experienced? Caitlin: Sure, yeah. I think it's spot on that there's this element of separation that we can piece apart. This feels a little bit more like OCD; this feels a little bit more like PTSD, but ultimately they're the same thing, or it's the same behavior. In my work, I usually try to, where I can, piece things apart clinically so that we can figure out what we should do with this particular response that you're having. When it comes to differentiating compulsions, OCD compulsions and PTSD safety behaviors, we can look towards both the presentation of the behavior as well as the function of it. In terms of presentation, I mean, we all know what compulsions can look like. They can be very rigid. There can be a set of rules that they have to be completed with. They're often characterized by a lot of doubting, like in Shala's case, the checking that, "Well, okay, I checked, but I'm not actually sure, so let me check one more time." Whereas in PTSD, although it's possible for that to happen, those safety behaviors, usually, it's a little bit easier to disengage from. Once I feel like I've established a sense of safety, then I feel like I can disengage from that. There doesn't tend to be kind of that like rigidity and a set of rules or magical thinking that comes along with an OCD compulsion. In terms of the function, and this is where it gets a little bit murky with post-traumatic OCD, broadly speaking, the function of PTSD safety behaviors is to try to prevent trauma from occurring again in the future. Whereas OCD compulsions, generally speaking, are a way to obtain certainty about something or prevent some sort of feared catastrophe related to someone's obsession. But of course, when the OCD is functioning along with the PTSD to cope with trauma, to prevent future trauma, that gets a little bit murkier. In my work, like I said, I try to piece apart, are there elements of this that we can try to resist from more of an ERP OCD standpoint? If there's a set of rules or a specific way that you're checking the door, maybe we can work on reducing some of that while still having that PTSD perspective of being a little bit more lenient about weaning off safety behaviors over time. TREATMENT FOR OCD AND PTSD Kimberley: It's a perfect segue into us talking about the treatment here. Caitlin, could you maybe share the treatment options for these conditions, specifically post-traumatic OCD , but maybe in general, all three? Caitlin: Absolutely. The APA, a few years back, reviewed all the available literature on PTSD treatments, and they created this hierarchy of the treatments that have the most evidence base and went down from there. From their review of all the research that's been done, there were four treatments that emerged as being the most effective for PTSD. That would be broadly cognitive behavioral therapy and cognitive therapy. But then there are two treatments that have been specifically created to target PTSD, and that would be prolonged exposure or PE, and cognitive processing therapy or CBT. These all fall under the umbrella of CBT treatments, but they're just a little bit more specific in their approach. And then, of course, we know of ACT and EMDR and these other treatments that folks use as well. Those fall in the second tier, where there's a lot of evidence that those work for folks as well, but that top tier has the most evidence. These treatments can be used in combination with OCD treatments like ERP. There are different ways that folks can combine them. They can do full protocols of both. They could borrow aspects of some treatments, or they could choose to focus really on if there's a very clear primary diagnosis to treat that one first before moving on to the secondary diagnosis. TREATMENT EXAMPLES FOR POST-TRAUMATIC OCD Kimberley: Amazing. Shala, if you're comfortable, can you give some examples of what treatment looked like for you and what that was like for you both having OCD and PTOCD? Shala: Yes, and I think to set the ground for why the combined treatment working on the PTSD and the OCD together can be so important, a couple of features of how all this was presenting for me was the shift in the focus of the uncertainty. With OCD, it's all about an intolerance of uncertainty and not knowing whether these what-ifs that OCD is getting stuck on are true or going to happen. But what I noticed when I developed PTSD and then the OCD came in to help was that the focus of the uncertainty shifted to it's not what if it's going to happen. The only what-if is when it was going to happen because something bad happening became a given. The uncertainty shifted to only when and where that bad thing was going to happen, which meant that I had lower insight. I've always had pretty good insight into my OCD, even before I got treatment. Many people with OCD too, we know what we're doing doesn't make any sense; we just can't stop doing it. With this combined presentation, there was a part of me that was saying, "Yeah, I really do need to be staring at the door. This is really important to make sure I keep that construction equipment out." That lowered insight is a feature of this combined presentation that I think makes the type of treatment that we do more important, because we want to address both of the drivers, both the PTSD and the OCD. The treatment that I did was in a staged process. First, I had to find a treatment provider, and Caitlin has a wonderful list of evidence-based treatment providers who can provide treatment for both on her website, which is great. I found somebody actually who ended up being on Caitlin's list and worked with that person, and she wanted to start out doing prolonged exposure , which I pushed back on a little bit. Sometimes when you're a therapist and you're being the client, it's hard not to get in the other person's chair. But I pushed back on that because I said, "Well, I don't think I need to do prolonged exposure on the original accident," because that's what she was suggesting we do, the accident when I was four. I said, "Because I wrote a book, Is Fred in the Refrigerator? and the very first chapter is the accident," and I talked all about the accident. She explained, "That's a little bit different than the way we would do it in prolonged exposure." What's telling, I think, is that when I worked on the audiobook version of Fred —I was doing the narration, I was in a studio, and I had an engineer and a director; they were on one side of the glass, I'm on the other side of the glass—I had a really hard time getting through that first chapter of the book because I kept breaking down. They'd have to stop everything, and I had to get myself together, and we had to start again, and that happened over and over and over again. Even though I had relived, so to speak, this story on paper, I guess that was the problem. I was still reliving it. That's probably the right word. Prolonged exposure is what I needed to do because I needed to be able to be in the presence of that story and have it be a story in the past and not something that I was experiencing right then. I started with prolonged exposure. After I did that, I moved on to cognitive processing therapy because I had a lot of distorted beliefs around life and the trauma that we call "stuck points" in cognitive processing therapy that I needed to work through. There were a good 20 or so stuck-point beliefs. "If I don't treat people perfectly nicely, they're going to attack me somehow." Things that could be related directly to the compulsions, but also just things like, "The world is dangerous. If I'm not vigilant all the time, something bad is going to happen to me." I had to work on reframing all of those because I was living my life based on those beliefs, which was keeping the trauma going. I recreated a new set of beliefs and then brought exposure in to work on doing exposures that helped me act as if those new beliefs were the right way to live. If my stuck point is I need to be hypervigilant because of the way something bad is going to happen to me, and I'm walking around like this, which was not an exaggeration of really how I was living my life when this was all happening—if I'm living like that, if I'm acting in a hypervigilant way, I am reinforcing these beliefs. I need to go do exposures where I can walk by a dump truck without all the hypervigilance to let all that tension go, walk by it, realize what I've learned, and walk by it again. It was a combination of all these and making sure that I was doing these exposures, both to stop the compulsions I was doing, like the door checking, but also to start living in a different way so that I wasn't in my approach to life, reinforcing the fact that my PTSD thought the world was dangerous. I also incorporated some DBT ( dialectical behavior therapy ) because what I found with this combination was I was experiencing a lot more intense emotions than I'd really ever experienced in having OCD by itself. With OCD, it was mostly just out-of-this-world anxiety, but with the combination of PTSD and OCD, there were a lot more emotional swings of all sorts of different kinds that I needed to learn and had to deal with. Part of that too was just learning how to be in the presence of these PTSD symptoms, which are very physiological. Not like OCD symptoms aren't, but they tend to be somewhat more extreme, almost panicky-like feelings. When you're in the flashbacks or flash forwards, you can feel dissociated, and you're numbing out and all of that. I'm learning to be in the presence of those symptoms without reacting negatively to them, because if I'm having some sort of feelings of hypervigilance that are coming because I'm near a piece of construction equipment and I haven't practiced my ERP (Expsoure & Response Prevention) for a while, if I react negatively and say, "Oh my gosh, I shouldn't be having these symptoms. I've done my therapy. I shouldn't be having these feelings right now," it's just going to make it worse. Really, a lot of this work on the emotional side was learning how to just be with the feelings. If I have symptoms, because they happen every now and then—if I have symptoms, then I'm accepting them. I'm not making them worse by a negative reaction to the reaction my PTSD is having. That was a lot of the tail end of the work, was learning how to be okay with the fact that sometimes you're going to have some PTSD symptoms, and that's okay. But overreacting to them is going to make it worse. Kimberley: Thank you so much for sharing that. I just want to maybe clarify for those who are listening. You talked about CPT, you talked about DBT, and you also talked about prolonged exposure. In the prolonged exposure, you were exposing yourself to the dump truck? Is that correct? Shala: In the prolonged exposure, I was doing two different things. One is the story of the accident that I was in. Going back to that accident that I thought I had fully habituated to through writing my book and doing all that, I had to learn how to be in the presence of that story without reliving it while seeing it as something that happened to me, but it's not happening to me right now. That was the imaginal part of the prolonged exposure. This is where the overlap between the disorders and the treatment can get confusing of what is part of what. You can do the in vivo exposure part of prolonged exposure. Those can also look a lot like just ERP for OCD, where we're going and we're standing beside a dump truck and dropping the hypervigilant safety behaviors because we need to be able to do that to prove to our brain we can tolerate being in this environment. It isn't a dangerous environment to stand by a jump truck. It's not what happened when I was four. Those are the two parts that we're looking at there—the imaginal exposure, which is the story, and then we've got the in vivo exposures, which are going back and being in the presence of triggers, and also from an OCD perspective without compulsive safety behaviors. Kimberley: Amazing. What I would clarify, but please any of you jump in just for the listeners, if this is all new to you, what we're not saying is, let's say if there was someone who was abusive to you as a child, that you would then expose yourself to them for the sake of getting better from your PTSD. I think the decisions you made on what to expose yourself were done with a therapist, Shala? They helped you make those decisions based on what was helpful and effective for you? Do either of you want to speak to what we do and what we don't expose ourselves to in prolonged exposure? Caitlin: Yeah. I'm glad that you're clarifying that too, because this is a big part of PE that is actually a little bit different from ERP. When somebody has experienced trauma, when they have PTSD, their internal alarm system just goes haywire. Just like in Shala's example, anything that serves as a reminder or a trigger of the trauma, the brain just automatically interprets as this thing is dangerous; I have to get away from it. In PE, a lot of what we're doing is helping people to recalibrate that internal alarm system so that they can better learn or relearn safe versus actual threat. When you're developing a hierarchy with someone in PE, you might have very explicit conversations about how safe is this exposure really, because we never want to put someone in a situation where they would be unsafe, such as, like you described, interacting with an abuser. In ERP, we'd probably be less likely to go through the exposures and say, "This one's actually safe; I want you to do it," because so much of the treatment is about tolerating uncertainty about feared outcomes. But in PE, we might have these explicit conversations. "Do other people you know do this activity or go to this place in town?" There are probably construction sites that wouldn't be safe for Shala to go to. They'd be objectively dangerous, and we'd never have her go and do things that would put her in harm's way. Kimberley: Thank you. I just wanted to clarify on that, particularly for folks who are hearing this for the first time. I'm so grateful that we're having this conversation again. I think it's going to be so eye-opening for people. Caitlin, can you share any final words for the listeners? What resources would you encourage them to listen to? Is there anything that you feel we missed in our conversation today for the listeners? Caitlin: I think, generally, I like to always leave on a note of hope. Again, I'm so grateful that Shala is here and gets to describe her experience with such vulnerability because it gives hope that you can hear about someone who was at their worst, and maybe things felt hopeless in that moment. But she was able to access the help that she needed and use the tools that she had from her own training too, which helped, and really move through this. There isn't sort of a final point where it's like, "Okay, cool, I'm done. The trauma is never going to bother me again." But it doesn't have to have that grip on your life any longer, and you don't need to rely on OCD to keep you safe from trauma. There are treatments out there that work. Like it was mentioned, I have a directory of OCD and PTSD treatment providers available on my website, which is www.cmpinciotti.com that folks can access if they're looking for a therapist. If you're a therapist listening and you believe that you belong in this directory, there's a way to reach out to me through the website. I'd also say too that if folks are willing and interested, participating in the research that's happening right now really helps us to understand OCD and PTSD better so that we can better support people. If you're interested in participating in the OCD and trauma study that I mentioned, you can email me at OCDTraumaStudy@bcm.edu. I also have another study that's more recent that will help to answer the question of how many people with OCD have experienced trauma and what are those more commonly endorsed ways that people feel that OCD and trauma intersect for them. That one's ultra-brief. It's a 10-minute really quick survey, NationalOCDSurvey@bcm.edu and I'm happy to share that anonymous link with you as well/ Kimberley: Thank you. Thank you so much. Shala, can you share any final words about your experience or what you want the listeners to hear? Shala: One thing I'd like to share is a mistake that I made as part of my recovery that I would love for other people not to make. I'd like to talk a little bit about that, because I think it could be helpful. The mistake that I made in trying to be a good client, a good therapy client, is I was micro-monitoring my recovery. "How many PTSD symptoms am I having? Well, I'm still having symptoms." I woke up in the middle of the night in a panic, or I had a bad dream, or I had a flash forward. "Why am I having this? I must not be doing things right." And then I took it a step further and said, "It would be great if I could track the physiological markers of my PTSD so I can make sure I'm keeping them under control." I got a piece of tracking technology that enabled me to track heart rate and heart rate variability and sleep and all this stuff. At first, it was okay, but then the technology that I was using changed their algorithm, and all of a sudden my stats weren't good anymore, and I started freaking out. "Oh my gosh, my sleep is bad. My atrophy is going down. This is bad. What am I doing?" I was trying with the best of intentions to quantify, make sure I'm doing things right, focus on recovery. But what I was doing was focusing on the remaining symptoms that were there, and I was making them worse. What I have learned is that eventually, things got so bad—in fact, with my sleep—that I got so frustrated with the tracking technology. I said, "I'm not wearing it anymore." That's one of the things that helped me realize what I was doing. When I stopped tracking my sleep, when I let go of all of this and said, "You know what? I'm going to have symptoms," things got better. I would encourage people not to overthink their recovery, not to be in their heads and wake up in the morning and ask, "How much PTSD am I having? How much OCD am I having? If I could just get rid of these last little symptoms, life would be great," because that's just going to keep everything going. I'll say this year, two has been a challenging one for me. I've been involved in three car accidents this year; none of them my fault. One of my neighbors, whom I don't know, called the police on me, thinking I was breaking into my own house, which meant that a whole army of police officers ended up at my house at nine o'clock at night. That's four pretty hard trauma triggers for me in 2023. Those kinds of things are going to happen to all of us every now and then. I had a lot of symptoms. I had a lot of PTSD symptoms and a lot of OCD symptoms in the wake of those events, and that's okay. It's not that I want them to be there, but that's just my brain reacting. That's my brain trying to come to terms with what happened and how safe we are and trying to get back to a level playing field. I think it's really important for anybody else out there who's suffering from one or the other, or both of these disorders to recognize we're going to have symptoms sometimes. Just like with OCD, you're going to have symptoms sometimes. It's okay. It's the pushing away. It's the rejecting of the symptoms. It's the shaming yourself for having the symptoms that causes the symptoms to get worse. Really, there is an element of self-compassion for OCD here. I like having bracelets to remind me. This is the self-compassion bracelet that I've had for years that I wear. By the way, this is not the tracking technology. I'm not using tracking technology anymore. But remembering self-compassion and telling yourself, "I'm having symptoms right now, and this is really hard. I'm anxious; I feel a little bit hypervigilant, but this is part of recovery from PTOCD. Most people with PTOCD experience this at some point. So I'm going to give myself a break, give myself permission to feel what I'm feeling, recognize how much progress I've made, and, when I feel ready, do some of my therapy homework to help me move past this, but in a nonhypervigilant, nonmicro monitoring way." As I have dropped down into acceptance of these symptoms, my symptoms have gotten a lot better. I think that's a really important takeaway. Yes, we want to work hard in our therapy, yes, we want to do the homework, but we also want to work on accepting because, in the acceptance, we learn that having these symptoms sometimes is just a part of life, and it's okay. I would echo what Caitlin said in that you can have a ton of hope if you have these disorders, in that we have good treatment. Sometimes it takes a little bit longer than working on either one or the other, but that makes sense because you're working on two. But we have good treatment, and you can get back to living a joyful life. Always have hope and don't give up, because sometimes it can be a long road, especially when you have a combined presentation. But you can tame both of these disorders and reclaim your life. Kimberle: You guys are so good. I'm so grateful we got to do this. I feel like it's such an important conversation, and both of you bring such wonderful expertise and lived experience. I'm so grateful. Thank you both for coming on and talking about this with me today. I'm so grateful. Shala: Thank you for having us. Caitlin: Yes, thank you. This was wonderful. Kimberley: Thank you so much, guys. RESOURCES: The two studies CAITLIN referenced are: OCD/Trauma Overlap Study: An anonymous online survey for any adult who has ever experienced trauma, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_0j4ULJv3DxUaKtE or by emailing OCDTraumaStudy@bcm.edu National OCD Survey: An anonymous 10-minute online survey for any U.S. adult who has ever had OCD, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_9LdbaR2yrj0oV7g or by emailing NationalOCDSurvey@bcm.edu

Nov 10, 2023

When things get hard, it's really quite difficult to find a reason to keep going. Today, we have an incredible guest, Shaun Flores , talking about what keeps us going. This was a complete impromptu conversation. We had come on to record a podcast on a completely different topic. However, quickly after getting chatting, it became so apparent that this was the conversation we both desperately wanted to have. And so, we jumped in and talked about what it's like in the moments when things are really difficult, when we're feeling like giving up, we are hopeless, we're not sure what the next step is. We wanted to talk about what does keep us going. This is, again, a conversation that was very raw. We both talked about our own struggles with finding meaning, moving forward, and struggling with what keeps us going. I hope you find it as beautiful a conversation as I did. My heart was full for days after recording this, and I'm so honored that Sean came on and was so vulnerable and talked so beautifully about the process of finding a point and finding a reason to keep going. I hope you enjoy it just as much as I did. Shaun: Thank you so much for being able to have this conversation. Kimberley: Can you tell us just a little background on you and what your personal, just general mental health journey has looked like? Shaun: Yeah. My own journey of mental health has been a tumultuous one, to say the very least. For around five to six years ago, I would say I was living with really bad health anxiety to the point where I obsessed. I constantly had an STI or an STD. I'd go to the clinic backward and forward, get tested to make sure I didn't have anything. But the results never proved to be in any way, shape, or form sufficient enough for me to be like, "Okay, cool. I don't have anything." I kept going back and forward. How I knew that became the worst possible thing. I paid 300 pounds for the same-day test results. Just to give people's perspective, 300 pounds is a lot. That's when I was like, "There's something wrong. I just don't know what it is." But in some ways, I thought I was being a diligent citizen in society, doing what I needed to do to make sure I take care of myself and to practice what was safe sex. But then that fear migrated onto this sudden overnight change where I woke up and I thought, "What if I was gay?" overnight. I just quite literally woke up. I had a dream of a white guy in boxes, and I woke up with the most irrational thought that I had suddenly become gay. I felt my identity had come collapsing. I felt everything in my world had shaken overnight. I threw up in the toilet that morning, and at that time I was in the modeling industry. Looking back now, I was going through disordered eating, and I'm very careful with using the word "eating disorder." That's why I call it "disordered eating." I was never formally diagnosed, but I used to starve myself. I took diuretics to maintain a certain cheekbone structure. Because in the industry that I was in, I was comparing myself to a lot of the young men that were there, believing that I needed to look a certain kind of way. When I look back at my photos now, I was very gaunt-looking. I was being positively affirmed by all the people around me. I hated how round my face was. If I woke up in the morning and my face was round, I would drink about four liters of water with cleavers tincture. I took dandelion extracts. Those are some of the things that I took to drain my lymphatic system. I went on this quest for a model face. And then eventually, I left the industry because it just wasn't healthy for me in any way, shape, or form. I was still living with this fear that I was gay. If I went to the sauna and steam room in the gym, I would just obsess 24/7 that if I could notice the guy's got a good-looking body, or if he's good-looking, this meant I'm gay. It was just constant, 24/7. From the minute I slept to the minute I woke up, it was always there. Then that fear moved on to sexual assault. I had a really big panic attack where I was terrified. I asked one of my friends, "Are you sure I haven't done anything? Are you sure I haven't done anything?" I kept asking her over and over. I screamed at her to leave because I was so scared. I must've been hearing voices, and I was terrified that I could potentially hurt her. I tried to go to sleep that night, and there were suicide images in my head, blood, and I was like, "There's something up." I just didn't know what was going on. I had no scooby, nothing. That night, I went to the hospital, and the mental health team said that they probably would suggest I get therapy. I said, "It's cool. I'll go and find my own therapist." I started therapy, and the therapy made me a hundred times worse. I was doing talk therapy. We were trying to get to the root of all my thoughts. We were trying to figure out my childhood. Don't get me wrong, there's relevance to that. By that time, it was not what I needed. And then last year, this is when everything was happening in regards to the breakdown that I had as well. I got to such a bad point with my mental health that I no longer wanted to be alive. I wanted time to swallow me up. I couldn't understand the thoughts I was having. I was out in front of my friends, and I had really bad suicidal thoughts. I believed I was suicidal right off the bat. I got into an Uber, called all my friends, and just told them I'm depressed and I no longer want to be alive. I'm the kind of guy in the friendship group everyone looks up to, almost in some ways, as a leader, so people didn't really know what to do. That's me saying as a self-elected leader. That's me being reflective about my friendship group. But I woke up one day, and it was a Saturday, the 4th of June, and I just said, "I can't do this anymore." I said, "I can't do this." I was prepared to probably take my life, potentially. I reached out to hundreds of people via Instagram, LinkedIn, WhatsApp, email, wherever it was, begging for help because I looked on the internet and was trying to figure out what was it that was going on with me. I was like, "Why am I having certain thoughts, but I don't want to act on them?" And OCD popped up, so I believed I had OCD . When I found this lady called Emma Garrick (The Anxiety Whisperer) on Saturday, the 4th of June, I just pleaded with her for a phone call. She picked up the phone, and I just burst out in tears. I said, "What's wrong with me?" I said, "I don't want to hurt anyone. Why am I having the thoughts I'm having?" And she said, "Shaun, you have OCD." From there on, my life changed dramatically. We began therapy on Monday. I would cry for about two hours in a session. I couldn't cope. I lost my job. There were so many different things that happened that year. In that same year, obviously, I had OCD. I tore my knee ligaments in my right knee. Then I ended up in the hospital with pneumonia. Then my auntie died. Then my cousin was unfortunately murdered. Then my half-brother died. Then my auntie—it's one of my aunties that helped to raise me when my dad died on Christmas day when I was six—her cancer spread from the pancreas to the liver. Then fast-forward it to this year, about a couple of months ago, that same auntie, the cancer became terminal and spread from the liver to the spleen. I watched her die, and that was tough. Then I had my surgery on August the 14th. But I'm still paying my way through debt. It was an incredibly tough journey. I'm still doing the rehab for my knee, still doing the rehab for OCD. That's my journey. I'm still thinking about it to this day. Me and my therapist talk about this, and he has lived experience of OCD . I still don't even know what's kept me alive at this point, but that's the best way to describe my story. That's a shortened, more condensed version for people listening. Kimberley: Can I ask, what does keep you going? Shaun: What keeps me going? If I'm being very honest, I don't know sometimes. There are days when I've really struggled with darkness, sadness, and a sense of hopelessness sometimes. I ride it out. I try not to give in to those suicidal thoughts that pop up. And then I remember I've got a community that I've been able to create, a community that I'm able to help and inspire other people. I think I keep going on my worst days because the people around me need someone to keep inspiring them. What I mean by that is some of the messages I've got on the internet, some of them have made me cry. Some of them have made me absolutely break down from some people who have opened up to me and shared their entire story. They look up to me, and I'm just like, "Wow, I can't give up now. This isn't the end." I've had really dark moments, and I think a lot of people look at my story and perhaps look at my social media, and they think I'm healed and I've fully recovered. But my therapist has seen me at my worst, and they see me at my absolute best. I think I stay here. What keeps me pushing is to help other people, to give other people a chance, and to let them know that you can live a life with OCD, anxiety. Depression I'm not sure if I fully align with. Maybe to some degree, but to let them know they can live a life in spite of that. I don't know. Again, I keep saying this to my therapist. There's something in me that just refuses to quit. I don't know what it is. I can't put it into words sometimes. I don't know. Maybe it's to leave the world in a better place than I found it. I really do not know. Kimberley: I think I'm so intrigued. I'm so curious here. I think that this is such a conversation for everyone to have. I will tell you that it's interesting, Shaun, because I'm so grateful for you, number one, that we're having this conversation, and it's so raw. Somebody a few months ago asked me, what's the actual point of all this? It was her asking me to do a podcast on the point, what's the point of all this? I wrote it down and started scripting out some ideas, and I just couldn't do the episode because I don't know the answer either. I don't know what the point is. But I love this idea that we're talking about of what keeps us going when things are so hard. Because I said you're obviously resilient, and you're like, "No, that's not it." But you are. I mean, so clearly you are. It's one of your qualities. But I love this idea of what keeps you going. In the day, in the moment to moment, what goes through your mind that keeps you moving towards? You're obviously getting treatment; you're obviously trying to reduce compulsions, stop rumination, or whatever that might be. What does that sound like in your brain that keeps you going? Shaun: Before I answer that, I think I've realized what my answer would be for what keeps me going. I think it's hope because it makes me feel a bit emotional. When I was at my absolute worst, I had lost hope, lost everything. I lost my job. I end up in mountains of debt that I'm still paying off. It's to give hope to other people that your life can get better. I would say it has to be hope. In those day-to-day moments, one of my really close friends, Dave, has again seen me at my worst and my best. Those day-to-day moments are incredibly tough. I've had to learn to do things even when I don't want to do them. I've had to learn to eat when I don't always want to eat, to stick to the discipline, to stick to the process, to get out of bed, and to keep pushing that something has to change. These hard times cannot last forever. But those day-to-day moments can be incredibly tough when my themes change, when I mourn my old life with OCD in the sense that I never thought consciously about a lot of my decisions. Whereas now, I think a lot more about what I do, the impact I have on the world, and the repercussions of certain decisions that I make. I would say a lot of my day-to-day, those moment-to-moments, is a bit more trepidation. I think that would be the best way to describe my day-to-day moments. I was just going to say, I was even saying to my friend that I can't wait to do something as simple as saving money again. I'm trying to clear off everything to restart and just the simple things of being able to actually just save again, to be able to get into a stable job to prove to myself that I can get my life back. Kimberley: To me, the reason that I'm so, again, grateful that we're here talking about this is it really pulls on all of the themes that we get trained in in psychology in terms of taking one step at a time. They talk about this idea of grit, like you keep getting up even though you get knocked down. I don't think we talk about that enough. Also, the fact that most people who have OCD or a mental health issue are also handling financial stresses and, like you said, medical conditions, grief, and all of these things. You're living proof of these concepts and you're here telling us about them. How does that land for you? Or do you want to maybe speak to that a little more? Shaun: I was reading a book on grits. I was listening to it, and they were talking about how some people are just grittier than other people. Some people may not be as intelligent or may not be as "naturally gifted," but some people are grittier than other people. A lot of people who live with chronic conditions such as OCD or whatever else, you have to be gritty. That's probably a quality you really have to have every single day without realizing it. To speak to that, even on the days when I have really struggled, as I said, I don't know what always gets me up. There's something inside. I look around at the other people around me who've shown grit as well—other people around me who have worked through it. The therapist I have, he's a really good therapist. I listen to his story, Johnny Say, and he talks about something called gentle relentlessness, the idea that you just keep being relentless very gently. You know that one step-a-day kind of mentality that, "Okay, cool, I'm having these thoughts today. I'm going to show myself some compassion, but I'm going to keep moving." For me, when I speak to him, I tell him he inspires me massively because he's perfected and honed his skills so much of OCD that he's able to do the job that he does. He's able to help other people, and that inspires me. When I look at the other people around me, I'm inspired by other people's grit and perseverance as well. That really speaks to what I need to be able to have. I think it's modeled a lot for me. Even in my own personal life with my mom, there's a lot of things that we've gone through—my father, who died on Christmas Day when I was six—and she had to be gritty in her own way to raise a single boy in the UK when she was in a country she didn't want to be in because of my granddad. I think grit has been modeled for me. I think it really has been role-modeled for me in so many different ways. When people say, "Just get up and keep going," I think it's such a false notion that people really don't understand the complexity of human emotions and don't understand that, as humans, we go up and we go down. A very long time ago, I used to be that kind of human where I was like, "Just get out, man. Suck it up. Just keep going, bro. You can do this. You've got this." I think going through my own stuff has made me realize sometimes we don't always feel like we've got it. We have to follow the plan, not the mood sometimes. But I honestly have to say, I think grit has been role-modeled a lot for me. Kimberley: Yeah. It's funny, as you were talking, I was thinking too. I think so often—you talked about this idea of hope—we need to know that somebody else has achieved what we want to achieve. If we have that modeled to us, even if it's not the exact thing, that's another thing that keeps us going. You've got a mentor, you've got a therapist. Or for those of you who don't have a mentor or therapist, it might be listening to somebody on a podcast and being like, "Well, if they can do it, there has to be hope for me." I think sometimes if we haven't got those people in our lives, we maybe want to look for people to inspire and model grit and keep going for us, would you say? Shaun: Absolutely. Funnily enough, when I was going through depression as a compulsion , my friend sent me your podcast about depression as a compulsion . The idea is that you feel this depressive feeling, you start investigating it, trying to figure out if you're depressed, and then it becomes a compulsion. And then, after that compulsion happens, you stay in this spiral with depression or whatever it might be. That's something else I realized—that having your podcast and listening to talking about being kind, self-criticism, and self-compassion was role modeled a lot for me because, again, growing up, I didn't have self-compassion. It's not something we practice in the household or the culture I'm from. But having it role-modeled for me was so big. It is huge. I cannot even put into words how important it is to have people around you who still live with something you live with, and they keep going, because it almost reminds you that it's not time to give up. Sadly, I've lost friends to suicide. I found out that someone had died in 2021 at what I thought he had died. We met at a modeling agency when I was modeling. We met at the Black Lives Matter march as well, regardless of whatever your political opinions are for anyone listening. I found that he had died. I remember I messaged some of the friends we had in common. I was like, "What happened?" And nobody knew. A couple of weeks ago, I just typed in his name. Out of nowhere, I just typed, and I was like, "What happened to him?" I found that he had taken his life when he was in university halls. I was just like, "You really don't know what people are going through." Some people have messaged me and said what I talk about has kept them going. I'm just sitting there like, "Wow, other people have kept me going." I think that becomes a role-modeled community almost in some ways. Kimberley: For sure. It's funny you mention that. I too have lost some very close people to me from suicide. I think the role model thing goes both directions in that it can also be hard sometimes when people you really love and respect have lost their lives to suicide. I think that we do return to hope, though. I think for every part of me that's pained by the grief that I feel, hope fuels me back into, how can I help? Maybe I could save one person's life. Actually, sometimes helping just gets me through a hard day as well. I can totally resonate. I think you're right. There is a web of inspiration. You inspire somebody else. They inspire you. They've been inspired by somebody. It's like a ladder. Shaun: Absolutely. I once heard someone say, the best way to lose yourself is in the service of others. One of the things that really got me through depression when I was at the thickest of my OCD was when I said, "How am I going to go and serve other people? How am I going to go and help other people?" When I asked my first therapist, I said, "Why are you so kind to me? Why do you believe in me?" she told me something that really sat with me. She said, "I believe you're going to go on to help so many other people." When I released my first story on August the 14th, and I had so many people reach out to me that I knew, people I didn't know speaking about OCD, I was like, "This is where it begins. That in the suffering, there is hope. In the suffering, I can live. In the suffering, I can find purpose. In the suffering, I can use that to propel me out of pain." But you are right. This conversation has really made me think a lot about how I keep going, like how I've been able to just keep pushing because my friends are, again, around me. My therapist knows that there are days when I don't want to do my therapy. I've gone to my physiotherapist, and I've said, "You have no idea what I've gone through." I said, "I'm not feeling to do anything. I just want to give up right now." I said, "I'm tired of this." I said, "Why is life so hard on me?" Death is one thing. Physical injury is another thing. OCD is another thing. Chasing money is another thing. Everything is a constant uphill battle. It really has made me think a lot about life. It's made me think a lot about my friends who have opened up to me about their struggles. Very similar to you, Kimberley, I want to go on to, at some point, become a therapist and change people's lives. When people reach out to me, I would love to be able to say to someone, if someone said, "I can't afford a therapist," I'd be like, "Let me try and help you and see what I can do on my part." That kind of kindness or that kind of empathy, that kind of lived experience, that understanding—it's something I really want to give back to other people. It's hope. Hope is everything. Kimberley: Yeah. It's ever-changing, too. Some days you need one thing, and the next day you need others. For me, sometimes it's hope. Sometimes it's, like you said, day-to-day grit. Sometimes it's stubbornness, like I'm just straight-up stubborn. You know what I mean? Shaun: It's funny you say that. Kimberley: We can draw on any quality to get us through these hard things that keep us going. My husband always says too, and now that we're exploring it and I'm thinking about it, because you and I did not prepare for this, we are really just riffing here—my husband always says when I've had a really hard time, which in the moment sounds so silly and so insignificant, but it has also helped, amongst these other things, "Put on the calendar something you're really looking forward to and remind yourself of that thing you're going towards every day. It doesn't even have to be huge, but something that brings you joy, even if it's got nothing to do with the hard thing you're going through." I've also found that to be somewhat beneficial, even if it's a dinner with friends or a concert or an afternoon off to yourself, off work. That has also been really beneficial to me. Shaun: Yeah. Taking aim at things in the future can give you things to really look forward to. In the thickest of my OCD, I had nothing to look forward to sometimes. I remember I turned down modeling jobs because of my anxiety. The only thing I could look forward to was my therapist, and that was my silver lining in many, many ways. I remember I would say to her, "I've been waiting for this session the whole week. I've needed this." Another thing you touched on that I think made me laugh is stubbornness. There is a refusal. There's a refusal to lay down. For example, I make jokes about this. I go to the gym sometimes, and I'll say to the guys, "I've had a knee injury. Why are my legs bigger than yours?" That small little bit of fun and a little bit of gest, a bit of banter, as we would say. I'll go to them, and I'll be like, "I need to show these guys that my legs are still bigger than theirs and I've got an injury. I'm not supposed to be training legs." Just small things like that have really given me things to look forward to. Something as silly as male ego has been-- I say this to everyone—male, female, anyone. I'm like, "How dare I get sexy? How dare I be mentally unwell but still sexy?" There is an audacity to it. There's a temerity, a gumption, a goal. There is a stubbornness to go out there into the world and to really show people that, again, you can live with it. When I delivered my TEDx talk in 2022 at Sheffield Hallam University about masculinity, I remember a lady came up to me afterwards. This is when I was doing something called German Volume Training. It was heavy, very intense training. I put on a lot of muscle in that short space of time. She came up to me and said, "You do not look like a guy who suffered with his mental health at all." She said, "You look like the complete opposite." Because people have this idea that people who live with illness are—there's this archetype in people's heads—timid, maybe a bit unkempt. They don't look after themselves. It really said a lot to me that there really is no one image of how people look. Even where I live, unfortunately, there's a lady who screams at people. She shaves her hair. She just sits down there. A very long time ago, I would look at people and judge them. One thing I've really learned from living with illness has been we never know what's happened in people's lives that has pushed them to the place of where they are. There was also another older gentleman, and he smelt very strongly of urine and alcohol. I was on the train with him, and the train was packed. You could just see he was minding his own business. He had a bag on him, and clearly he had alcohol in it. There were two girls that were looking at him with such disgust, contempt, and disdain. It really got to me. It really irked me about the way people looked at him because, in my head, I'm like, "You don't know what that guy's gone through. You just have no idea what led him to become clearly an alcoholic. He probably is potentially homeless as well." I got off that train, and I just felt my views on things had really changed, really changed in life. Dealing with people just-- I don't know. I've gone off on a tangent, but it's just really sat with me in the sense of looking forward to things—how I look forward to how my views are evolving and how my views on life are changing. Kimberley: Yeah. I'm sort of taking from what you're saying. You bring up another way in which you keep going, which is humor, and I've heard a lot of people say that. A lot of people say humor gets me through the hardest times. You say you make jokes, and that, I think, is another way we can keep going. Shaun: Yeah, you are correct. When I go to the gym and I banter all the guys, I'm laughing at them, and typical male ego—that has really helped me on many, many occasions. Even people around me who we have sit down and we have a laugh. There's times when I quite honestly say to people, my life is a Hollywood movie at this point. I need a book. I need a series of unfortunate events, a trilogy, whatever it might be at this point, because it's almost as if it can't be real. Humor has been a propelling agent in me helping to get better, but it's also been an agent in everything that I do. My first therapist, Emma, said to me, "OCD leaves you with a really messed-up sense of humor because you've got to learn how to laugh at the thoughts. You've got to learn how to not take everything seriously." I have had some of the most ludicrous thoughts I could imagine. I told my friend, and she started cracking up at me. She started laughing. She's like, "Do you know how ludicrous this is?" And I said to her, "I know." Or, for example, again, at my absolute worst, I couldn't even watch MMA, UFC, or boxing because guys were half naked. I couldn't be around guys who were half naked because of how my sexual orientation OCD used to really play with my head. There were so many ridiculous situations. I would walk outside and I'd have a thought, "Kill the dog," and I'd be like, "Oh, well, this is bloody fantastic now, isn't it?" I've had images of all sorts in my head. I told my friend, and he started laughing. I was like, "Bro, why are you laughing?" But it made me laugh because it took the seriousness out of what was going on. It really did. Humor—it's been huge. It's funny how that can even maneuver into the concept of cancel culture because there was a comedian who has OCD, and he said, "When was being clean really a bad thing?" I know, obviously, we know the way people see OCD, but he drew light on the fact that he has quite severe OCD himself. He's using humor clearly to help him get better. But humor has been another thing. Humor, stubbornness, grit, resilience—all these things in my life experience have really helped me to still be here. I still say that as a guy who hasn't been paid this month from work. I'm on sick leave. I'm still trying to find ways to make money. I'm still trying to train to become a therapist. I'm applying for courses. I've applied for a hundred jobs within the National Health Service over here in the UK. That's just to put it into perspective. Again, as my therapist would say, a gentle relentlessness to keep pushing humor to find some of the joy and some of the sadness that happens. Kimberley: I cannot tell you how grateful I am that you have allowed us to go here today. I think this is the conversation that we needed to have today, both of us. My heart is so full. Can people hear more about where they can get in touch with you, hear more about you? You've talked so beautifully about the real hard times and what's gotten you through. Where might people get ahold of you? Shaun: I say to people, you can reach out to me on Instagram , TikTok, wherever you want. I say to people, just reach out, and please feel free to message me. I don't know whether this has happened to you, Kimberley. Some people reach out to me when they're really struggling with their OCD, and then some people I never hear from again. Some people don't turn up to phone calls. I think for a lot of people, there's a big fear that if they reach out to me, I'm going to hear something that I've never heard. I can honestly say to people, I've had every thought you could imagine. I've had the most ludicrous thoughts. I've had pretty much every single theme at this point. I really want, and I really encourage people to please reach out and have a conversation with me. You can find me anywhere on social media. Kimberley: I have so enjoyed this conversation. Are there any final statements you want to make to finish this off? Shaun: If you give up now, you'll never see what life would look like on the other side. That's the one thing I think I have to really say. Kimberley: It's amazing. Thank you.

Nov 3, 2023

If you want to know how to be uncomfortable without making it worse, you're in the right place. Today, we're talking all about being uncomfortable and learning how to be uncomfortable in the most skillful, compassionate, respectful, and effective way. This applies to any type of discomfort, whether it be your thoughts, your feelings, any physical sensations, or the pain that you're feeling. Anything that you're experiencing as discomfort, we're here to talk about it today. Let's do it. Welcome back, everybody. For those of you who are new, welcome. My name is Kimberley Quinlan. I'm a marriage and family therapist in the state of California. I'm an anxiety specialist, and I love to talk about being uncomfortable. It's true, I don't like being uncomfortable, but I love to talk about being uncomfortable, and I love talking about skillful ways to manage that. WHAT IS DISCOMFORT, REALLY? Now, before we get started, let's first talk about what we mean by being uncomfortable. There are different forms of discomfort. One may be feelings or emotions that you're having—shame, guilt, anxiety, sadness, anger. Whatever it is that you experience as a feeling can be interpreted and experienced as uncomfortable. Another one is sensations. Physical sensations of anxiety , physical sensations of shame, and physical sensations of physical pain. I myself have a chronic illness. Physical sensations can be a great deal of discomfort for us as human beings. We're also talking about that as well. We're also talking about intrusive thoughts , because thoughts can be uncomfortable too. We can have some pretty horrific, scary, mean, and demanding thoughts, and these thoughts can create a lot of discomfort within us. What we want to do here is we want to first acknowledge that discomfort is a normal, natural part of life. It truly is. I know on social media, and I know in life, on TV, and in movies, it's painted that there are a certain amount of things you can do, and if you were to attain those, well, then you would have a lot less discomfort. But as someone who is a therapist who has treated the widest range of people, I've learned that even when they reach fame, a lot of money, or a degree of success, we can see that they have some improved wellness. They do have some decrease in discomfort, but over time, they're still going to have uncomfortable thoughts. Sometimes having those things creates more uncomfortable thoughts. They're still going to have physical pain, and they're still going to have emotions that cause them pain, particularly when they're not skillful. What I've really learned as a human being as well is we can have a list of all the things that we think we need in these circumstances to be happy. But if our thoughts and our feelings and our reactions to them aren't skillful, compassionate, wise, and respectful, we often create more suffering, and we're right back where we started. Now, I don't want it to be all doom and gloom, because the truth is, I'm bringing you some solutions here today—things that you can apply right away and put into practice, hopefully, as soon as you've listened to this podcast. Let's get to it. WHAT MAKES DISCOMFORT WORSE? First, I'm wondering whether we can first discuss what it means to make it worse because a lot of you go, "What? Make it worse? Are you telling me I'm to blame?" And that's not what I'm doing here. But I do think that we can do some kind of inquiry, nonjudgmental inquiry into how we respond to our suffering. LIFE IS 50/50 Think of it this way: I am a huge proponent of some Buddhist philosophy here, which is that suffering is a part of life. Discomfort is a part of life. I believe that life is 50/50. There is 50% wonderful, but you're still going to have 50% hard. Sometimes that percentage will be different, but I think it creates a lot of acceptance when we can come to the fact that there's going to be good seasons, but there's also going to be some really hard seasons in our lives. It doesn't have to be that it's 50/50 all the time. Sometimes you might be in a really wonderful season. Maybe you're in a really tough season right now. I'm guessing that's the case because you're listening to this episode. I recently went through a really tough season, which inspired me to make this episode for you. But in life, there is suffering. But what we know about that is how we respond to that suffering can actually determine whether we create more and more suffering. WE RESIST IT One way that we make it worse is, when we are experiencing discomfort, we resist it. We try to get rid of it. We clench up around it. We try to push it away. What often happens there is, what you resist persists. That's a common saying we use in psychotherapy. Another thing to consider here is, the more you try to push it down, the more it's going to bubble up anyway, but in ways that make you feel completely out of control, completely lost in this experience, and maybe overwhelmed with this experience. Another thing is, the more you resist it, the more you're feeding your brain a story that it's important and scary, which often means that it's going to send out more anxiety hormones when you have that situation come up again. That's one way we make it worse. WE JUDGE IT Another way we make it worse is, we judge it. When we have discomfort, we judge it by going, "This is wrong. This is bad. You're a bad person for having this discomfort. What's wrong with you for having this discomfort? It shouldn't be here." WE THROW "TANTRUMS" I've done a whole episode about this, and this is something that is my toxic trait, which is I go into this emotional tantrum in my head where I'm like, "This is bad. This is wrong. It shouldn't be happening. It shouldn't be this way. It should be this other way. It's not fair. I can't believe it's this way." I totally can catch myself going down a rabbit hole of judging the situation, the circumstance, and myself and my discomfort, which only creates more discomfort for myself. WE RUMINATE Another way we make things worse is rumination, which is similar to what I was just talking about. But rumination is, we try and solve things, we loop on them. Again, it could be a looping on, "Why is this happening? It shouldn't be happening," like I just explained. Or maybe it's trying to figure it out. Often, we ruminate on things that actually don't have a solution in the long run anyway. Maybe you have chronic pain. Let's say you do, and you're ruminating, "What could it be? Why is it there?" I mean, the truth is, we don't usually have a medical degree. Our rumination, it might feel productive, but we don't actually have the details to know the answer. Let's say something went wrong at work and you made a big mistake, and we ruminate about what we did, how bad it was, and how humiliating it was. But in that situation, we're trying to solve something that's already happened that we have no control over anymore. For people who have anxiety, maybe they're trying to ruminate, trying to solve whether bad things will happen in the future, but we all know we can't solve what's going to happen in the future. That's a dead end. That's a dead-end road, and it again creates more suffering on our part. WE PUNISH OURSELVES The next piece here is, we punish ourselves. We punish ourselves for having discomfort. We might withhold pleasure. We might treat ourselves poorly. We might not show up in ways that really honor our mental health and our self-care because we've made a mistake, we are going through a hard time, or we're having this uncomfortable experience. These things, while in the moment they feel warranted and they feel productive and effective, they're actually not. All they're doing is adding to the suffering you're already experiencing. For those of you who say, "Yeah, no, but I deserve to suffer more," that's actually not true either. We have to really catch that because punishing someone with this sort of very corporal punishment kind of method—or we need to beat you up—actually, we've got so much research to show it doesn't make you better. It doesn't prevent uncomfortable things from happening. It doesn't make it so that you don't make a mistake. You're a human being. We're all struggling. We're all doing the best we can, and we're not going to do it perfectly. HOW TO BE UNCOMFORTABLE, EFFECTIVELY & COMPASSIONATELY What can you do differently? Let's now talk about how we can be uncomfortable in an effective, productive, compassionate, and respectful way. For me, one of the first things that helps me is to really double down on my mindfulness practice. Sometimes the best thing you can do with mindfulness is to become aware that you're engaging in these behaviors, to catch them, and to label them when you are. It might be as simple as labeling it as "I'm in resistance." You might just say 'resistance' or 'rumination.' You're bringing to your mind and you're bringing to your attention that you're engaging in something that you've identified as not helpful. That in and of itself can be so helpful. Now, for those of you who are new to me, I have two episodes that I've done on this type of situation in the past. Number one was Episode 188, where I talked about how to tolerate uncomfortable sensations specifically. The other one is Episode 113, which is where we talk about specifically how to manage intrusive thoughts . You can go on there after you've listened to this, but stay with me here because I'm going to give you a little step-by-step process. MINDFULESS Number one, with mindfulness, we're going to identify and become aware that we're in resistance, that we're ruminating, that we're beating ourselves up, and we're also going to practice non-judgment as best as we can. Think of this like a muscle in your brain. You're going to practice strengthening that muscle. But once we are aware of it and once we've acknowledged that we're judging, we're then going to be aware of or bring our attention to where we are in resistance to allowing it to be there because that's ultimately a part of our work. Discomfort rises and falls so much faster when you do nothing about it. What I want to offer you is, the solution, in some way, can be quite simple, which is to do nothing about the discomfort except love it. Be careful and gentle with yourself. Do nothing at all about trying to make it go away. Do nothing at all about punishing yourself. NON-JUDGMENT The non-judgment piece is where we allow it to be there without making a meaning about it. Here's an example. You've had an intrusive thought that was really, really scary, and you wish you didn't have it. You actually are concerned about it. It alarmed you. What you can do is, in that moment, acknowledge that thoughts are thoughts. They're not facts. They don't mean anything. They're just sentences that our brains come up with. What we often do is, when we have it, we think, "What does that mean about me? Why am I having this thought? Why am I having this sensation? Why am I having this anxiety? Why am I having this anger? Why am I having this shame? Why am I anxious in this social situation? Why is this hard?" NOT OVER-IDENTIFYING What we want to come back to is not making meaning of it, not over-identifying with it and just acknowledging that this is a normal part of human life. This is a normal part of being a human. We all have intrusive thoughts. We all have strong emotions, some more than others. But if you're someone who has strong emotions more than you maybe think others are, there's a couple of things I want you to remember. Number one, we actually don't know how other people are doing, so you can't actually say that they're not having these emotions. Maybe they are. Often, people will say to me, "You always seem so calm." I'm like, "Oh, you have no idea." Like, yeah, I am calm in many situations, but it doesn't mean I don't have anxiety about certain things or big, big, big emotions about certain things. You just don't see it. You don't see it on the camera; you don't see it in the podcast. You don't see it in my daily life. It's at home in my mind when I'm experiencing it as I'm regulating. But we want to work at not over-identifying with "What does it mean about me" and that "I'm bad for having these experiences." One thing you must take away, and I say it quite often, is there is no thought, feeling, sensation, urge, or image that makes you bad. The meditation vault , which we just launched, is an online vault, a collection of meditations for people with sticky thoughts, intrusive thoughts, anxiety, and so forth. They're very, very specific in almost every single one. I work at getting them to not overidentify with the experience they're having. Oh, you're having an intrusive thought. Let's not make meaning of what that means about you. Oh, you're having shame. Your shame is telling you that you're bad. Let's not agree with it. Let's acknowledge that it is a thought and a feeling, but it's not a fact about you. You've made a mistake; you failed. Okay, we can acknowledge that, but that doesn't make you a failure. We want to catch over-identifying with what our discomfort is experiencing and how we're experiencing that discomfort. The over-identification, the labeling, and the making meaning often is what contribute to us feeling double the discomfort. MAKE SPACE FOR THE DISCOMFORT The next thing you want to do is make space for the discomfort. My clients roll their eyes because they know I'm going to say it. I'm going to say, "Why can't we make some space for this emotion," or "Would you be willing to make some space for this emotion as it rises and falls?" If we make space for it to be here while we go about our day, while you interact with your child or your loved one, or your client, or your employer or your employee—if we can just make space for it to be there, nonjudgmentally, it tends to be less loud. BE WILLING TO BE UNCOMFORTABLE The whole point of the work that I do here with my patients and with you is to nurture a sense of you having any emotion, any feeling, or any discomfort in a safe way, in a way where you make space for it. I often will say, we want to work towards you being able to have any thought, feeling, sensation, urge, or image so that you know that there's nothing you can't handle. If you're really willing to feel it all, if you're really willing and have practiced giving yourself permission to feel all the discomfort, there's very little that can be painful for you. There's very little that can stump you. There's very little that can hold you back. Often, when people ask me, "How do you do what you do? You spend all day with clients who are suffering, and you're in the suffering with them. And then you get online and do these videos, or you do social media. How do you do all that?" The only reason, there's nothing special about me, truly. The only thing about me is I'm willing to feel a lot of discomfort. I really am. The more I practice having it, the more I feel empowered that I can handle anything. Confidence to do things isn't something you just learn and have; you get it by feeling feelings. Having them willingly and making space for them—truly, this is the work. If there's really anything I've learned, it's that—we have to be better at making space and feeling our feelings and having the discomfort and saying, "Great, this is a wonderful opportunity for me to practice being uncomfortable." If something gets thrown out of whack this week for you, I urge you to say, "Okay, good. This is another great opportunity for me to practice being uncomfortable. Where do I notice my resistance to being uncomfortable? Where do I notice the judgment? Where do I notice that I overidentify with it? Where do I notice that I'm punishing myself for it?" Okay, good. Now that we know, we're aware, and we're non-judgmental, let's use this as an opportunity to be able to feel any experience that comes up. Things get a whole lot less scary if you've already practiced feeling your feelings. FEEL YOUR FEELINGS I actually did a whole podcast on that as well. It's Episode 65, where I talk about how your feelings are meant for feelings. That's another resource if you want to jump into that kind of topic as well. But then once you've done all that—we've done this zooming in and now we zoom out—then you move on with your day. You don't just sit there and feel your feelings and sit on the couch and stare at the floor going, "I'm feeling my feelings. I'm feeling my feelings. Here they are." That's fine if that's what you feel right about. But ideally, you would take the feelings with you and go mow the lawn or do the things you love or do the things that you need to get done today, your chores or whatever that might be. But take this practice with you, because if you can get good at feeling discomfort, then you can marry that skill. It's a skill. It's not something that you were born with; it's something that you can learn to do. But once you get good at that, then you can marry it with, "Now I'm going to go live my life while I use that skill." And then you 10x your life, truly, 10x your ability. You're still going to be uncomfortable. You're still going to have hard days. You're still going to have some discomfort, but your experience of it will not be one of, "Oh no, geez, I hope it goes away. I hope it's not strong today. I hope it doesn't stay all day because it really messes me up." It won't be like that. You'll be like, "It doesn't matter. I know it's here, and I'm going to be here with it, and I'm going to make space for it. I'm going to be kind. I'm going to be non-judgmental about it. But it can come. I've done it as much." One thing I did learn, and I'll use this as an example, is I used to have the most excruciating sleep anxiety. I used to worry about not sleeping. Because if I didn't sleep, I'd have massive anxiety. The next day, I'd be teary. I just couldn't function well. As I got pregnant and went to have my first child, I was so worried about how my mental health would go. Don't get me wrong; not having sleep did impact my mental health for sure. But getting less sleep and having to get up and take care of a baby, and then having to get up and go to work once I'm done with maternity leave, and learning that I can actually get through a day, using my skills, seeing my patients, and managing my emotions, a lot of my sleep anxiety went away because all I could think of was that I've done worse. I've literally gone a night where I slept for 25 minutes and I still was able to cope. Even if I can't fall asleep tonight, I know I can handle it. That empowerment is gold. That change in perspective. That attitude shift about discomfort is a game changer. Now, of course, you know what I'm going to say. This has to be done with an immense degree of compassion. This has to be done in small, baby steps. I'm not here to tell you to throw yourself into 10 out of 10 discomfort, but if you have to, I still trust and believe wholeheartedly that you can still handle it. I always say to my patients, no one has ever died from discomfort itself. It won't kill you. It's just going to be really hard. We can practice holding ourselves kindly as best as we can as we ride that wave. That's the work. A RECAP: BRING ON THE DISCOMFORT To recap, what makes it worse? Discomfort and uncomfortability get worse when we do anything to try and make it go away. We won't resist it with this urgency to get it go away. But the solution is acceptance, willingness, non-judgment, compassion, making space for it, and then engaging with your life. Again, I'll say it again. The solution is accepting the discomfort. Willingness is the willingness to be uncomfortable. The non-judgment of being uncomfortable. It's neither good nor bad; it's neutral. It is still uncomfortable, but it doesn't mean you are bad or it's bad. We're going to be self-compassionate as we feel this uncomfortable feeling. And then we're going to keep making space and moving back into our lives, doing maybe baby steps at a time. Even if you do this for 10 seconds, I applaud you. Let's celebrate you. If you do it for 30 seconds and you're able to do that multiple times a day, you are on the right track. If you can be uncomfortable for three minutes at a time, you're basically winning at life. I want to encourage you, this is huge. Sometimes, when things are really hard at the Quinlan household and I want to scream, yell, or totally do something that I know I will regret, stopping and saying, "Okay, this is discomfort. Can you stay with it? Can you make space for this for three minutes or 30 seconds," has given me an opportunity to not say things I don't mean, to not react in ways that will end up causing me more suffering that keep me in line with my values. This ability to be uncomfortable has saved me from making some big mistakes in my life. Not all of them. I've still made mistakes, of course, but relationally, huge mistakes I could have made had I not slowed down and made a little space for the fact that I'm angry. "Okay, I'm going to make space for this anger," or that I'm hurt, or that I'm really anxious. There's been times where I've wanted to run away from my anxiety, but my ability to, for 30 seconds at a time or 10 minutes at a time, make space for the anxiety, not judge it, allow it, and bring it on has meant that I've been able to face some really scary things, and that's what I want for you. That's how you're uncomfortable. Is it easy? No way is not easy. Is it doable? Absolutely. I want to remind you, this is a practice in which you can grow. Before you know it, there will be these moments of empowerment that will shock you, and you can't believe that you've made these changes out of nowhere. I fully and wholeheartedly believe that. I've heard it from so many patients and so many students. A lot of you have also shared how helpful it's been. That is why I say it's a beautiful day to do hard things, because when we do hard things in a very skilled way, they actually make us feel really empowered, and we have a sense of "I can handle things now." All right. It's a beautiful day to do hard things. Again, please go to CBT School if you're interested in any of our online courses. They talk about all these kinds of things. We have courses for OCD, anxiety, depression, BFRBs, meditation, mindfulness, time management—the whole deal. My hope is that this type of message can be taken in any area of your life, and hopefully, it makes it so much better. Have a great day.

Oct 27, 2023

In today's episode of Your Anxiety Toolkit podcast, you will learn how to meditate to reduce anxiety. You'll also learn which meditation is best for anxiety and how to find a meditation practice that suits your lifestyle and your recovery needs. With the pressure of today's society and the news being so scary, people are rapidly turning to meditation as a powerful tool to calm their minds and ease their anxiety. My name is Kimberley Quinlan . I am a licensed therapist and anxiety specialist, and my hope today is to teach you how you can use meditation to help manage and reduce your anxiety. What Is Meditation? Now, what is meditation? Meditation is a training in awareness, and the goal is to help you get a healthy awareness and understanding of what is going on in your mind. So often, our minds are like a puppy. They are just going all over the place, jumping, skipping, yelling, screaming, and going in all different directions. If we aren't skilled, and if we aren't intentional with that, we can be off with that, off down the track in negative thinking, scary thinking, and depressive thinking. The Benefits Of Meditation For Anxiety Relief There are many benefits of meditation for anxiety relief. Meditation helps train your brain. Now, there are so many benefits to meditation for anxiety relief, and I want to share with you some of those benefits. The first one is, it rewires your brain. It reduces the activity in the amygdala, which is the part of the brain that is responsible for the fear response. Meditation can also lower stress hormones such as cortisol. It can increase the production of those feel-good neurotransmitters like serotonin and dopamine. This is really important, particularly if you struggle with depression. It can also shift the brain chemistry and lead to improved mood, reduced anxiety, and an overall sense of well-being. We could also argue that this would be helpful for anybody, even if they don't have anxiety. We also know that meditation cultivates mindfulness, which we talk a lot about here on Your Anxiety Toolkit, which is the practice of being fully present and nonjudgmental in the moment. Meditation increases self-compassion and acceptance, which I think we all agree can help us with our mental health, and it helps reduce negative thinking patterns and also reduces self-criticism. Common Problems People Have With Meditation Now, there are a couple of problems here, though, with meditation. Often, when people come to me, they'll say, "I don't know about this whole meditation thing. It sounds a bit like a cult or a bit like a scam or a fad, a psychology fad." Often, that's because people have a misled idea about what meditation is and how it works. One of the main problems that I hear is that people expect that meditation will, poof, make their anxiety go right away. As they're practicing meditation—and it is a meditation practice—as they're starting to practice this meditation, they're getting frustrated because they're thinking, "This isn't working. It's not making my anxiety go away." We want to first challenge the idea that meditation is not a quick fix. It's not something that's going to, poof, make your anxiety go away, but there are so many benefits that I will talk to you about here in just a second. Another problem that people have with meditation is they get frustrated with the practice. They have these expectations that they should be able to do it. Well, simply because it's often sitting or very stationary, they assume, "I must be really good at this. It's such a basic task." But the truth is, it's not. We have to remove those expectations that we will be excellent at it, that it should be easy, or that discomfort won't arise. Another problem people have is that they do experience anxiety while they're meditating, and they'll say, "I'm here to get away from my anxiety, but when I'm meditating, everything is still, and I actually feel more anxious." We'll talk about that here in just a second. People also don't like meditation because they have been told that the solution to anxiety is to make it go away. And so, what would this mindfulness meditation practice really do if we're actually just sitting there thinking? What a waste of time, actually putting more focus on the actual problem of anxiety. Again, not true, but these are the common problems people have. The last one is, people say, "I don't have time for meditation." I always laugh because I do know that the Dalai Lama said, "For those who don't have time to meditate, they're the ones who need to meditate twice as long." That always made me laugh because there's been many times where I've said, "Oh, I don't have time today," and I laughed thinking, okay, even more important that these are the days that I focus on meditation. Which Meditation Is Best For Anxiety? Let's talk about which meditation is best for anxiety, because I know you're here to talk about how meditation can help with your anxiety. Now, there are many types of meditation. No one really agrees what the best one is, and no one really even agrees on the specific types because there are so many and so many modifications. But here are some options—we will also talk about later how to apply these to your anxiety disorder—that you may want to consider. VIPASSANA MEDITATION The first one is mindfulness, or what we call Vipassana meditation. Now, this is a meditation that really helps you become skillful in how you respond to your intrusive thoughts, your feelings, and your sensations. BODY SCAN MEDITATION Another type of meditation is body scan meditation. This is very body- and somatic-centered in that we're focusing on different parts of the body, often with some kind of relaxation technique to slowly move down the body and move us into a place of relaxation. Now, there are pros and cons to this meditation. Some people find it very relaxing, especially when we're looking at getting sleep. Others find that, again, their expectations are very high, and then they get quite frustrated when they're unable to get relaxed, because the truth is, when we're anxious, when that amygdala is firing in our brain, it is really hard to relax. Sometimes meditation in and of itself is not going to fix that. But a body scan meditation is a really effective one, particularly if you're trying to slow down the nervous system. Maybe look at trying to get some sleep, a nap, or some rest. VISUALIZATION MEDITATION Another type of meditation is visualization meditation. This is where you actually visualize something happening to you. Maybe you're walking along a path or along a beach. You're in a relaxed setting. Let's say you're an athlete. It might be visualizing you doing the activity, the exercise, or the skill that you're practicing—a layup for basketball, running a marathon, or so forth. The visualization can help with empowerment. It can help promote creativity. It can help create a sense of mastery over something that you haven't yet mastered. WALKING MEDITATION Another type of meditation is walking meditation. This is a great one, particularly if you're someone who is very sedentary during your work. I am one of those people. I sit a lot during my day. Walking meditation is similar to mindfulness meditation in that you're very aware of the present moment, what it feels like for your feet to touch the ground, for the balls of your feet to touch the ground compared to the heel of your feet, what it feels like for the wind to blow on your face, or what it feels like for the weight balance, going from left foot to right foot, and so forth. SELF-INQUIRY MEDITATION Another type of meditation practice is self-inquiry meditation. This often involves inquiry or curiosity to who I am in this moment. It might be, who am I as I hear these sounds? Who am I when I have these thoughts? There are some pros and cons to this for those with anxiety. Sometimes, when we have anxiety, we already spend a lot of time doing a lot of self-inquiry or self-rumination about who we are. What's our identity? Are we good? Are we bad? This type of meditation can be beneficial for some, but for many people with anxiety, they may find it not helpful at all unless they're with someone who can very much direct them and keep them on track with the active inquiry instead of going into rumination. MANTRA MEDITATION Another type of meditation is mantra meditation. This is where you repeat a mantra, a phrase, or a sound over and over again. It's about the training of the mind and the training of discipline for one specific sound, tone, or word. It can be very helpful, again, if there's a particular intention you're trying to go towards. But again, for those folks with anxiety, this can be very frustrating because, again, there's sort of this attachment and expectation and clinging to a certain outcome. For those of us who have anxiety, that can actually create a lot of distress in our bodies. Not to say that any of these are bad or good; it's just dependent on your specific set of situations. LOVING KINDNESS MEDITATION One that I always love and talk about all the time is loving-kindness meditation. This is an act of compassion where you send yourself others and all sentient beings loving kindness and care. It is a way of generating, practicing, and nurturing self-compassion. It is a beautiful way to be in connection with people out in the world that maybe we don't have a connection with, particularly if we're lonely or feeling isolated and alone. Loving-kindness meditation can be so beneficial to people with anxiety or depression, OCD, health anxiety, and so forth if they're feeling so alone and they're really very hard on themselves. Loving kindness is absolutely a beautiful meditation for people with anxiety. ZAZEN MEDITATION Another type of meditation is zazen meditation, which is a specific zen meditation where the goal is to be focused on a direct experience of this present moment. The main goal is non-attachment. The goal is to allow everything to be just as it is. It's a very disciplined practice, but can be very beneficial to people who have anxiety. BREATHE MEDITATION The last two: number one, breath meditation where you focus on the breath and you have that as your focal point. This is very beneficial for people with anxiety. The only thing I would say is, for those who have somatic obsessions of a specific type of OCD, if your somatic obsession is already focused on the breath, we actually then wouldn't practice this because it would actually add to their hyper-awareness. But overall, breath meditation is a very beneficial practice for people with anxiety. SOUND MEDITATION And the last one is a sound meditation. This is where your focal point is on sound. Very beneficial for those with somatic obsession and very beneficial for people who really like the vibration of sound and really love music, and music is something that grounds them, lifts them up, motivates them, and so forth. There are different types of meditations and some pros and cons, but there are some specific things I want you to know and remember as you start a meditation practice and while meditating, because so many people have come to me to say, "I don't like meditating. It doesn't help me. Therefore, I'm not going to do it." I feel that that is such a shame because meditation can be such a powerful mental health practice. It can be such powerful training for the brain. I often say to my clients, when you start to notice some tightness in your knee or some shoulder pain, you don't just ignore it. You think, okay, I have an opportunity to strengthen that muscle around the knee or stretch out that shoulder. We usually move in and do some work, exercises, and practices to create an environment where that pain can go away. I think of meditation as being exactly that. It's like physical therapy for the brain, and it can help. Like I talked about, there are so many benefits to meditation, but it does require that we do it specifically in a way that doesn't make more anxiety. Now I have a really exciting thing I want to mention to you before I get into all the things I want you to remember as you move into your meditation practice. Because so many people have come to me and said that they've listened to meditations online, they've gone to meditation trainings, and they actually found it to be not helpful for their anxiety, for their intrusive thoughts, or for their depression. I have created an online meditation vault specifically for those who have anxiety and repetitive intrusive thoughts. My goal with this meditation vault is to make it very informative for the person who struggles with high expectations and rapid, repetitive intrusive thoughts, and I try to bring that concept into the meditations so they're specific for people with anxiety. There are over 28 meditations. There are specific meditations for people with OCD , health anxiety, social anxiety, panic, generalized anxiety, and depression. There are meditations on sleep, meditations on compassion , meditations on mindfulness, and meditations on strong emotions like guilt and shame. I did my best to pack them all into one specific place so that you have a wide range of guided meditations specifically for whatever it is that you need. There's even a meditation for people who don't want to meditate. I felt that that was really, really important. You can click the link in the show notes below if you're interested. You can also go to CBTSchool.com to get information about the vault. It is very low-cost. I want it to be low-cost so everyone can access it, and I'm so excited for you guys to check that out. How To Meditate To Reduce Anxiety If you are wondering how to meditate to reduce anxiety, there are things you need to remember as you practice meditation. Do not expect anxiety to magically disappear. Number one, if that were to happen, it probably wouldn't be for very long anyway. I want you to imagine this practice as the slow and steady growth of a muscle. If you were going to train at the gym, you wouldn't go straight in and pick up a hundred pounds right away. You would start low; 10, 15, maybe 10 to 12 and a half, then to 15, and you would slowly work your way up. You wouldn't have these expectations that your body would be able to pick up a hundred pounds at a time without pain afterwards. You would go in knowing that the cost of this is going to be that I may get pain if I overdo it, and I want you to think about that with your meditation practice as well. Not that you'll have pain, but that it's healthy to take baby steps and do it slowly and steadily. Another thing I want you to think about is, again, to think of this as an opportunity to change the way your brain responds to anxiety. Think of this as an opportunity to change how you respond to discomfort, how you act in your daily life, and how you can change your habits to benefit your mental health. How Long Does It Take For Meditation To Reduce Anxiety And Stress? Often, people will ask: how long does it take for meditation to reduce anxiety and stress? The answer here is very simple, which is, let's not put pressure on that to be the outcome. I know you came here to learn that exact answer, but the thing to remember here is, the more we resist anxiety, the more we want it to go away, the more we try and avoid it, the more we're feeding to our brain that it's dangerous and scary, and it will make our brain send out more stress hormones. We want to use meditation as an opportunity to train our brains that we are no longer going to run away from anxiety and stress. Instead, we're going to open up a space for anxiety and stress and have it be a safe place. Have our bodies and our minds be a safe place for anxiety to rise and fall. It's important that we understand that this, again, is an opportunity for you to change your specific emotional reaction to having anxiety and stress. Now that being said, I will still answer the question, which is, I think within time, you will probably see a very significant improvement. Most research shows that a short meditation practice of four to six weeks will significantly reduce people's stress and significantly improve people's relationship with their anxiety. I often say to my patients, give it 30 days. Go in with a solid commitment to practicing as often as you can for 30 days. Track your anxiety; maybe even put it on a scale from 1 to 10. If you're able to do it in this way, where you're not trying to get rid of anxiety but instead trying to make it a place where you can have anxiety and not respond with judgment, criticism, and resistance, you'll probably find that you'll have significantly reduced levels of anxiety and stress after 30 days. Now, again, I want to emphasize that there is significant research to show that meditation for stress is very beneficial. In fact, we've found that practicing meditation again downregulates your stress response. It reduces your nervous system's activity and reactivity to stressful events in your life and can greatly benefit your overall well-being. Definitely, if you're someone who's struggling with a very stressful time, and I think we all are given that the news is so, so painful right now, I think it's a beautiful opportunity for us to start a meditation practice. Another thing I want you to remember here is that by practicing meditation, you widen your window of tolerance. Now, what does this mean? I've talked about it on the podcast before. If your window of tolerance is very narrow, it means, as soon as you have any kind of strong emotion, strong experience, sensation, or pain in your body because you haven't practiced being able to tolerate that, you are very much more likely to rely on unhelpful safety behaviors to cope with that distress. In discomfort, as I mentioned, we actually widen our window of tolerance. The wider we can have this window of tolerance, the more likely we are to be regulated when we have a lot of emotions. We can be steady and really intentional in how we respond. We are more likely to act according to our values than according to our fears. So we want to practice widening that window of tolerance. There is so much benefit to doing that. Another thing to remember, and I've mentioned this already, but I think it's really important as we finish up, is to not put pressure on yourself to get this right. I will often say to clients, and I say it all the time in the meditation vault over and over again, expect anxiety to show up over and over again. Expect your mind to go off track and go off and think about the grocery list. Your job is to bring it back to the present moment. Don't be upset with your brain for going off track. That's its job. Its job is to be highly functioning and thinking about all the things. But the training and the benefit is that discipline to bring you back to the focal point that you're on right now, depending on the type of meditation that you're doing. I hope that you can practice letting meditation be messy, because it is. Even very, very skilled monks who practice meditation for hours a day still report that there are days when meditation is messy. There are days when your brain will be all over the place like that puppy dog, but with practice, you will start to see an improvement in your ability to be disciplined and intentional with where you put your attention, which again, as I mentioned, reduces the chances of you engaging in safety behaviors that aren't helpful, reduces the chances of you engaging in compulsions, and reduces your chances of going back down into those negative thought processes. There are so many benefits. The last thing I want you to remember is, as you begin this practice, be curious. Be open. Instead of being judgmental and rigid about what you think will happen, be curious about what might come from inquiring and moving into this practice. Meditation has changed my life. It has calmed me in the darkest hour. It has been there for me when I needed support, and I hadn't had anybody else to lean on. Meditation, as I mentioned, is a practice where you teach yourself to be a safe place for you to experience any emotion at all, and you know that it's there; you can take it with you wherever you're at. It costs nothing to practice meditation in the moment, and I hope that it's something that will bring you as much joy and as much wellness as it has for me. Have a wonderful day, everybody. As always, it is a beautiful day to do hard things. Again, if you're interested in the mindfulness meditation vault , you can click the link in the show notes. Have a wonderful day.

Oct 20, 2023

If you are scared to take medication, you are in the right place. Today, we are going to take a deep dive into a very common fear that impacts many people and their recovery, and that is the fear of taking medication. If you're someone who needs help with this, I think this is going to be really helpful for you. Hello, my name is Kimberley Quinlan. I am an anxiety specialist, and I help people with anxiety. My hope is to make it an easy and a kind recovery for you. FEAR OR TAKING MEDICATION Now, today we're talking about the fear of taking medication, and a lot of what I do with my patients in my private practice, which is in California, is really helping them work through that fear. In addition, on my online platform called CBT School , I often get a lot of questions about this, such as whether or not people can take meds, should they take meds, and so forth. But before we get into all that, what I want to share with you first are a few housekeeping points that will keep us on point and in the right direction today. If you're someone who is scared to take meds, we first have to acknowledge that this episode is not going to cover whether you should take meds or not. I am not a medical doctor. I am not a medical professional. I am a mental health professional, and I do not prescribe medication. I am not licensed to do that. But I am here to help you manage the fear around it. If you are someone who wants to take medication but is afraid of it because of the side effects, or maybe because of the shame, the guilt, and the stigma around it, my hope today is that we can work on managing that fear and getting you the information and skills you need so that you can speak with your medical professionals and make a decision based on what is best for you. It is important to remember that every person is different, and it's important that you make these decisions with your medical doctor so that we're making a decision based on your medical history, where you're at in your mental health recovery, your genetics—all of the things that you need to discuss with your medical doctor. But today, let's get going. We're talking about managing medication anxiety. Where did this episode come from? I actually made a post about this on Instagram not long ago, and the response was overwhelming, with people saying, number one, "I'm too afraid to do it. Help me," and number two, a lot of people said, "I had a lot of anxiety around taking medication. I got the help I needed and I managed it, and now I'm so relieved that I did." I wanted to spend some time today talking about the reasons people are scared to take an antidepressant or other psychiatric medications or even medications in general. REASONS PEOPLE A SCARED TO TAKE AN ANTIDEPRESSANT OR OTHER PSYCHIATRIC MEDICATIONS There are multiple reasons patients do not take their medications , due to fear. In this episode, we are coming the core reasons fears stops people from taking their antidepressants or other medicines. FEAR THAT MEDICATION WILL CAUSE SIDE EFFECTS The number one reason that people reported being scared to take medication is the fear that medication will cause side effects. This is a very common fear around taking medication, and it is true. We will talk about the side effects here later in this episode, but that is a valid concern. But often, people are afraid of the side effects, even though they are not afraid of it being a catastrophic side effect. They're often afraid of just change, or they're afraid of what is uncertain and unknown, and that is a big thing for them. OCD FEAR OF TAKING MEDICATION Another reason that people are afraid to take any kind of medication is an OCD fear of taking medication . The reason I say it like that is, it's beyond just a generalized fear of the side effects. It's often around a belief of what this medication will do to you. One example I've had in my private practice has been the subtype of OCD called emotional contamination . They're afraid that by taking the medication, it will dramatically change their personality or that they'll turn into a different person. There's a lot of compulsions around that, rumination around that, and avoidance around that. They're also doing this kind of avoidant compulsions in other areas of their lives as well. HEALTH ANXIETY: WHAT IF MEDICATION CAUSES AN ILLNESS Another OCD fear of taking medication is under the umbrella of health anxiety. A lot of people are afraid that the side effects will be catastrophic, that it will give them some catastrophic medical condition if they were to take this psychiatric drug or any medication in general. PHARMACOPHOBIA (PHOBIA OF DRUGS AND ALCOHOL) Now, in addition to that, there is actually a specific medication phobia called pharmacophobia , which is a phobia of drugs and alcohol. This is a specific phobia where people are afraid of any and all drugs. Often, in this case, they're afraid to take headache medication or allergy medication. They're even afraid to look at pills for reasons that could be plentiful. It could be a learned behavior around medication, particularly if they've heard stories of people who have misused drugs and bad things that have happened. That is another reason why people are often scared to take meds. FEAR OF MEDICATION SEXUAL SIDE EFFECTS Another common fear, as we've already discussed, is fear of medication's sexual side effects. Now, for those of you who have a specific fear around the side effects, you have a valid concern. There are some medications that do cause sexual side effects, and we did an entire episode on Your Anxiety Toolkit talking specifically about the sexual side effects of anxiety medications . We had a psychiatrist come on and speak about this. It's episode 332, and I will link to it in the show notes if your interest is specifically more in-depth information about that. But I will also give some tips and tools to use around that later on here in this episode. I AM ASHAMED TO NEED MEDICATION (MEDICATION STIGMA) Another fear around taking medication includes the fear of being ashamed or the fear that you're weak or that you're stigmatized for taking medication. This is a really, really big one. A lot of people feel that they are weak, faulty, or wrong for needing medication. Now, this is where I slow down and get very transparent. I am very comfortable sharing that I take medication for anxiety. I have, through different stages of my life, needed to take medication for this, and I'm an anxiety specialist, guys. I want to tell you that, not because I want to make this about me, but because I want to share with you that you can have all the tools and skills, and they really do work. Research does show that if you were to compare medication and CBT, especially for anxiety disorders, Cognitive Behavioral Therapy is actually the number one way to get recovery from these anxiety disorders. But even better than that, the research shows that combining medication and cognitive behavioral therapy is the gold standard. And so, if you're really struggling, by combining these, this is where you can get massive help with your mental health struggle. Again, I want to really share with you that even though I have the skills and the tools, I take medication. There's no shame in that. A lot of times, we often will compare that you wouldn't feel ashamed for taking diabetic medication. You wouldn't feel ashamed if you needed medication for another medical condition. There is no shame, no guilt, and no stigma that I want you to take away from this episode from taking medication. Now, I want to also validate, yes, there is still a stigma. There will be some people out there who may even respond to this episode by saying, "You shouldn't take meds, and you should try this other treatment," and so forth. That's still going to be there. But I want to offer you a degree of compassion and a degree of education that there is absolutely nothing wrong with you if you want to take medication or need to take medication. FEAR THAT I WILL BECOME ADDICTED TO MEDICATION Last, the fear about taking drugs is the concern that the medication will be addictive or that the person will become reliant on the medication. We'll talk about that here in just a little bit, but the one thing I want to mention here is, if you are in contact with your doctor—you're being constantly followed by your doctor and checked in by your doctor—you can bring up these concerns with them, and they can help determine that. Again, each of the questions you have, you should go to your doctor and bring it up because if you do have a history or if, in generations above you, you have a history of addiction, then absolutely bring that up to your doctor and they can help make decisions around different medications that can help prevent that for you. MANAGING MEDICATION ANXIETY (SKILLS & STRATEGIES) Now let's go into managing medication anxiety. This is where the good stuff comes in. Number one is, I want you to prioritize finding a skilled and trustworthy psychiatrist or medical professional. It doesn't have to be a psychiatrist. In fact, there are other people who can help prescribe your medication, whether it be your pediatrician, your medical doctor, or your intern. It could be a nurse. There are psychiatric nurses who can prescribe medication. You want to find somebody who's going to slow down, take their time with you, not just push you through really fast, and answer your specific questions. Now, when it comes to managing anxiety, OCD , or health anxiety, we usually discourage asking compulsive questions, repetitive questions, or going overboard with the questions. But I do think that it's important that you give yourself permission and honor your need to ask the questions that you have about the medications you want to go on. That will help you understand the medication, understand the side effects, and understand the pros and cons so you can make an informed decision. As we've said before, we want to understand questions about side effects , sexual side effects, addiction, how long you should be on medications, and what specific side effects you should be looking out for. We want to understand this. We want to know what the norm is for these medications on what it would look like, how fast you can see results, and what this process is going to look like. Don't be afraid to ask lots of questions. Now, if you have OCD fear of taking medication or pharmacophobia, a thing you might want to consider is finding an ERP therapist. I've had a lot of clients come to me who have consulted with their doctor, and they've agreed that medication would be helpful for their recovery and that they required some mental health advice in moving in that direction. What we did is either start by just looking at pictures of medication or we might fill the prescription of the med that they need to take and just have it with them, hold the medication, put it in their hand, smell the medication, and take one with the care and following of a medical professional. Start that process by slowly exposing them and practicing being around that medication to start with. If you are someone who's struggling in that area, absolutely consider seeking out an ERP therapist ( exposure and response prevention ) who can help manage all of that as we go and help with the response prevention piece. Because remember, exposure is not the main work; it's also catching any compulsions that you're doing around the medication. Maybe you're doing a lot of compulsive checking with the medication and so forth. Another thing I want you to think about is being able to challenge your faulty thoughts and beliefs about the medication. As we talked about before, with those reasons that people are afraid, there is often a lot of faulty, catastrophic thinking around medication. Ones that are common that I see with my patients are, "I won't be able to handle the side effects." Let's say a common side effect for a medication might be some nausea. Then we will say, "Okay, let's talk about your ability to handle nausea. Have you handled nausea in the past?" Let's say it's headaches. "Okay, what could you do if those headaches were to appear? How might you speak with your doctor about those? How might you be able to plan for that?" Maybe it's like, "What if I have a panic attack if I take the medication?" "Okay, let's talk about some skills and talk about challenging your ability to manage the anxiety that you feel." A lot of people say, "I already have a lot of anxiety. I don't want to do things that create more anxiety." Again, we'll say, "Are you willing to tolerate that anxiety? What are you telling yourself about your own mastery of riding waves of discomfort and so forth?" If you have, let's say, emetophobia, the fear of nausea and vomiting, "What do we believe about vomit? Do you believe that you can't handle that?" And again, you may need to defer to an ERP therapist to help you if you have emetophobia, the fear of vomiting and nausea, to help you manage that so that you can take the medications if that's something you're wanting to do. We do want to challenge faulty thoughts, and we want to challenge faulty beliefs about medication. Again, here is where I get really, really passionate about saying: There is absolutely no shame in taking medication. Taking medication does not mean you're weak, does not mean you're lazy. It doesn't mean you're doing anything wrong. It doesn't mean that you're never going to get better, and it doesn't mean you need to be on it forever. Again, we're here to encourage you to consult with your medical doctor and be flexible with your recovery. Now, being flexible is so important here. So often, patients of mine will say, "But what if I don't like the medication? What if I get on it and I really don't like it, or it makes me feel terrible and I can't function?" Well, okay, we'll cross that bridge when we get there. We're going to be flexible with this. We don't have to stay on it forever. Once you get on it, if then there is an issue, we will address that issue. Then we're not going to spend time before taking the medication trying to troubleshoot all the possible catastrophes and scenarios. We're only going to take one day at a time, and with each day, we're going to make measured, skillful, and wise decisions based on the actual events of that day, not on the possible scenarios that may happen, that may be catastrophic that haven't happened yet. So often, people who have a fear of medication are responding to things that haven't even happened yet. I know when I got POTS (postural orthostatic tachycardia syndrome), I was not functioning, my anxiety was through the roof, I was depressed, and the doctors strongly advised me to take medication. A big part of me was absolutely like, "What if this makes it worse?" and all these things. I had to just say, "Kimberley, be present. Stay with what's happening today, and we will address that as it goes. We'll cross that bridge when that happens. If that does happen, we will speak with a medical professional. We will take one step at a time and we will do what we need to do." We want to catch that anticipatory anxiety about medications and the anticipatory anxiety about the side effects. It's very, very important that we catch and manage that as we go. Another thing to remember here is, you have to be willing to have side effects. As you go on medication, you have to be willing to feel some feelings that may be uncomfortable. As I mentioned, common side effects: headaches, nausea, tiredness, maybe a little jittery, and so forth. Again, I want to keep prefacing: please speak to your medical professional about the side effects because each medication is different. But be willing to have side effects. Again, being flexible, knowing that if this medication doesn't work for me, we can try something else. I know for me personally, I had to try five medications before I found one that fit me. Five. It took a long time. I had to taper up and then I had to taper down, and I had to try another one, which brings me to the next skill I want you to practice, which is patience. I just kept honoring my own needs and said, "I'm going to be patient with this process." A lot of my patients have found one medication that was prescribed by their medical professional and found that it was great. It's worked for them straight away. But we want to be patient, and we want to be willing to have a lot of different sensations. I'm not saying you will, but we want to be willing. I actually have a whole other episode on Your Anxiety Toolkit called How to Have Uncomfortable Sensations. If you're struggling with that, that may be a good resource for you to use as you go through this process as well. Now, if you have, or if you're afraid of sexual side effects, again, I talked about listening to that episode, but I will also say one thing that they did say in that episode: It is okay to seek out a sex therapist or try other skills, such as a skill called sensate focus, or speak to your medical professional about that. Now, there are a lot of meds that do not have sexual side effects. If that's something that is a concern for you, please mention that when you're seeing your psychiatrist or your medical professionals so that they can pick a medication that will reduce the likelihood of that. Again, we don't want to catastrophize about potential problems that haven't happened, but it is okay to bring that up if that's important to you. Now, of all the things and skills I'm going to give you today, the one thing I really want to emphasize is, please give yourself lots of space and lots of permission to rest during this process as you begin medication. I remember when I first went on medications, my mom actually said to me, "Hun, why don't you just use this time? Thin out your schedule and give yourself lots of time to rest. If you do have side effects, then you won't be overwhelmed with trying to work and push through." Any way you can during this process, take as much help as you can, whether that be neighbors helping you pick up the kids, grocery delivery, whether it be you don't clean the house this week and you just let things sort of slide a little. You let your colleagues, your teacher, or your coworkers know that you've started a medication and that you might be feeling well. Take as much space and take as much care as you can as you start this process. It is scary. It is anxiety-provoking. I'm not here to tell you that it won't be, but what I am here to say is we can do hard things. How can we support you as you make this value-based decision? How can you find help, support, and care as you lead forward with your values? You're not letting fear stop you anymore. You're doing the hard thing. You're taking the step for your long-term recovery, even though it's the hard one. How can we be very kind, compassionate, and effective moving forward as you move through this process? The next tool I want you to think about is being mindful around the side effects. What I mean by that is, when we do have side effects, we can be non-judgmental, we can stay present, and we can stay in non-resistance to that side effect if you have any. What we know here is, research does show that mindfulness practice does reduce people's experience of suffering. What we mean by that is, if you're suffering, your experience of it could be, "This is very, very bad," or your experience could be, "This is tolerable and doable, and I can handle it." How can you take the judgment out of the side effects? When you're having them, are you catastrophizing, saying, "This is terrible, this is bad, I can't handle this," or are you saying, "This is neutral and tolerable, and I can manage this"? If you're having a side effect, are you resisting it, pushing it, and fighting it, or are you giving yourself permission to be uncomfortable, and are you willing to allow those sensations to rise and fall? As I've already discussed, one of the points I had here in my notes is to remind you to always put your values first. If you believe that medication is the right choice for you, lead with that value. Do not let fear interfere with your decision here. That was a lot of rhyming words, but we're going to go with it. The next thing I want you to think about is to talk with your doctor about whether it would be helpful for you to log any changes. I find that it's very beneficial to log your symptoms. The day you start taking your meds and how many days you take that meds, you probably will need to taper up maybe, depending on what your doctor has told you to do. Take note of when you change any medications. Are there any changes in your anxiety? Is there any change in your mood? What side effects are you experiencing? And that will be there to help when you talk with your doctor next about how it's going and whether it's actually the medication. I know a lot from my patients, they'll say, "The medication is definitely causing this problem for me. I'm tired all the time." But actually, if they've logged, we can see, "Actually, around that same time, you started getting less sleep for reasons like around school, or maybe you had a lot of travel, or it was the holidays. Could that be what's actually causing your symptoms?" Take that log to your medical professional and let them help you decipher whether it is in fact the medication or if this is actually a lifestyle change that has happened in your life. Again, let's challenge the stigma here. My main hope here with this whole episode is to take the stigma out of it. There is absolutely no reason for you to feel ashamed for taking medication. There is no reason to believe that you are weak for needing medication. I personally am proud of myself for saying and honoring that I matter. My wellness matters. I will do nothing but put my wellness, my mental health, and my medical health as number one, and I will do that proudly. If that means taking medication, so be it. If other people want to judge me, that's fine. I don't really mind if they judge me. Yes, it hurts my feelings sometimes, but they can have their opinion. I'm still going to do what's best for me. I hope that that empowers you to, again, learn from your medical professional what's best for you. Decide for yourself whether this is a value-based decision. Decide whether you're going to let fear stop you, and take baby steps. I cannot emphasize how important it is to take baby steps and to stay present. Only deal with problems as they arise. Do not make decisions based on potential problems that may show up in the future. Because if that's the case, you'll never move forward with your values. You'll always move forward with fear. We recently did a whole episode about how to act according to your values, not fear. This is another very important step for your recovery. The last thing I'm going to say is, it's a beautiful day to do hard things, and you can do hard things too. If you have a fear of taking medication, if you're scared to take medication and it's impacting your recovery, I hope that this has helped you to manage medication anxiety, to give you a little bit of empowerment, a lot of hope, and hopefully help you to manage your anxiety as you move forward. Have a wonderful day, everybody. It has been a pleasure being with you again. I know your time is incredibly valuable, and I'm so honored that you chose to spend your time with me today. I'll see you next week.

Oct 13, 2023

If you are wondering if you have (Generalized Anxiety Disorder) GAD vs. OCD (Obsessive Compulsive Disorder) and how to tell the difference, this episode is going to be exactly what you need. My name is Kimberley Quinlan. I'm a cognitive behavioral therapist. I specialize in all anxiety disorders, and I help people overcome their anxiety in the kindest way possible. Now, I have treated generalized anxiety disorder and OCD for over 15 years, and I want to share with you that it is true—there is a massive overlap between OCD and GAD. They do look very similar. So I'm going to break it down and address the GAD and OCD overlap. Let's go. GAD versus OCD. You might know this, but in the world of anxiety disorders, this is actually a very controversial topic right now. I've been to conferences and master classes where clinicians will very much disagree on how we differentiate between the two. In fact, some people believe that they are so similar that they should be labeled as the same thing. We don't all agree, and the reason for that, as I said, is that they do look similar. They do follow a very similar cycle. My hope is that in order to understand what GAD is and what OCD is, we need to actually go through the diagnostic criteria. And that's what we're going to do for you today so that you too can understand the difference between GAD and OCD and determine for yourself what you think will help move you in the right direction. Let's talk about it. GENERALIZED ANXIETY DISORDER SYMPTOMS As I mentioned, in order to get a GAD diagnosis, you do have to have a specific set of symptoms, and we're going to go through them. Number one, if you have GAD, the first symptom you need to have is anxiety and worry, and that's usually focused on everyday events like work, school, relationships, money, and so on. Now, the frequency of GAD needs to occur more days than not for at least six months. The person needs to find it difficult to control this worry and anxiety, and it focuses on areas that are not consistent with other mental health struggles. What we mean by that is, let's say the focus was on being judged by other people. Well, that's better understood as social anxiety. Or if the focus of your worry was on your health, then we would actually be better diagnosing you or understanding your symptoms as health anxiety. If it was focused on a specific thing, like planes, needles, or vomit, we would better understand that as a specific phobia. In order to have the diagnosis of GAD, it needs to not be under the umbrella of a different diagnosis. Other things that we would rule out when we're thinking about GAD are things like panic disorder, body image, or even a previous trauma. Now, the fifth symptom is it needs to cause distress and impairment. That's very, very important here because, again, we're talking about a disorder. What that means is a lack of order, no order. So what we want to see here is that it's highly impacting their daily lives, highly impacting their ability to function. And then the sixth criteria is it has to be ruled out that these symptoms could be from a medical condition or substance abuse. An example of that might be even me with POTS. I have postural orthostatic tachycardia syndrome. A lot of the symptoms of POTS can actually look a little bit like generalized anxiety. The seventh criteria are the specific symptoms, and this is important to recognize because this might be true of a lot of different situations, symptoms, diagnoses, medical and mental. You need to have symptoms such as restlessness or being on edge. You need to be either easily fatigued, have difficulty concentrating, or have what we call a blank mind. You might have irritability, you might have muscle tension, and you could also have sleep disturbances. That is the breakdown for GAD. As I said, it's very easy to mix it up with other mental health disorders, such as OCD, because they can look very, very similar. OBSESSIVE COMPULSIVE DISORDER SYMPTOMS Let's talk about OCD now. What is OCD? Now, in order to understand what OCD is, we need to again address the specific criteria to get a diagnosis of OCD. The symptoms of OCD include the presence of obsessions and compulsions or one. Sometimes, again, you might have obsessions without the compulsions, but usually, at the onset of the disorder, you will have both. You'll also have intrusive, unwanted, repetitive thoughts, feelings, sensations, urges, or images, and these cause a very high degree of distress and anxiety, as we mentioned with GAD. The individual with OCD will often attempt to avoid or suppress these thoughts, feelings, sensations, or urges, and they will try to neutralize them using what we call compulsions. Now there are five different types of compulsionS. A lot of you who have followed Your Anxiety Toolkit will know about these compulsions. We've talked about them. We actually go over them extensively in our online course for OCD called ERP School . If you're interested to learn more about that, you can go to CBTSchool.com . We have a whole array of courses there to help you work through this and get help if you don't have access to treatment of your own. We do have five different types of compulsions. The first one is avoidance. The second one is mental compulsions. The third one is reassurance-seeking, whether it be from Google or a loved one. The fourth one is physical compulsions, like checking or jumping over cracks or washing your hands, just to give a few examples. The last one is self-punishment. So there are five types of compulsions. Now, these compulsions are not connected in a realistic way and the way that they're designed to neutralize or prevent. They're usually clearly excessive behaviors done repetitively and done usually from a place of not wanting to do them, but more that the person with OCD feels like they have to do them to reduce or remove their obsessions. Now, obsessions or compulsions are time-consuming. The frequency here is that they need to take up more than one hour per day or cause a significant degree of distress and impairment in their social, occupational, or other areas of functioning in their lives. The next criteria is that the obsessive-compulsive symptoms are not attributable to physiological symptoms, substance abuse, or a medical condition. Similar to GAD, again, we want to always check for medical and substance abuse issues before we go ahead and get a diagnosis of either GAD or OCD. And then, last of all, the disturbance is not better explained by another mental health condition. Again, if the worry or the obsession is around needles, like we talked about before, or being judged by somebody else or health conditions—if that were the case, we would give them a different diagnosis. Now, this is also true for trauma. Again, I want to make sure we understand that. Often, this same cycle will play out in different anxiety disorders—PTSD, BFRBs, phobias, health anxiety, BDD (body dysmorphic disorder). Once we have ruled those out, we can then move forward and acknowledge that this might be OCD or it might be GAD. OCD VS GAD Now that we've gone through all that, we can actually slow down a little and really take a look and talk about OCD versus GAD and how to tell the difference. Let's break it down. Both GAD and OCD have intrusive thoughts or what we call obsessions. A repetitive thought. Now, both have the presence of rumination compulsions and reassurance-seeking compulsions. That is true for both conditions. DIFFERENTIATING GAD FROM OCD OCD tends to be more on irrational topics and subjects, whereas GAD tends to be more focused on daily stresses and rational actual events in the person's life, but not always. Again, sometimes the person with GAD may engage in a lot of catastrophic thinking or irrational thinking that can actually make this disproportionate to their daily life stresses. ARE YOUR FEARS INTRUSIVE AND REPETITIVE? Questions that you might want to ask yourself when you're considering how to tell the difference between GAD and OCD are questions like, are your worries related to a daily stressor, or are your fears intrusive and repetitive? People with OCD tend to identify that their thoughts are very intrusive, that they can't stop them, they're relentless, they're repeating themselves over and over, whereas people with GAD tend to find that these are more preoccupations with problems in their lives, and they're trying to solve them. ARE MY FEARS REALISTIC OR ARE THEY IRRATIONAL/DISTORTED? Another question to ask is, are my fears realistic or are they irrational and distorted? That question too can help us differentiate whether your symptoms are more related to OCD or GAD. GENETICS AND GAD VS OCD Another question to ask is, does anyone in your family have GAD or OCD? We know that these conditions are very, very genetic. If you've got someone with OCD in your family, it might actually help us to determine, is this something that's going on for you? Are you better understood as having symptoms of OCD than you are GAD? GAD TESTS & OCD TESTS Another question or thing you might want to do is, you can take a GAD test or an OCD test . We have specific diagnostic tests that can help determine these. I strongly encourage, if you're still having a hard time differentiating after you've listened to this episode, please do go and speak to a mental health professional who can help you determine and do those tests so that you can really be clear on what you've got and help you get the correct treatment. CAN YOU HAVE BOTH OCD AND GAD? Let's answer some questions about this topic that commonly come up, which hopefully will help you get even more clarity on this topic. One of the most common questions we get asked in this area is, can you have OCD and GAD? Often, some of you are looking at these criteria going like, "Yes, yes, yes, yes, yes, yes, yes." And the truth here is, yes, commonly, people do have OCD and GAD. There is a very strong GAD-OCD overlap here. So it could be that you have both. TREATMENT FOR OCD & GAD The good news here, if that is the case, is that the treatment for GAD and the treatment for OCD are very, very similar. In fact, again, like I said, it's very controversial. Some clinicians say it doesn't even matter. We don't have to differentiate between OCD and GAD because the treatment is going to be so, so similar. We're going to use a combination of cognitive behavioral therapy and exposure and response prevention. We call cognitive behavioral therapy CBT , and we call exposure and response prevention ERP for short. Those treatments are focused on reducing those safety behaviors or compulsions, such as rumination, avoidance, reassurance-seeking, physical compulsions, and self-punishment, and also encourage you to identify your fears and learn to face them as much as you can. Learn to navigate those fears by experiencing them, tolerating them, being kind to yourself as you ride the wave of distress, and practice mastering your ability to be uncomfortable. That's a huge piece of this. Also, master your ability to be uncertain, because in both conditions, they often require you to spend a lot of time trying to seek certainty, to get clarity, to solve the fear, and to prevent the fear. And we actually instead work at reducing that by increasing our willingness to be uncertain. We also have an online course called Overcoming Anxiety and Panic , and we go through the same steps with that. They're two separate courses because we want to make sure the person feels very understood and feels like they have a really good plan. Again, if you're interested in that, you can go to CBTSchool.com. We have two courses for specific diagnoses, and that will help you make a plan for yourself. They are there specifically for people who do not have access to or do not have the means to access mental health services. These are self-led, on-demand courses. You can take them as many times as you want to put a plan together for you. WHAT ABOUT OTHER ANXIETY DISORDERS VS OCD? Let's get back to the questions. What about other anxiety disorders vs OCD? Well, what we've talked about already—hopefully, we'll clear that up—is the real way to determine what your specific problem or struggle is, what is the focus of your intrusive, repetitive thoughts? Again, if it's on your body and your body image, we would look at an anxiety disorder, an eating disorder, or maybe even BDD. If the focus is on your health, we're going to look towards health anxiety or hypochondria. If your fear is around being judged, we're going to look towards social anxiety. If your fear is in response to an actual trauma you've been through, we're going to look at PTSD and other trauma symptoms that you might be having. It's important to identify the core fear, and that can actually help determine what specific struggle and diagnosis you have. CAN GAD LEAD TO OCD? Another important question that people ask is, can GAD lead to OCD? We don't actually have a lot of research on this, so it's important that we recognize that yes, they can overlap, that yes, you can have GAD, and then you can proceed into having OCD. But I wouldn't actually say that GAD leads to it or causes it. Usually, again, we don't really have a lot of clarity on what causes OCD, but we do know that there is a genetic component and an environmental component that are contributing to having OCD. Lastly, what's the difference between having OCD and general anxiety or just anxiety in and of itself? Often, again, we're going to look at that core fear. Now the thing to remember here is, everybody has anxiety. Everybody experiences anxiety. It is a normal part of being a human. But if that anxiety is starting to impact the functioning and quality of your life, if it's starting to take up a lot of time, if it's starting to stop you from being able to do the things you want to do, that's usually when anxiety becomes what we call an anxiety disorder. When that happens, I'm going to urge you to seek help. There are treatments, there are solutions, and there are practices that can help you overcome this anxiety and get you back to living the life you want to live. You don't have to live a life where we just accept anxiety at this rapid rate without getting help, skills, and tools to help you move forward. The whole reason I created Your Anxiety Toolkit is because there are tools that can help you navigate anxiety in the most effective, wise, and kind way. So my hope here is that today, as we've learned to differentiate the difference between GAD and OCD and even other anxiety disorders, you can then go to get resources to help you overcome those specific struggles and challenges. Again, if you're interested, please go to CBTSchool.com. We are also here on Your Anxiety Toolkit, where we have over 350 free episodes to help you navigate these conditions. It is an honor and pleasure to help you with these struggles in your life, and I'm so grateful to be able to do that. I hope that's been helpful. Have a wonderful, wonderful day, and I'll talk to you soon.

Oct 6, 2023

If you want to live a life according to your values, not fear, you're in the right place. I am going to give you a detailed look at how you can do this for yourself, but I will also show you how not to do this. Lots of people are talking about this idea of living life according to their values, not fear. I want to really inspire you, highlight the way that you can do this, and also show you how it cannot be done so well. I'll actually give you some personal experiences. Hopefully, my goal here is to inspire you to live a life where your values lead the way and fear no longer makes your decisions. Your fear is no longer in the driver's seat; you are. If that's good for you, let's go. Hello, my name is Kimberley Quinlan. I'm a marriage and family therapist. I, myself, have struggled for many years with anxiety . In little ways, anxiety just took away the things I wanted, took me away from doing the things I wanted, showing up the way I wanted, and learning how to live a life according to my values, not fear, has literally changed my life. Now, my hope here is that I can explain this to you. There have been times where my clients have said, "I'm hearing about this idea of values, but it literally doesn't make any sense to me. Like, how would I navigate that?" So my hope here is to make it nice and clear, give you some clarity and some directions so that you too can live your life according to your values and not fear. Now, the thing to remember here is that this idea of values has probably been spoken about in many different modalities, but the one that's really popular right now that people are talking about is a type of therapy modality called Acceptance and Commitment Therapy . What they do is they talk about values as this idea of principles that govern how you want to act. Again, it's not being perfect. It's principles that are going to guide you. Now, unlike just setting goals, values are never fully accomplished. They're something that involves continuous behaviors. They're small baby decisions and little pivots that you are going to make throughout your entire life, and they guide your choices and your decisions according to the person that you want to be, the kind of person you want to see yourself as, or that you identify with. Now, often when we're talking about values, the biggest question I get asked is, "How do I determine these values?" Let's just stop for a minute and just talk about how we're going to apply this. As you probably already know, fear is a very, very good motivator, and it's a driver of behaviors. Let's say you're just walking along or you're at home enjoying your day, and then you have a thought or a feeling of danger, like what if something really bad happens? For you, it will be a specific thought or feeling, but for the sake of just making this really broad, basically, your brain has interpreted, "There might be something wrong. There could be danger. Bad things could happen. I feel uncertain about the future." When that happens, our natural human instinct is to fight that fear, run away from that fear, freeze in that fear, or go into people-pleasing mode. We call it the fight, flight, freeze , and fawn response. This is a normal human reaction. We all do it. It's nothing to be ashamed of. It doesn't mean that you're wrong or bad. If there was actual danger, if there was somebody who was intruding on you or making you uncomfortable and that you were in danger, this 5Fs, the FFFFF approach, is a very appropriate response to being in danger. But when our brain tricks us or sets off the alarm, the danger alarm too fast or inappropriately, we often perceive there to be danger, and we go into a response where we respond to that fear as if it is a real danger, and before we know it, we've completely gone in the wrong direction from the way we wanted our day to be. Again, I might be dropping off my children at school, and I might have the thought, "What if something happens to them today?" I have to make a decision in that moment whether I'm going to respond to that fear, that thought, that feeling as if it's fact, or if it is just a thought, a feeling, or an experience or sensation. The first step here is being able to stop and identify when fear is showing up and identify then, "How do I want to respond?" And that's where your values come in. What I'm going to encourage you to do once you've finished listening to this is go onto Google or whatever search engine you use and Google ' Values List PDF .' There are hundreds of them, and they're going to give you a list of all of the different values that you then may want to think about as things that can guide you in the direction that lines up with the way you want to show up in your life. Again, think of it like a crossroads. You're going up to this crossroad; there's a stop sign. The stop sign says, "There could be danger here." You have to make a decision. Am I going to take a right or a left, which doesn't matter, towards fear and trying to resolve that fear, or am I going to make a left where I act according to my values? On these lists that you've Googled, you will see an extensive list of ways in which you can respond right now. Some examples of values would be patience, kindness, strength, integrity, and honesty. That's just a few. Like I said, there's hundreds of these. And then you can start to decide for yourself which value you want to lead with your step forward. What do they say? Put your best foot forward. That's what we're talking about here—the value that you pick is going to be the one that helps you in the long term, is the most skilled response, and is the one that lines up with who you want to be and how you want to be. Again, think of it through the lens of the one-year-old or the three-month-old you. What would you want that person to do? And that's how we can then start to choose values over fear. So, so important now. A lot of people get overwhelmed with the list. Let me help you get clear on how to determine the values that you're going to choose. Number one, pick values that have always led you in the right direction. Do a little inventory on when was the time that I really showed up for myself, or I showed up in a way I wanted to in an uncomfortable situation. What was one of the values that led me in the right direction? Often, with patients, I'll ask them, "What was a time where you really had to muster through a really difficult time?" And they'll think about, "Oh, there was this one time where there was this one sort of emergency, or I was running a marathon." I'll say, "Okay, great. You were able to achieve that. What were the values that got you through that uncomfortable time?" And there it falls very quickly without even looking at the list. It could be some values that matter to you or that have been effective for you. Another option is, pick values that give you a sense of purpose that helps you look in the long term, not just with short-term relief, but long-term accomplishment, long-term mastery, and long-term relief. In addition to that, pick a value that feels like it serves you in the 'you-est you' you can be. I know that's a funny way. I say that with my patients all the time, like, "What's the 'you-est you' that you can be? What value would lead you towards the 'you-est you' that you can be?" Because we're all different and we all show up in different ways. We have different strengths and different challenges. So we want this to be very specific to you. But there is an important thing to remember here. There are no "right values." You are going to look at this list. And as I did when I first started doing this work, I was like, "Oh my gosh, which ones should I pick?" Often, and this is one of the problems that I found, when I looked at them, I ended up with this long list of all the things I wanted to be. I was like, "Check, check. Yes, I want to be that. Yes, I want to be that. Yes, that's a value of mine. Yes, that's a value." It was kind of like a want-to-be list. I had basically highlighted the majority of the values on the list. They were all important to me. But what we're talking about here is, yes, they might be all important to you, but the goal is just pick two or three to start with. What we want to do here is pick two or three that will help you with this specific struggle or problem that you're working through. If it's fear and it's anxiety, well, let's work on that. But if you're going through a medical condition, a family issue, a relationship issue, or an academic issue, you can then make a decision on, "What are the two or three values that will help me get through that particular problem?" Another issue that often people ask me about is that theyre getting overwhelmed with this idea of "I want all these things in my life." What we end up doing is using this idea of values as a way to fix their humanness, that these values work can become a breeding ground for perfectionism . This was the case for me. I was like, "Yes, a good person would check off that one," and "I wish I was more generous. Yes, I'll check that off." It really just ended up making me feel guilty about who I was. I was really picking values based on what I thought a "good person" would pick. We want to move away from that because, yes, you're going to look at this list of values as I did and be like, "I want to be all those things. I want to show up in those ways all the time, every day." But the truth is, you're a human being. You're a messy human being, as am I, and we don't want to overload ourselves with values and these ideas in a way that just is a way of being perfectionistic, hyper-responsible , and overly moral. We want these values to guide us towards being the person we want to be, but we don't want to pick them with this idea that we have to fix our humanness. We're still going to be human. We're still going to make mistakes. We're still going to hurt people and say things that we wish we didn't, and we can still go and repair that and show up as best as we can and be the best that we can. But please don't use values as a way of raising the level so high and the expectation so high that you are destined to fail and destined to feel bad about yourself. We want to be as compassionate and realistic as we can as we do this valued work. The solution is to be gentle and kind as you peruse these values. Maybe you need to put your pen down and your highlighter down and just take a second to acknowledge that you might not be in a season where you can choose the "good Samaritan" values. You mightn't be in a season where you can choose some of the values on the list. I know when I was really sick from a chronic illness, and I looked at this values list, generosity was a big value that showed up where I was like highlighting, "Yes, I want to be more generous." But I wasn't in a season where I had the capacity to give back. I was in a season where I needed help from other people. And so I had to stop in that moment and look at the list and say, "Given the season I'm in, which of these values will help me recover?" I had to work through a little bit of self-judgment and a little disappointment and sadness that I wasn't in a season where being generous was the priority, at the top of the list. You can still be a respectful, compassionate person while you work on whatever struggle you're working on. Absolutely. It doesn't mean we're giving you permission to not be a good person. But we have to be able to prioritize and bring things up to the top, but without discounting or thinking black and white that because they're not at the top, that makes us a bad person. Just because I couldn't put generosity at the tippy top of my list and priorities for values didn't make me a bad person. It just meant that because I was in this season, I had to reprioritize values to get me through this season so I could move on to being in the next season, which might have generosity at the top. Here is a pro tip with this, and I talked about this before. Find one area that you want to improve, and pick one to two values that might help you course-correct. Just do a small pivot. We don't want to overcorrect. We want to do just a very slight course correction to start. Today, we're talking about choosing values over fear. In this case, it might be a small value. Something that's there for you that will help you face that fear. That being said, let me also say, if your fear is really loud and really aggressive and it's hitting you from every angle, you might need to pick a value that's actually very, very, very important to you, the most important to you, and have just that one thing. Often, and here's an example—but please, I don't want you guys to feel you have to use this or feel like you're a bad person if you don't use this—a lot of my patients put family at the top of their values when they're talking about managing their anxiety. If they have an anxiety disorder that's taken so much from their life, they might say, "My kid is my highest value. And so when fear shows up, I'm going to imagine a picture of my kid, and I'm going to move towards that fear because that allows me to be with that kid," or that partner or that parent. Other people might say, "My career matters to me so much that when fear shows up, because I want that career so much, I'm willing to be uncomfortable. I'm willing to ride some big, big waves of discomfort. I'm not going to choose fear anymore when I get to that crossroads; I'm going to choose that one really important fear." Underneath, there might be a smaller one like compassion, hopefully. But again, you get to choose. You get to choose what's right for you. This is your journey. Please do not let anybody tell you what your values should and should not be. Now, one of the reasons that I was so committed to doing this episode today was that I recently have come upon a realization about values that I didn't know were there, which is that sometimes your values can compete. Now, I talk to my patients about this all the time. That wasn't the part that shocked me. Let's talk about what that might look like. Often, people get confused. "Well, if I have these values, what if they compete with each other?" Let me give you a personal example. For me personally—but please don't use this as your values unless they line up with your values—I highly value, number one, work ethic and discipline. It is a huge part of how I was raised. I love the fact that I have a very strong work ethic, and I'm very, very disciplined. It is something I hold as a very high priority, has gotten me through some very difficult times, and has allowed me to have the life that I am trying to create. My second value is compassion, and I'm still working on that. It doesn't mean I'm perfect at it, but it's still a high value. The third is family—my family. My husband and my children are probably the most important things to me above all. The fourth is my mental health. Now they're in order, but depending on the day, they will switch, as I've talked to you about before. But then patients will often ask me if I share that: "But that doesn't make sense. If work ethic is a value, but family is a value, how do I make both of those happen? Does that mean I have to choose to be a stay-at-home mom and be with my family? But if I go to work, obviously, I'm not valuing my family. They're competing with each other." Some people will say, "I really value rest, but I really value exercise or being strong. How do I make room for both of those? They're competing." The thing to remember here with values is, it's not always, as I said, in the same order. Throughout our day, because we have to be flexible, we can make room for multiple values at a time, and we can find balance within these values. I can show up to work or right here today and give everything I have, and then still show up for my kids later on. It doesn't mean I have to give my whole attention to that one value all day, every day, consistently at a hundred percent. Because I value compassion, some days that will mean I take a break, or I value mental health means I don't have a strong work ethic or be with my kids. I take a drive, I go to the beach, or I take a walk and have some time to myself. It's important to recognize that while it might feel like these values are competing, it's not. It's about us finding a balance of using them to guide us, but not, again, making them perfect. Any time, when we're using these values , when we're going overboard with them, we want to catch our rigidity in making them the only thing that we do, the only way we think, and the only way we act. We want this to be a flexible, moving target. As we said, values are never finished. They're never completed. They're something that we are constantly checking in with ourselves. What do I need? The most beautiful, compassionate question—what do I need? And using values to guide us, not fear—values. Allowing those values to decide what's important to us, decide how we want to show up, and decide what the future me would want me to do. Now, this is where I have gotten stuck, and here is where I've found a-- how would I say it? A problem. Maybe it's just me. Maybe it's just me. But I want to bring it up in case this is true for you too. Now, I've already shared with you my core values. There's work ethic and discipline, compassion, my family, and my mental health. These are all incredibly important to me, depending on the season, the day, the hour, and the minute. But I realized recently that work ethic, while it's one of my biggest values, is actually partially fueled by fear. I'm holding it as a value, but it's actually a partial fear response. Let me explain. Often, and this is something I want you to look out for, fear will dress up as values and pretend to be values when really it's just fear. Think of it as a Halloween costume. Fear is like, "Oh, I know how to trump this system. I'm going to dress up as a value and show up in Kimberley's life (or in your life), and I'm going to pretend I'm a value, but I'm actually really fear. I hope she doesn't catch that I'm actually in a costume and I'm actually really fear. And so I'm going to see if this works." I do genuinely value work ethic and discipline. Like I said to you before, it has really given me so many beautiful things in my life and has allowed me to show up and serve you guys, and it's been wonderful. But when I was with a client, we were talking about this exact problem, and I asked them a question, which was, if that value—when we're talking about values—if that showed up, what would the non-anxious, trusting version of you do in this moment? And they realized that it was not the values they'd been working on. And then I thought, "Oh my goodness. I'm going to actually check in with myself on this, because if I asked myself, what would the non-anxious, trusting version of myself do in this moment, a lot of the time it wouldn't be work ethic and discipline." I realized that a small part of my work ethic and discipline is coming from a place of fear that if I don't stay disciplined, that if I don't hold my work ethic, everything will fall apart and bad things will happen. This stopped me in my tracks because—again, I want to reinforce this—my values were being tricked by fear. Fear was actually leading a part of that important value, or maybe I could say it was coming in and taking advantage of that value, and it might do that for you as well. And so what I want you to think about when you're looking at values—and again, please don't put pressure on yourself that you have to get this perfect. It's a work in progress. I've been doing this work for a decade, and only now I'm realizing this—is slow down and just check in on "What would the non-anxious, trusting version of myself do in this moment?" I think that is where we can actually really get to the crux of " What are your values ?" Again, they will be ever-changing. Again, we will be forgiving and kind to the fact that we're still messy human beings. We don't have to get it perfect. But it did open me up to realizing a value that I didn't know was so important to me. When I asked myself this question, I actually realized that the answer is playfulness and stillness—these two values that I've never really relied on. As I look back at my PDF of values, I've never highlighted them. When I asked myself this question of what would the trusting version and the non-anxious part of me do, playfulness and stillness was the value that rose up to the surface. It was a beautiful moment. I actually cried. Now, from that, and I'm actually going to tell you a little bit of my news, I thought to myself, how could I implement playfulness and stillness into my life where I still value work ethic, compassion, family, and mental health? Into my mind came the image of a Volkswagen bus. Do you remember the old hippie buses? We call them Kombis in Australia. That was what showed up for me. Like, if I could show up in my business from a place of playfulness and stillness, I wouldn't be working from this office. I would be working from a 45-year-old Volkswagen bus. And so I did. I did exactly that. I went and bought a Volkswagen van. It's a 1985 Volkswagen Westfalia. I love, love vintage cars. I am actually a car person. I don't know if you know that about me, but I love vintage cars, and I never allowed myself to really think about doing this. I've loved them forever. I've looked at them forever. I've wanted one forever, but I've always thought, "That's not high on my priority list right now." Until I realized that if I'm going to move towards trusting myself and honoring this bigger piece of me, playfulness and stillness have to come up on that list as well. So if you live in Los Angeles and you see a gold Volkswagen Westfalia—it has, like I said, 195,000 miles on it—if you see one of those driving around Los Angeles and you see me, please beep your horn. That will be me driving around and parking my van at a beautiful place and working from there from now on, and that is my hope. That is my hope for myself, and I hope that you can use values to discover who you are so that you can be the 'you-est you' you can be. I love the idea of implementing values into recovery. That is why I think act is so important as a complementary treatment to anxiety. I think that with some care, compassion, and some thoughtfulness, you too can identify the values that are important to you and learn to live and act from those values, not fear. I hope that has been helpful for you today. I have had so much fun chatting with you about values. I am sending you so much love. Do not forget, it is a beautiful day to do hard things. I will see you next week. Have a wonderful day.

Sep 29, 2023

Perfectionism anxiety almost destroyed my life. If you are someone who suffers from perfectionism, you know exactly what it's like to be stuck in the perfectionistic trap. It's hell, quite frankly. We're here today to talk about how to overcome perfectionism and how to create a life where you can still succeed. You can still do the things you want just without being constantly anxious and depressed and never feeling like you're enough. Hello, my name is Kimberley Quinlan. I'm a marriage and family therapist. I'm an anxiety specialist, and I personally have walked the walk of perfectionism and have had to overcome it as it was starting to severely impact my life. I am so excited to be here with you today to talk all about perfectionism and perfectionism anxiety. Now I am 15 years recovered from an eating disorder. I was personally completely overwhelmed with perfectionism anxiety, and I was in a perfectionism trap. So, let's talk about it. First, let me give you a little bit of a personal update or a background. When I went off to college, I was really naive. I was wise and smart, but I had no idea what I was getting myself into. I had lived at home with my family on a rural farm, on a ranch, if you live in America, for my entire life. And then I went off to what was considered the big city for college, and I felt like I had to be perfect. I had this belief as soon as I left my family that if I could be perfect, I would be safe. I would be emotionally safe. I would be physically safe, and as long as I could keep everything perfect, nothing bad would happen. I also believe that if I could be perfect, people would not abandon me, disprove of me, or judge me. And so, I went out of my way to make sure everything was as perfect as I could make it, even though I understood that I wasn't perfect. I was on a mission to try and get to the top of that hill and stay at the top of that hill. It was a protective measure, a safety behavior I engaged in to manage the anxiety and overwhelm I felt going off to college. I also believe that if I could stay perfect, it would protect me from really uncomfortable emotions like shame and guilt, and it would help me feel like I'm in control. I would try to give myself a false sense of control in a world where I felt very out of control. THE PERFECTIONISM TRAP Now, a big part of this was me understanding what we call the 'perfectionism trap.' The perfectionism trap is, yes, when you start perfecting yourself and perfecting your life, you start to get praised from people around you. You start to get rewarded for your perfectionistic behaviors. My grades started to improve because I was being perfectionistic. My bosses gave me extra shifts because I was so good at my job. But the problem with that is, as I was getting better and trying to perfect everything in my life and please all of the people, I started to feel overwhelmed with all that I had taken on. In addition to that, once I had gotten to this 'perfect place,' which again, I totally understood that I wasn't perfect, but as I started to climb that mountain and get to the peak and start to have the relief of anxiety that I made it, I'm at the top, I'm doing really well, then I started to have the influx of anxiety. "What if I can't maintain this? What happens if I make a mistake and fall off this perfectionism mountain that I have climbed?" And then I was constantly anxious and constantly feeling hopeless about the fact that I can't maintain staying at this high level for as long as I was. This is the perfectionistic trap. The more you try to become perfect, the more pressure, stress, and anxiety you feel. The more hopeless you feel about being able to maintain that, the more depressed you feel that you're stuck in this cycle, and all of a sudden, nothing is worth it. Often, people completely fall down. They can't go on in this way. They burn out, they get sick, which happened to me, or they become so paralyzed with anxiety that they have to avoid things and start telling little white lies just to get through the day because they've built up this idea of being perfect on the people around them. If you're experiencing this, you're not alone. Please do not feel bad about this. This is a common experience, particularly if you're someone who's set up for anxiety. PERFECTIONISM ANXIETY SYMPTOMS OR SIGNS Let's go through some additional perfectionism anxiety symptoms or signs. The first one is, people with perfectionism have a severe fear of failure. They're overwhelmed by the idea that they might mess up, they might make a mistake, and when they do make a mistake, they see it as a failure. Not a blip on the road, not a challenge that they will learn from, but it's that they are a failure, that their mistake and their failure mean that that person is. In fact, their identity is a failure, and that can be incredibly emotionally painful. Another perfectionism anxiety symptom is shame and vulnerability. There is so much shame around making mistakes or being seen as vulnerable, weak, not perfect, or not keeping up with the Joneses. And that can be so emotionally painful that that's what propels them into continuing perfectionistic behaviors, pushing themselves harder than they can maintain, putting them or raising their hands in situations that they really honestly shouldn't be saying yes to. They don't even have the capacity for what they've already signed up for. You may know the quote that says, "If you want something done, find the busiest person." That's commonly the perfectionist because they're the ones who can get jobs done and they're willing to put their own mental and physical wellness aside to get the job done. Another sign of perfectionism often shows up at work. When you have perfectionism anxiety, work can become very frustrating or depressing, and this is often, again, because of the expectations you've put on yourself. You associate work with being an incredibly stressful environment because, as you walk into work, you're bringing in these expectations. You're bringing this goal of being perfect and not making mistakes. And that can create an incredible amount of anxiety and distress. It also creates, as I said, a lot of depression, hopelessness, or helplessness because often people with perfectionism are suffering in silence. They don't feel like they can share with other people how much they're suffering or how they're succeeding. They make it look maybe even so easy, but underneath they're really struggling, and they don't want people to find out. They feel like that would be letting other people in on the lie that you're actually not the person that you're perceived to be. Another really important sign is this ongoing fear or belief that I'll never be good enough. This deep-down belief that you don't have the worth of just being who you are, that you have to show up being more and more and more in order to be respected, to be loved, to be accepted by people. And that can be incredibly stressful. PERFECTIONISM AND PROCRASTINATION A big overlap is between perfectionism and procrastination. Again, as I said, when you raise the bar so high, often the only thing that people can do is to avoid the thing because they're overwhelmed at the prospect of making a mistake. They're overwhelmed by the expectations they've put for themselves. They go into a freeze mode where they can't even move forward. It's too overwhelming. Their nervous system is shutting down. They're having an increased heart rate, tightness in their chest, nausea, stomach issues, muscle aches, headaches, and migraines. And so, because of that, they just procrastinate and keep pushing, pushing, pushing the deadline away. Often, when I see someone, they have been told they're not perfectionistic because they've procrastinated and avoided so long. A professional or a doctor has said no, that you can't be perfectionistic because you're not getting anything done. But often, those who are avoiding are more perfectionistic than the people who they know are succeeding. It's the heavy layer of expectation that causes them to stall and avoid moving forward in any way. Now, when you suffer from perfectionist anxiety, relationships can also become really strained. Really common imperfectionism is people pleasing, or the fear that you have let people down. You spend a lot of time worrying about what they think of you. In addition to that, it's not just worrying about what they think of you. Often, people with perfectionism become highly judgmental of their loved ones, their friends, their children, or their partner. They may also become easily annoyed when other people can't maintain that perfectionism. Often in relationships, if there's a person with perfectionism and their partner is struggling, the person with perfectionism gets quite frustrated because, in their mind, they're like, "Just be perfect. Get it fixed. Fix it. I'm doing all the perfectionistic behaviors; why can't you?" And that can cause an incredible amount of strain on the relationship. They also might experience a degree of anger, frustration, and irritability. And that's not because they're horrible people; it's because they've raised the bar and the expectations so high to be perfect that even if their loved ones are struggling by association, they feel like that's jeopardizing their perfectionism. And this is a really common thing that comes into couples counseling. Once they get there, the relationship has been so strained without identifying that perfectionism could be a massive driver behind their relationship issues. IS THERE A PERFECTIONISM ANXIETY DISORDER? Now there is something to note here. There is no such thing as a perfectionism anxiety disorder. A lot of people are searching for those terms to see if this is, in fact, a disorder. But there are common disorders such as eating disorders, generalized anxiety disorder, and OCD that do co-occur with perfectionism. PERFECTIONISM OCD Now, there are specific types of OCD, one of them being perfectionism OCD. That is a specific subtype of OCD where the underlying force towards the compulsion is perfectionism, and it's often coming from a place of anxiety and uncertainty. Usually, people with perfectionism OCD, they're not doing their compulsions or safety behaviors from a place of wanting to; they usually feel like they can't stop doing them. They feel like they're stuck in a loop of doing these behaviors even though they don't want to. This is very common alongside other subtypes, like just right OCD, symmetry OCD, and moral and religious OCD as well. PERFECTIONISM VS PERFECTIONISM OCD Now, often people do ask. Let's weigh it out. Perfectionism versus perfectionism OCD, how do we know the difference? Well, a thing to remember here is that often perfectionism is what we call 'ego-syntonic,' meaning it's in line with their values. They want to be perfect. It's a driving force to be perfect. It actually reduces their discomfort by moving in that direction. For those with perfectionism OCD, it's actually ego-dystonic, which means they don't want this obsession. It's intrusive. It's repetitive. They really don't believe in the point of perfectionism, but they feel compelled to engage in this behavior, and they feel like they can't stop engaging in this behavior. Now I want to really slow down here because that's not always true for everybody. I've often seen where clients will have a combination of the two, or maybe on a spectrum, they might be closer to the perfectionism OCD end, but they do still have some ego syntonic perfectionism that's showing up. So, I want to make sure that if you are having these perfectionism symptoms, go to a mental health professional so you can work out specifically what's true for you. So that's an important point to make here. Please don't misdiagnose yourself here. This perfectionism can also show up in PTSD. It can show up in depression. It can show up in other disorders as well. I want us to use this as information, but please do not use this as a way to diagnose yourself. PERFECTIONISM OCD TREATMENT Now if you do have perfectionism OCD, there is a specific OCD treatment that is helpful for that. For those of you with perfectionism, I'm actually going to go through that right here in a second. But first, let's just address that OCD treatment usually will involve a type of cognitive behavioral therapy called ERP (exposure and response prevention). Now, in this case, we actually expose you to being imperfect on purpose. We have you practice reducing your safety behaviors and compulsions around perfectionism so that you can practice riding the wave of discomfort, uncertainty, or anxiety, and learn that by riding that wave, you can actually tolerate that discomfort and move on without engaging in behaviors that make your life more stressful. It often involves saying no. It often involves slowing down. It often involves, again, being imperfect on purpose. HOW TO STOP BEING A PERFECTIONIST But now let's move over to how you can stop being a perfectionist and how you can overcome perfectionism if that is in fact what you're dealing with. I again want to share with you, I get how painful this is. I worked through this for close to a decade, and I still see it come up. I still see it show up in my life where I have to catch it. It shows up in a way that's sneaky and it feels, in my experience, as it's a powerful feeling when you're engaging in perfectionism, but I also notice that when I'm starting to feel really burnt out and really overwhelmed and my anxiety and depression are going up, it's usually because I've allowed that sneaky perfectionism to get into my life more than I would've wanted to. OVERCOMING PERFECTIONISM So when we're talking about overcoming perfectionism, here are a few things that were really helpful for me. Identify how perfectionism keeps you trapped Number one is, identify the ways that perfectionism is keeping me trapped. For me, when I had an eating disorder and a lot of perfectionism, I actually had to do a deep study on how it was impacting my life because, as my therapist was trying to get me to change these behaviors, I was showing up with a lot of restriction and a lot of resistance. I did not want to stop. I said to her, "I'm not ready to get rid of these behaviors. They keep me safe. They keep me feeling like I'm in control. I don't want to feel out of control. I don't want to feel imperfect. I don't want to feel shame. I don't want to feel vulnerable. I don't want to take these behaviors away." But as I looked at how they were impacting my life, I then started to realize how they're actually keeping me trapped and holding me back. Explore how society encourages perfectionism The second piece was, I had to then do a deep exploration and look at how society had encouraged me to maintain my perfectionism. I had people all around me cheering me on. "Good job. Keep going." "You're so thin. Look at you thrive." "You're so successful. I can't believe how you do it." "I'm so impressed. You inspire me." I was constantly fed reinforcement. That kept me trapped in perfectionism and made me want to stay in perfectionism, but kept me anxious, kept me feeling like I was a complete fraud, kept me feeling like I was an imposter who, if anyone would ever find out that I'm actually this imperfect, terrible, hopeless human being with no worth, I couldn't bear the idea of that, And so, I really had to look at how society had fed me into this system as a woman, but also as a human being and as a young person, how this had kept me stuck, and how it was going to keep keeping me stuck if I didn't start to change some things. Determine how YOU want to live your life Now, the next thing I had to do is really look and determine how I wanted to live my life, and that was really influenced by my personal values. What was important to me? Is my uncle's opinion of me or my coworker's opinion of me more important than my own opinion of me? I used to first say yes, but with practice and really looking at it, I started to realize I'm going to die with everyone thinking I was perfect and I'm going to die miserable. I wouldn't have done the things I wanted to do. I was living a life based on what other people thought of me and living a life basically hiding from all of my feelings, which brings me to the next big, big, big point of my recovery. Learn to feel your feelings If I could say one thing was the most important in my recovery, it would be this: I had to learn how to feel my feelings, and I had to be willing to ride out some really uncomfortable feelings that I had about myself. I had to write out shame and still do. I had to write out feelings of being worthless, and still do. They still show up, and when they do, I instinctually go to run away from them, and then I have to slow myself down and say, "Kimberley, just stay. Be here with it. Running from this emotion, patching it up, or making it look pretty is only going to keep you trapped and create a life where you're more and more and more anxious." Develop a self-compassion practice I also had to develop a very strong self-compassion practice, but that actually came last for me. I'm really doing my best with my patients and with you here today to have that be a beginning part of your recovery. But for me, I refused it. I hated the idea, and I didn't want to do it. I felt it was weak, and I actually thought it would override my perfectionism and make me into some kind of weak loser who can't control their life, and all these words, like, I'll be a failure, I won't be successful, it'll make me lazy. I had a whole belief about what self-compassion would do to me. But with time, I did start to see the benefit of it. And again, it's something I still have to work on. Understand that this is a life-long process of recovery I had to also recognize that this was a lifelong practice. I do remember, and I will share a story with you, that early in my perfectionism treatment, I actually stopped treatment. I told them, "I'm fine. I'm doing great. I don't need you anymore," and off I went. A part of that was me, because I think I was really afraid to do the next level of work, but I think another part of me truly thought that that was all it took. But then, as I struggled with different stresses in my life, or as it continued to show up in my relationships and at my work, I realized this is a lifelong practice. This is something I'm going to need to practice for some time. BELIEFS THAT WILL HELP YOU OVERCOME PERFECTIONISM Now, before I finish up with you, I want to share with you some beliefs that I had to adopt to help me overcome perfectionism, and I had to remember these every step of the way. Now, I was really lucky I had a therapist who would reinforce this with me every single week, but maybe you don't. And so, I wanted to just be here to share them with you, just in case they're helpful with you managing your own perfectionism. So, here they are. IT IS OKAY TO MAKE MISTAKES The first belief I had to adopt is, it's okay to make mistakes. It's human to make mistakes. I also had to reframe what a mistake meant. As I said before, a mistake didn't make me a failure anymore. Instead, a mistake was data to help me learn and challenge this problem I was having. And now I've done my best. I've even done episodes on Your Anxiety Toolkit, talking about how I went out and purposely made mistakes a hundred times in less than a year because I still realized I had to challenge this idea that getting a no, getting rejected, or making a mistake is a problem. IT IS OKAY IF PEOPLE DO NOT UNDERSTAND ME OR LIKE ME Another thing I had to adopt is, it's okay if people do not understand me or like me, and this one still breaks my heart. I'm not going to lie, it's still really, really hard for me. But it is important to recognize that most of the time, you can be imperfect, and people will still make space for you. It is okay to not be perfect. In fact, I have learned the more perfect I tried to be, the more disconnected I was with people. The more perfect I tried to be, the more I sabotaged relationships. I made other people feel judged and uncomfortable. I made it feel unsafe for them to be imperfect, therefore impacting our ability to be vulnerable and in deep connection with each other. WHEN I AM IMPERFECT, I BECOME MORE CONNECTED So by being imperfect, I actually learned that the real relationships started to show up, that I could be vulnerable, and then they would be vulnerable. And I would feel seen, and they would feel seen. And then I would feel worthy and they would feel worthy. And it healed itself in that respect through the relationships, through showing up imperfectly in relationships and letting them see that I'm actually struggling. I'm actually really having a hard time. I remember talking to my therapist and saying, "Nobody would know." Nobody would know that I'm having such a hard time. But when I actually started sharing, other people started sharing, and I realized that I didn't have to be perfect because nobody was getting through this life without going through their own struggles and challenges. MY WORTH IS NOT RELATED TO MY OUTPUT Another really important thing I had to adopt is that my worth is not related to my output. And this is one I still have to remind myself that I do not deserve self-care and kindness just because I kicked butt at work today. That I'm allowed to have compassion, self-care, and pleasure, whether I was successful, made money, or achieved the things on my to-do list. That I'm always deserving of self-care and pleasure. That that is something innate inside of me and that I can use at any time if my body needs it. LISTEN TO MY BODY. IT IS WISE And then the last thing I had to adopt was truly listen to your body. Stop pushing through discomfort in a way where you know that you're pushing your body too hard or too fast. I would say yes to everything, even if my body was exhausted. I had to learn to listen to my body and listen to when my body was gently nudging me, saying, "Stop. I'm tired. I need to rest." That is still something I'm working on and something that I'll always have to be working on as I age and as my limitations change as well. So that's the things I want you to adopt to help you overcome depression. Now, you may have some other things that you need to adopt as well, and that's okay. I want you to make this as personalized as possible. But I do hope that this, number one, validated you and your perfectionism anxiety. I hope that it informed you of ways that it shows up for people. And third, I hope it gives you some inspiration that you too can overcome perfectionism anxiety and depression, and hopefully go on to live a very fulfilling life. Have a wonderful day, everybody, and always remember it is a beautiful day to do hard things.

Sep 22, 2023

What if I never get better? This is a common and distressing fear that many people worry about. It can feel very depressing, it can be incredibly anxiety-provoking, and most of all, it can make you feel so alone. Today, I'm going to address the fear, "What if I never get better?" and share tools and strategies to stay hopeful and focused on your recovery. If you have the fear, "What if I never get better?" I want you to settle in. This is exactly where you need to be. I want to break this episode down into two specific sections. So, when we are talking about "What if I never get better?" we're going to talk about first the things I don't have control over, and then the things we do have control over. That will determine the different strategies and tools we're going to use. Before we do that, though, let's talk about first validating how hard it is to recover. Recovery is an incredibly scary process. It can feel defeating; it can feel, as I said, so incredibly lonely. When we're thinking about recovery, we often compare it to other people's recovery, and that's probably what makes us think the most. Like, will I ever recover? Will I get to be like those people who have? Or if you see people who aren't recovering, you might fear, "What if I don't recover either?" even if you're making amazing steps forward. It can be an exhausting process that requires a lot of care, compassion, and thoughtful consideration. Most of all, recovery requires a great deal of hard work. Most people, by the time they come to me, are exhausted. They've given up. They don't really feel like there's any way forward. And I'm here to share with you that there absolutely is, and we're going to talk about some strategies here today. Now, that being said, while all of those things are true—that it is hard and distressing and can be defeating—I wholeheartedly believe that recovery is possible for everyone. But what's important is that we define recovery depending on the person. I do not believe that there is a strict definition of recovery, mainly because everybody is different, everybody's values are different, and everybody's capacity is different. So we want to be realistic and compassionate, and we want to make sure our expectations are safe and caring as we move towards recovery. Let's talk about what that might look like. Again, it's going to be different for every person. WHAT IF I DON'T GET BETTER FROM OCD? If we're talking about recovery for OCD , let's say we're going to be talking about what's realistic. Again, what's compassionate? So, if someone comes to me and says, "I want my goal of recovery to be never to have anxiety and never have intrusive thoughts ever again," I'm going to say to them, "That sounds really painful and out of your control. Let's actually work at controlling your reaction to them instead of trying to tell your brain not to have thoughts and not to have feelings, because we all know how that works. You're going to have more of them, right?" But again, the degree in which you recover is entirely up to you. WHAT IF I DON'T GET BETTER FROM GENERALIZED ANXIETY DISORDER? Recovery for anxiety or generalized anxiety is going to be the same. I am probably going to use me as an example. I have generalized anxiety disorder—it doesn't stop me from living my life as fully as I can. It's still there, but I'm there to gently, compassionately respond to it and think about how I can respond to this effectively. I think I'm genetically set up to have anxiety, so my goal of recovery being like never having anxiety again is probably not kind; it's probably not compassionate or realistic. WHAT IF I DON'T GET BETTER FROM DEPRESSION? Recovery for depression —again, it's going to look different for different people. Some people are going to have a complete reduction of depressive symptoms . Other people are going to have a waxing and waning, and I consider that to still be a part of recovery. It might be that your definition of recovery is, "As long as I'm functioning, I can take care of my kids, and I can go to work and do my hobbies." If that's your definition of recovery, great. Other people might say, "My definition of recovery is to make sure I get my teeth cleaned, go to the doctor once a year, and have an exercise schedule," and whatever's right to them. Really, again, I want to be clear that you get to decide what recovery looks like for you. I've had people in the past say, "I've considered my recovery to be great. I'm not ready to take those next extra hard steps. I'm happy with where I am, and I'm actually going to work at really accepting where I'm at and living my life as fully as I can, whether these emotions or these feelings are here or not," and I love that. WHAT IF I DON'T GET BETTER FROM HAIR PULLING AND SKIN PICKING? Recovery for hair pulling and skin picking —another disorder that we treat at our center in Calabasas, California—might be some reduction of those behaviors. For others, it might be complete elimination, but you get to decide. WHAT IF I DON'T GET BETTER FROM MY CHRONIC ILLNESS? I know that for me, the recovery of a chronic illness was not the absence of the chronic illness. It was getting in control of the things I knew I could control and then working at compassion, acceptance, care, support, and resources for what I could not control. So I really want to emphasize here first that we want to be respectful. I want to be respectful of your definition of recovery before we talk about this fear specifically related to "what if I don't recover." Some people have the fear that they won't recover, and that might be valid because they've put their expectations so high that the expectation in and of itself causes some anxiety. WHAT DON'T I HAVE CONTROL OVER? So let's talk about it first. We're going to first talk about what I don't have control over, and this is what we're talking about here in regards to how I manage this fear. Now, the first thing to do when we're talking about what we don't have control over is, we don't have control over the fact that we have this fear. Of course, this fear is coming up for you because you want to recover, you want to live your best life, and you deserve that. You deserve to have a life where you go on to succeed in whatever definition that means to you. But we can't control the fact that your brain offers you the thought, "What if I don't recover?" We don't have control over that, so let's try not to stop or suppress those thoughts. We know that with research, the more you try and suppress a thought , the more often you're going to have it. The other thing we don't have control over, and I actually mentioned this before, is, we have to acknowledge our genetics and acknowledge that genetics does have a play in this. I'm never going to probably be someone who is anxiety-free. My brain comes up with some ridiculous things. My brain loves to catastrophize. My brain loves to find problems where there aren't problems. That is my brain. As much as I can work at eliminating how I react to that, I'm probably not going to stop that entirely. So I'm going to accept that I don't have control over my genetics, and that's okay. A quick note here too is, if you do have anxiety and it is a part of your genetic—DNA, your family team tends to have it—also catch your anger around that. You're allowed to be angry; you're allowed to be dissatisfied or have grief about that. But we also want to catch that as well. Again, we do have to just acknowledge that no one has control over their genetic makeup. The third thing to remember here is that recovery is a series of valleys and peaks. That we do not have control over. Some people have extreme fear that they will never recover because they believe or were led to believe that recovery should be this very straightforward recovery process where you go from A to B, there's no peaks and valleys, and it's all straightforward from there. We do have to accept that it is normal. Recovery will always have peaks and valleys. It will always have highs and lows. And that actually doesn't mean you are relapsing or anything bad is happening. I actually say to my clients a lot of the time, and I often will demonstrate to them as I'll say, "You're in the messy middle. You've started recovery, so you've made that huge step. You've gone through that chapter where you're learning and you're ready for it, and you've educated yourself and you're prepared. And now you're starting to make some strides. You're seeing where you're doing well. We're also seeing where there's challenges. You're in the messy middle, and this is where valleys and peaks, ups and downs are going to happen. Our job isn't to beat you up when you're in a valley or a low; our job is to stop and just inquire, nonjudgmentally, what's going on? What can we learn from this? What could help me with this if I were to navigate this in the future?" This has been a huge piece of my work managing a chronic illness because I could wake up tomorrow and not be able to get out of bed, but today I feel like I'm full of energy and all good. It's completely out of my control sometimes. On the days where I don't feel like I can get out of bed, my job is to recognize that this is normal. This doesn't mean it's going to be forever. Can I be gentle with myself around this hard day and not catastrophize what that means? So, there are the three things we can't control. WHAT DO YOU HAVE CONTROL OVER? Now we're going to move over to the things we can control. There are actually seven of these things, and we're going to go through them, and they will inform the tools and strategies you are going to use when you're handling the fear, "What if I don't ever recover?" HOW DO I RESPOND TO THIS THOUGHT? Number one, something that we do have control over, is: how do I respond to this thought? Now, you must remember, the fear, "What if I don't recover?" or "What if I never get better?" is actually just a thought. It's not a fact. It's not the truth. It's a thought your brain is offering to you, and we want to thank it for that thought because your brain's trying to help you along. It's saying, "Just so you know, Kimberley, there is a small possibility that you won't recover. What can we do about that?" But if you have that thought and you take it as a fact, like you won't recover, or recovery is not in your future, and you respond to it that way, you're going to probably respond in a way that increases anxiety, increases depression, increases hopelessness, and isn't kind or effective. So we want to first acknowledge, okay, in this present moment, maybe it's Tuesday at 9:30 in the morning and I'm having the thought "what if I don't recover," knowing that on Tuesday at 9:40, I might be having different thoughts, which is again evidence that thoughts are not facts. They're fleeting. They're things that show up in our minds. We can decide whether to respond to them or not. Now, what we want to do when we do have this thought is respond to it in a kind, compassionate way. For those of you who know me and have followed me for some time, I'm always talking about this idea of a kind coach. The kind coach would say, "Okay, I acknowledge that's a thought. Okay. What do we need to do? Kimberley, you've got this. Keep going. Keep trying. You know you've done this valley and this peak before. What did you do in the past that was helpful? What did you do in the past that wasn't helpful? Great, let's do more of that." The kind coach cheers you on. It's there to encourage you. It's there to remind you of your strengths. HOW COMPASSIONATE ARE YOU TOWARDS YOURSELF It's not there to bring your challenges and use them against you, which brings us right to tip number two, which is, you have 100% control over how kind you are to yourself throughout the process.Actually, let me renege that maybe not a hundred percent because I know a lot of you are new to the practice of self-compassion, and sometimes we do it without even knowing. So let's also be realistic about that as well. Forgive me. We can really work at changing how kind we are to ourselves when we have that thought. Let's say you've been through the wringer. It's a very Australian frame or quote, but you've been through the wringer, which means you've been through a really tough time, and you're thinking, "I only have evidence that things go bad or things get worse." A kind coach , your compassionate voice, or your compassionate self—that compassionate part of you would be there to offer gentle, wise guidance on what you need to do for the long term to move you forward. Again, that compassionate voice will validate how hard it's been. It will not invalidate you. It will say, "I understand it has been hard. I understand that this is really, really challenging." It will also offer you kind, effective, wise ideas for what you could do in that moment. Sometimes the kindest thing we can do is just acknowledge the thought and keep going. Sometimes the kindest thing we can do is to say, "No, brain," or "No, anxiety," or "No, I'm not buying into this today. Thank you very much for offering it to me, but you do not get to determine where I'm headed. I get to determine where I am headed." So, compassionate reactions aren't just gentle. Sometimes they're quite assertive and they'll say, "No." Sometimes they might even swear, like, "Bug off, anxiety. I'm not dealing with you today. You're not going to tell me what to do. You can come along for the day's ride. I know I can't get rid of you. I know it's out of my control to try and get rid of you, but you will not determine what I'm going to do today. You'll not get to tell me that my life will be bad, or my life will be terrible or unsuccessful, or I won't have recovery." You get to stand up to fear in that way and let that then inform the actions you take from there. HOW MUCH TIME ARE YOU DEDICATING TO RECOVERY? The tip or tool number three is, also take a look at how much time you're dedicating to recovery. I've had patients who've come to me really struggling with this fear that "what if I never recover?" We actually find that they're not engaging enough in the recovery skills and tools throughout the day. It's sort of like going to the gym. If I went to the gym for an hour, once a week, yes, I would have some improvements, but to really maintain those improvements, I do need to be doing my homework, my stretches, my walks, and my weight training in a way that's effective and not overdone throughout the week. So a lot of you, if you're struggling with this, be gentle around this question, because we don't want to overdo it either. But we may want to check in and say, "Let's be strategic here." I know that in our online course—we have an online course called Time Management for Optimum Mental Health . It's a course to help people schedule and manage their time so that they can prioritize mental health and other things they have to get done. There are other priorities, chores, and things they have to do. We often talk about, let's put mental health first. Have you scheduled it in your day to do your homework if you're doing ERP ? Have you done that? Have you scheduled a time or an alarm to go off to remind you to sit and journal, do some self-compassion practice, or meditate? For me, a big one from my mental health is an alarm to say, "It's time to leave the house. You need to get outside." I work from home. I'm often indoors with my patients. "It's time for you to go outside." That is important for your long-term mental health or your medical health. And so, it's important that we are very strategic and effective about scheduling. I call it calendaring. We calendar recovery-focused behaviors . That is something you do have control over. Again, you do not have control over the fact that the fear is here. You don't have control over whether it will return tomorrow, but you do have control over your recovery and the steps you take, acknowledging that there will still be peaks and valleys. It will not be perfect. One thing I want to stress to you—and I shouldn't laugh because it's actually not funny; it's actually very serious—is that so many people start recovery and get perfectionistic about it, which is often why they're having the fear "what if I never recover," because they've told themselves there is this one way that they are going to recover and that it again shouldn't have peaks and valleys and it should be this way, and I shouldn't be hijacked by any other things. But the truth is, life happens along the way. You might be cruising along with recovery for your specific struggle, and then all of a sudden, a life stressor happens, like COVID. Here in LA, my husband works in the film industry. There's a huge strike happening. It's a huge stressor for a lot of families. It's been going on for months. A lot of families. I have all kinds of stresses—financial, relationship, and scheduling struggles. Life does happen, and so we have to be gentle with ourselves on the times when our recovery isn't going to the speed we would've liked because of the life hiccups that happen along the way that slow our progress. When that happens, we can gently encourage ourselves that we are doing the best we can. We're going to be okay with the fact that it's a little slower. We're going to let ourselves have our emotions about the fact that it's slower than we would've liked, and we're going to gently just keep taking one step at a time in the direction you want to go in. HOW WILLING AM I TO RIDE THIS WAVE OF DISCOMFORT? Now the fourth thing you want to remember here, and something that is in your control when it comes to the fear "What if I don't recover?" or "What if I never get better?" is how willing am I to ride waves of discomfort? This question is key, you guys, and will determine a huge degree of how speedy your recovery is. Maybe it's not even speedy. For some people, it's speedy, but for others, it's how deep the recovery process goes. I know for me that I often will try to get things to move along nice and fast and on schedule and so forth, but I've really missed the true meaning, which is, have I actually learned how to be with myself when I'm uncomfortable? Have I actually slowed down and really had a degree of willingness to be with whatever discomfort it may be—tightness in my chest, racing thoughts, not in my throat, an upset stomach? Am I actually willing to allow that to be there AND still moving in the direction towards my long-term wellness? Often, when discomfort comes up, we're like, "I don't want to feel this. I don't want to have this experience." And that's often when we engage in behaviors that keep us stuck and keep us out of recovery, keep the disorder going. We know that when we engage in behaviors like compulsions, avoidances, and mental rumination, that often just keeps us stuck and keeps us cycling on the same anxiety and the same disorder. The big question: How willing am I to ride this wave of discomfort? You may want to even put it on a scale of 1 to 10. You might say, "Out of 10, how willing am I to ride this wave? 10 being the most, 1 being not at all." I always say to my patients, and I've said it here before, we want to be up around the 7s, 8s, 9s, and 10s. Even 7 is fine. It's all fine, but we're looking for 8s, 9s, and 10s here of how willing you are to really, truly just allow discomfort to be there and observe it as it's there and not engage in it again, as if it were a fact. HOW ACCEPTING AM I OF THE UPS AND DOWNS? Number five is, how accepting am I of the ups and downs? Now, we've talked about this, the peaks and the valleys. When you're going through peaks and valleys, how accepting are you of that? Or when they happen, are you like, "No, this shouldn't happen. I don't like it. I don't want it. It's not fair"? I want to validate you. That response is normal and human, but we want to be careful not to stay there too long because when we're there, we're actually not moving forward. We're then often so much more likely to beat ourselves up, put ourselves down, and compare ourselves to other people. What we want to do is just gently accept. I understand. I validate that this is hard and that we may have taken a step back, and I do accept that. I take responsibility for that in the most compassionate way, and I'm still going to stand up and keep moving forward. It's like that song. I may be aging myself here, but they say, "I get knocked down, but I get up again." He talks about how nothing's going to get him down. This is what recovery is. You get knocked down; you get up again. Maybe it should be your theme song—you get knocked down, you get up again; you get knocked down, you get up again. And that is so brave. I celebrate any of my clients or any of my students when they say, "I got knocked down, but I got back up again." That is so powerful. So courageous. So resilient. I just have all the words to say. I celebrate anybody who is willing to get knocked down and still get up again. So I hope that you can practice that for yourself. HOW PATIENT AM I WITH THIS PROCESS? Number six is, how patient am I with this process? A lot of these are similar, I know, but patience is actually something I talk with clients about all the time. Often, particularly when they have the fear, "What if I never get better?" it's often because they're struggling to really connect with patience. They're doing the actions. They're engaging in their homework. They're moving forward. The only thing that's getting in the way is they're losing patience with the process. This takes time, guys. Changing your brain takes time. It is a long-term process. Just like any muscle that you're building, whether it be bicep curls, quadriceps, or your brain, it does take time. We do have to practice the mindfulness of being patient, steady, and slow, letting it be a process. I know, I hate it too. No one wants to be patient . It would be so much easier if it just happened fast, and you're probably seeing other people where their successes happen faster than yours. But again, go back to: how willing am I to be uncomfortable? How accepting am I of my ups and downs? How can I be accepting of my own genetic makeup and the way that my brain responds? How patient can I be with myself in this process? AM I ASKING FOR HELP? And then that brings us to tip number seven, which is, are you asking for help? Please, guys, as you navigate recovery and as you navigate the fear that you won't recover, please do not hesitate to ask for help. Ask for support. Ask for resources. We have over 350 episodes here at Your Anxiety Toolkit. They're there to support you, to cheer you on, and to celebrate your wins. There are therapists there who are there to help you and guide you. We have a practice in Calabasas, California , where we help people move towards their values as well. There are clinicians in your area. If you don't live in California, we have a whole range of vaults of online courses, if you're needing more resources or reminders. A lot of the people who take out online courses at CBTSchool.com actually have been through treatment, but taking a course helps remind them of the core concepts. "Ah, yes. I needed to remember that. I forgot about that." It's okay. The courses are there. You can watch them as many times as you want. They're on demand. Again, you've got unlimited access. They're there to encourage and support you and push you towards the same concepts of moving towards your definition of recovery. They're the seven tips I want you to think about. We are here to encourage and support you as best as we can and give you those strategies and tools. But the big question again is, are you putting them into practice? Please don't listen to this podcast and go on your way. The only right way that this podcast will truly help is if you put the skills, the tips, and the tools into practice. I always say it's a beautiful day to do hard things, and I really believe that. So I hope today has been helpful. We have really gone over what is in your control and what is not in your control. Please focus on the things that are in your control, and I hope you have a wonderful, wonderful day. I'll see you next week.

Sep 8, 2023

[00:00:00] If social media causes anxiety, you will find this incredibly validated. Today, we are covering the nine reasons why social media causes anxiety and depression, and we will get specific about how you can overcome social media anxiety and depression. In a way that feels right to you, so let's go. If you hear yourself saying, social media gives me anxiety, you are not alone. In fact, many people say it gives them such overwhelm and panic they just want to shut it down completely. That is a common experience, and I want to provide a balanced approach here today. So, let's first look at some social media stats. Research shows that people use an average of 6.6 social media networks monthly. When I heard that, I thought that couldn't be true, but I counted the ones that I use, and it is. I thought that was [00:01:00] very interesting. That sounds like an incredibly massive amount of social media networks. But the average time spent on social media daily is two hours and 24 minutes, not weekly, daily. While 67% say they have a drop in self-esteem as they compare their lives to others they see on social media, 73% of people report. They also find solace and support in these platforms during tough times. We all experienced that during COVID-19, and I know that as someone who lives in America but is Australian, social media has allowed me to be friends with people from high school & college; I get to be connected with my parents' friends. I have found it to be an incredibly beautiful process, but today, we're looking specifically at how social media impacts our mental health, particularly how it causes anxiety and depression. Now [00:02:00], we have some social media depression stats here as well. We do have research to show a link between social media use and depression. More than three hours on social media daily does increase your risk of mental health problems. This study was done specifically for teens, but I think as adults, we could all agree that's probably true as well. There are also some social media addiction statistics that we want to know. We know that 39% of social media users report being addicted to social media, meaning they want to get off but can't. Or, they experience adverse experiences and consequences when they're not using it in moments of distress and needing to regulate. We may also look at some social media anxiety disorder statistics . Studies showed that around 32% of teenagers say social media increases their anxiety and hasn't had a [00:03:00] negative impact on people of their age. However, I found it interesting that only 9% believed it was the case for themselves, but they believed that for others. Interesting statistic. 67% of adolescents report feeling worse about their own lives after using social media, and most teenagers say that social media has had neither a positive nor a negative effect on themselves. So, we are getting some mixed statistics here. The real point for you is to decide for yourself. Is it helping me, or is it hindering my mental health? And if it is, let's discuss some skills we can use. So here we go. NINE REASONS SOCIAL MEDIA CAUSES ANXIETY We have nine reasons social media causes anxiety . Now, to be clear, this needs to be scientifically backed. I did a review from people on Instagram . It's funny how it's a social media platform. Still, I did interview them and did a poll and also have a question box where they get to put [00:04:00] their specific reasons why some social media has impacted them negatively. And here are the results. SOCIAL MEDIA COMPARISON So, the number one reason social media causes anxiety is comparison. Social media comparison seems to be the biggest reason for increasing anxiety and depression, and I think it's important that we identify how social media comparison impacts us. Now, what I've found as a clinician and a marriage and family therapist in helping people with anxiety is how often social media reinforces untrue beliefs they have about themselves. Or, we could say negative beliefs that they had already. Examples: I'm not good enough. I'm not doing enough. I'm not happy enough. I'm not making enough money. I don't have enough followers. I'm not succeeding enough. And that constant, having it in your face of what they're doing and seeing their highlight reels makes us feel like we're not doing enough [00:05:00] and maybe bringing up the insecurities that we aren't enough. So, it's really important that we first use social media as an opportunity to take a look at those beliefs and those thoughts. What thoughts does social media bring up for you? Are the thoughts true? Are they helpful? Do they determine facts, or are they just feelings and thoughts you've had on a whim because of your anxiety? When we look at those thoughts, we can then determine whether we want to respond as if those thoughts are true. It's also important to recognize that people only post what I call their "A-roll." They don't post their B roll. They don't post their C roll. They only post the highlights. They post the things they're most excited about. They post the things they want you to think about. No one wants you to see their dirty socks, laundry, meltdowns [00:06:00], and relationship struggles. People are talking about that on social media, but even those people, we can't assume they're not showing us, you know, only the good stuff. It could be that they're also showing, you know, only the good stuff. FEAR OF BEING JUDGED BY OTHERS Now, we can move on from there and look at the number two reason that social media causes anxiety and depression, and that is the fear of being judged by others. The truth is that social media can cause social anxiety , which is the fear of being judged, humiliated, and shamed publicly. I'm going to really encourage you guys to use social media as an opportunity to practice letting people have their opinions of you. One thing I have learned. Being on social media a lot and being a public figure in many, you know, this small area that I'm a public figure in is I've had to learn how to let people have [00:07:00] their opinions about me. I've had to give them permission not to like me. I've had to practice allowing the right in writing the wave of discomfort that I'm not for everyone. The truth is, when we are on social media, we have to face the fear that our opinions may upset people. People may say things about or critique us, which may impact how we feel about ourselves. I've been through a lot of therapy here, so I can speak about this a lot. I'm okay with people not agreeing with me, not liking me, or understanding me. I've gotten really good at allowing them to have their feelings and thoughts about me. I'm going to have my feelings and my thoughts about them too. Does that mean I don't care about what they think? Absolutely not. I deeply care what they think, but I have learned not to let it imprint how I show up on social media [00:08:00] and how I feel and think about myself. TROLLS The number three reason that social media causes anxiety is trolls. Getting bullied is a huge piece of social media; we see it daily. I have been trolled. People have insisted on taking me down for years, and I have, through what I just talked about, learned to give them permission to really not like me. I've even considered their opinion and really thought about, "Do they have a point?" How can I look at this from a place of compassion? Is it true? Is what they're saying? Factual In many cases, no. Right. Um, the truth is, hurt people hurt people. So, the people online who are saying horrible things usually come from a great deal of hurt, harm, and pain. That doesn't mean I'm saying it's okay that they're doing this behavior. [00:09:00] We must also recognize from a place of compassion that most trolls out there are doing it, not because they're happy, fulfilled people, but because they're on a mission to take people down with them. And that really helps me to be compassionate and not take on their opinion, um, and allow it just to be a part of social media and not take it personally right now. FEAR OF BEING CANCELLED The fourth reason social media can cause anxiety is the fear of being canceled. You may see that these points are growing on each other. Cancel culture is a thing, folks, and I get it. It is scary out there. Many of you say that being on social media, even commenting on your friend's posts, creates the fear that you might say something that will offend them and cause you to get canceled [00:10:00] Maybe you feat that on a whim, you say something or you make a joke that causes you to get canceled. This is a widespread one as well. A lot of folks who weighed in were saying that this is a true fear for them. As someone who has come head to head with this, what was really helpful for me was actually to write down a cancel campaign of my own, which is like, what is the worst thing someone could say about me, you know? What would it, what would they say? Sometimes people will say negative things, which doesn't hurt my feelings, and sometimes I'm afraid they'll say certain things that would really hurt my feelings. I use that as an opportunity to look at those and ask, why are those things so important to me? Is it my values? Is there something about that where I was taught to be ashamed of those qualities as a child? Am I afraid of how people will stand up for me? Or am I afraid of how I will handle this sort of public shaming that goes on. [00:11:00] It was a super helpful experiment that I did with a therapist to really help me get to the bottom of what the fear is, um, and go from there. Of course, I won't say anything mean on social media. I'm not concerned about that, but I am worried at how people will go out and attack me, because it has been something that I've dealt with in the past, and it sounds like it's something that's bothering you guys as well. FOMO Now, we move on to number five. The fifth reason that social media causes anxiety is FOMO . The fear of missing out is a real thing. If you fear missing out, social media can make this so much worse because you will often see other people going off to college, and you see somebody else starting a job in their hometown. You might be thinking that maybe I should have done that. Maybe that the fear of you're missing out on that opportunity. Perhaps you chose to go [00:12:00] to the movies, and then you see a social media post about other people who decided to go to a party, or maybe you went to the movies not knowing there was a party, and then you had deep hurt feelings about not being invited. These are true real emotions, and I want you to slow down for all of these points, but especially this one and give yourself a ton of compassion. And understand that social media does have everybody's a-rolls, and it will mean tou will have emotions. Normal human emotions like jealousy, envy, anger, and resentment. That is a normal human emotion. When we're on social media, we judge ourselves for the emotions we feel about what we see on social media. I shouldn't be judging them. I shouldn't be jealous. I shouldn't be angry. I wanna give you permission to acknowledge and feel all of those feelings [00:13:00] 'cause they're normal human experiences. SOCIAL MEDIA HIGHLIGHTS NEGATIVITY The sixth reason that social media causes anxiety and depression is that social media highlights negativity. Many of you said that you have tried your best to turn off the news. I don't sign onto the news apps, but other people post about things that frighten me when I go on social media. Shootings, global warming, politics, religion, and they were saying that this really creates a lot of anxiety and stress on their nervous system as they just want to have some fun on social media and have a few laughs and watch a few baby dogs and kittens. Have a little fight over a piece of string or something. I get it. I've had that same experience, too. It's the end of the day you're thinking, "ah, I just want to check out and do a little deep breath and then zone out on social media, " yet you're faced and [00:14:00] bombarded with negativity. If that's the case, and this goes for all of the points we're making, do an intention check as you log on to social media. Check in. Do I have the capacity to see things I don't want to see when you see them? Have I got the discipline to turn it off if it's unhealthy for me? It is really, really important piece that we have to remember here. Similar to that. SOCIAL MEDIA TRIGGERS MY ANXIETY DISORDER The seventh reason social media causes anxiety is seeing things that trigger my anxiety. A lot of you said that you go on social media, and lo and behold, your exact fear shows up in somebody's feed, right? Maybe you're afraid of spiders and they've posted a photo of a funny spider, or maybe you're afraid of throwing up or getting sick. Someone's posting about getting cancer and having to be admitted into the hospital. I know [00:15:00] personally, when I was sharing about, you know, all of the medical issues I was having in 2019 and 2020, a lot of people were so kind and so loving, and some people actually reached out and said, I am so incredibly triggered. What's happening to you right now is literally my worst fear coming true. And so I get it. Again, we have to do an intention check when we go on social media and be prepared to see what we don't want. Right? One thing to know here, too, and this is a skill I want you to take on or more, it's actually a strategy, is you can train the algorithm to do what you want it to. So, as you've probably already experienced, if you wanna see more videos of dogs, Google or search for dogs and it will start to show you more, particularly if you watch the video from start to end. You can also click on specific content. When you see something you don't want to see, you can click a button and say, see less of this, [00:16:00] or block this topic, or block this hashtag. And that can be a way to help you keep your social media clean. Right. Another thing to remember here and going back to seeing other people's a role, is you can actually mute your friends. They won't even know if what they're doing is too triggering and it's causing you so much depression, right? Because we do know that social media can cause depression. It's okay to take a break from them, particularly if they're in your face a lot with all their successes and wins. You can mute them. You don't have to unfollow them or block them. You can mute them, so you're still remaining friends. They still know that you're important to them and they're important to you, but you don't have to be seeing their content. You can take a break and set healthy boundaries with social media so that you're not continually being bombarded by what they're posting. That goes with things that trigger you as well, anxiety-wise. Now, the eighth thing that causes [00:17:00] social media, um, to cause anxiety is perfectionism. Now I've put two things in one here, which are perfectionism and exceptionalism. Perfectionism is the hope to be perfect and not make mistakes. The truth is, on social media and off social media, you will make mistakes. You're not going to be perfect, and you have to bathe yourself in a ton of self-compassion when engaging on social media and giving yourself permission again to be imperfect is to let it be a little rough. You don't have to be perfect and make it curated. And all the things some people posted about how they even had anxiety about what graphics they use, um, how they're making their posts, whether they line up perfectly, whether the music is exactly the right thing. Again, just be real. No one wants to be friends [00:18:00] with perfect people. Believe me, I have found much more success on social media being a normal human being who is imperfect and is just regular old Kimberly. And yes, there are perfectly polished accounts, but you have to ask yourself, is that helpful for my social media? Maybe what they're doing is good for their mental health. Is it good for me? 9. SOCIAL MEDIA CAUSES OVER-STIMULATION Right now, the last one, the last point on why social media causes anxiety is overstimulation. This is a big one, and I finished with this one for a reason is social media posts are made to keep you on the platform. That's how they make money. The posts that get sent to you and are suggested to you are so short, fast, and funny because they're promoting the exact videos and campaigns that will keep you engaged. But the problem with that is if you're [00:19:00] engaging and consuming content that is fast-paced, short, the content is very quick and it changes 1, 2, 3, 4, really, really fast and example would be TikTok, it actually will leave your nervous system quite overstimulated. This is a problem, folks. The overstimulation. How social media content is delivered to us increases people's anxiety and stress levels. It increases the chance that they engage in safety behaviors such as compulsions because you put the phone down and you're literally vibrating from overstimulation. I'm going to encourage you again to do a check-in. Is this good for me? Does this makes sense.?Are the benefits outweighing the negative? And a lot of the time the answer is no. How do we fix this? A lot of it that I have found is around setting strong [00:20:00] boundaries with social media. I created a course called Time Management for Optima Mental Health , and a reason for that wasn't because of social media; it was because many people with anxiety and depression tend to engage in behaviors that make their anxiety and depression worse. What we do in this course is work at scheduling the healthy behaviors first and then building your day around that. If social media is a problem for you, we're going to set some limits and intentionally put some parameters and boundaries in to help you manage your mental health. Other resources include that most phones have a shut off time or an alarm that will alert you to when you've gone over or you have spent too much time. Some phones also will give you a usage report. [00:21:00] I know my iPhone sends me a usage report every Sunday. Kimberly, your social media uses up by such and such a percentage. Or it's down, or you know, you're within your limits if you set limits for yourself. I know my daughter set a social media limit for herself because after a certain amount of time, she was getting overstimulated, and she was starting to feel lethargic and crappy. And then she wanted not to eat, exercise, sing, or do the things she loved to do. And that was an effective move on her part very, very wise. Another thing to remember is many phones. Well, all phones will have an app. There are many apps you can access that will shut your phone off so that you actually cannot access that social media app or pro platform once you've used a certain amount of time. And if you are someone who struggles with boundaries and really disciplined in that area. Go ahead and get [00:22:00] those apps. Invest in them because they will be better than therapy that you get. Maybe, probably not, but it will contribute and complement your therapy in that you've invested in this tool to help shut down. These apps if they're not helping you. Now, once again, I'm not saying all social media is bad. Again, social media has lifted me out of depression in many cases. When I was having a lousy day showing me funny things, you know, me passing back, . Funny, you know, reels between my husband and I is a way for us to connect when he's at work, when he's away, or when he's upstairs and I'm downstairs. It's not all that. It's about being intentional and checking in on what's helping you. What's not, it's going to be different for every person. So truly listen to yourself and go from there. Now, as I always say, it is a beautiful day to do hard things, and what that means [00:23:00] is setting limits is hard. It's not fun. It actually takes a lot of willpower. So do employ your support systems, ask for help, get a therapist if you need one, who can help you implement some of these tools. As always, I hope this has been helpful, and I look forward to talking with you next week.

Sep 1, 2023

Am I doing ERP correctly? This is a common roadblock I see every week in my private practice. I think it is a common struggle for people with anxiety and OCD. Today, we will talk about the three common OCD traps people fall into and how you can actually outsmart your OCD and overcome it. https://youtu.be/Ngb_lQK5Fnk?si=9FU42GZZZDJ58f-W Now, when we're talking about Expsoure & response prevention ERP , we must go over the basics of ERP therapy, so let's talk about what that means before we talk about the specific traps that we can fall into. ERP is exposure and response prevention. It's a specific type of cognitive behavioral therapy and is the gold standard treatment for OCD to date. And it's a detailed process, right? It's something that we [00:01:00] have to go through slowly. It's a detailed process where we first identify OCD obsessions and OCD intrusive thoughts. So, you'll identify precisely the repetitive, intrusive, and distressing things for you. Once we have a good inventory of your OCD obsessions, we then identify what specific OCD compulsions you are doing now. A compulsion is a behavior that you do to reduce or remove your anxiety, uncertainty, or doubt, or any kind of discomfort that you may be experiencing. And once we do that, then we can move towards exposing you to your fears. Exposure therapy for OCD involves exposing yourself to those specific obsessions. And then engaging in [00:02:00] response prevention, which is the reduction of using those compulsive safety behaviors. Now, common OCD response prevention will involve reducing physical behaviors, reducing avoidant behaviors, or reducing thought suppression. It's reducing reassurance, seeking, reducing mental compulsions, and in reducing any kind of self-punishment that you're engaging in to beat yourself up for the obsessions that you're having. Then we get you engaged back into doing the things you love to do; getting you back to engaging in your daily life, your daily functioning, the things that you find pleasurable, and your hobbies as soon as possible. That's the whole goal of ERP. Right? The important thing to remember here is that ERP therapy for OCD is greatly improved by adding in [00:03:00] other treatment modalities, such as acceptance and commitment therapy or mindfulness-based cognitive therapy, DBT , and medication. I should have mentioned medication first because most of the science shows that that's one of the most helpful to really augment ERP therapy for OCD. If you want to go deeper into that, I strongly encourage you to check out Exposure and Response Prevention School . I'll show you how to do all of those steps in ERP school, our online course for OCD. You must know how to do those steps and that you're doing them in a way that's careful and planned so that we're not overwhelming you and throwing you in a direction that you're not quite prepared for; you don't have the tools for yet. And so today, I wanted to discuss three questions that come directly from people who've taken ERP school [00:04:00], and they're really trying to troubleshoot these three common OCD traps that OCD gets them stuck into. So, let's get to the good stuff now. OCD TRAP #1: IF I DON'T ENGAGE WITH AN OBSESSION, AM I THOUGHT SUPPRESSING? What if I don't engage with an obsession? Am I thought suppressing? One of our listeners said, "I know what you resist persists. We talk about that in ERP school, but I also know that obsessive thinking and worrying can become compulsive. Is it possible I could be caught in both situations, and how common is this?" So I want to really be clear here in what we're saying when we say to practice ERP. So when you have an obsession or the onset of an intrusive thought or intrusive feeling, sensation, urge, it could also be an image. When you have that,[00:05:00] you're old way of dealing may have been to try and push that thought away with some urgency and aggression. We call that thought suppression and that's an avoidant compulsion, so yes. This student of mine is correct. That becomes compulsive, right? But we also know if we go into the obsession, try and figure the obsession out, give it too much of our attention. We're also engaging too much with it in terms of using mental compulsions. That too is a compulsion. So we want to see that these two things can happen. But when we have the thought, and we observe that it's there the obsession, we've noticed it's there. Right? We talked about this in previous episodes of your Anxiety Toolkit podcast. When you identify it's there and then you say, I am gonna let it be there and still move on. To what you love to do, [00:06:00] what you value that is not resisting it, that is engaging back into what you find important and effective, and valuable for your life. It's not avoidance, it's not thought suppression. Now, if you do that in a way where you're like, oh, I don't want that thought. I want to engage in what I'm doing. Now you're crossing into that reaction being with . Urgency and resistance, and anytime we're doing anything in a sense of urgency and resistance, well, yes, it may be becoming a compulsion, right? And what we're talking about here, the way to manage this trap, right, is to find middle ground, and it often involves slowing. Down being a little more thoughtful in how you respond, and that's often using mindfulness. We talk a lot about mindfulness here in your, your anxiety toolkit [00:07:00] in observing, okay, this is happening. I. I'm going to respond in a way without urgency, and I'm going to come back to what I'm practicing. That isn't thought suppression. It's also not avoidance. It's also not doing a mental compulsion or ruminating. It's what we call occupation. You're engaging back into what you need to be doing. Right, which brings me right to trap number two, which is did I expose myself to the thought enough? OCD TRAP #2: DID I EXPOSE MYSELF ENOUGH TO THE FEAR? The fear, "Did I expose myself enough to my fear?" and, "if I dont engage with an obsession, am I thought suppressing? These are two very close obsessions. But, there's a nuance difference that I want to ensure we address here. So the student says, right now when anxiety sets in, I divert my attention to something else to focus on my values. Beautiful. Right? Then usually anxiety will wear off pretty quickly and I choose to move on. The problem is what happens next? So, so far this is beautiful. [00:08:00] Just like what we said they go on to say, my mind immediately points out the fact that I didn't quote, unquote, savor the anxiety or look it in the eye, right? And that they're doing that to prove they're not scared of it. Or that they can they can tolerate it, right? And so they go on to say, "OCD accuses that my diversion wasn't in fact occupation or being functional and effective, that it was avoidance and, and that I'm avoiding to deal the anxiety feeling that I have. And they then go on to say, this makes me more scared of the intrusive thoughts in the long run." So, if we were to break this down, this person had a thought, they responded really effectively. But then, this is the trap. OCD will usually tell you there's a way you're doing this wrong or there's a way that there's an additional thing you haven't addressed yet. It usually [00:09:00] is like you who I have more to say, have you thought about this? Like it's saying, you know, there's other things you should be worried about. And in this case, they have dealt with it really beautifully. But then OCDs come in and said, no, you didn't look at it long enough. You didn't face it enough. If you don't face it enough, well then you're gonna keep having this anxious feeling in the long run. And really in that situation, all we need to do, I. Is practice exactly the same tools we use with the first obsession, which is to go maybe, maybe not, but I'm not tending to you. I'm not trying to make this perfect. I'm going to move forward with what I am going to do and allow the uncertainty that I may or may not have anxiety about this in the future, or I may or may not have looked my fear in the face enough, right? Remember here that O C D. Is always going to try and bring you back into doing [00:10:00] a compulsion to try and get that uncertainty. And your job is to catch the many ways OCD consistently pulls you out of using effective behaviors and tries to get you to use compulsions. If you can find those trends, you can identify them as, okay, we know what to do when they come. When it tells me I'm not doing it enough, or I'm not looking at my fear enough, or I'm avoiding it, or whatever, you can go, I'm not tending to that. I'm moving back to my values. Right. Which beautifully now brings us onto the final trap, trap number three, which is, how do I know I'm doing ERP correctly? OCD TRAP #3: HOW DO I KNOW IF I AM DOING ERP CORRECTLY? People often ask, "How do I know if I am doing ERP correctly?" This is a very common one. In fact, I have consulted with dozens of different OCD therapists, including the ones in my private practice . For those of you [00:11:00] who don't know, I have a private practice in Calabasas. We have eight incredible licensed OCD therapists. We are constantly consulting on this kind of question or these traps in particular, and it's often around, how do I know I'm doing this right? And it makes sense, right? If you're doing ERP therapy, you want to get better, you're here to get the job done, and you want your life back. You're not putting in all this time and paying all this money and investing your valuable resources, um, to just . Have a good time and waste it, right? You're here to get better. And so it makes sense that you're going to have some anxiety about how well you're doing it, and you're obviously wanting to do it well, like you're someone who is thorough and is invested, so it makes sense that you're going to have this fear. But this is the thing to remember. This is another trap of OCD to try and get you to go back to rumination, right? To try and figure something out. [00:12:00] Here is the facts. No one does ERP correctly. You are going to do ERP, and you are going to fall and you're going to try again, and you're going to fail again, and you're going to try again, and you may fail again. That is a normal progression of ERP. I tell my patients all the time, you're not backsliding. Nothing is particularly wrong right now. This is just the normal progression that we get better over time. Just like when we're learning to walk. You stand up, you fall down. It's not like you say, I'm not able to walk, I'll never be able to do it. You get back up, you walk three steps, you fall down, then you get back up, you walk five steps, you fall down. That's normal, right? We are not going to say to a young baby like, oh, you're not walking correctly. You know, this is bad. You're never gonna be able to walk because you're not walking correctly. No, we're going to say to them, keep going, keep trying. Just keep trying. And with time, those muscles will strengthen. And you'll be able to stand up and do this work a little longer each time, but do not fall into the trap [00:13:00] of O C D telling you it has to be done perfectly and you have to do mindfulness correctly, and you have to do response prevention correctly, and you can't do any thought suppression or you'll never get better. That is another trap, and your job is to say, good one, OCD. Thank you for your input, but I'm still over here with the focus of not trying to engage in rumination and trying to get certainty, but to, to move towards my values, to allow fear to be there imperfectly, right imperfectly, knowing that it won't be perfect every time. You may engage in some compulsions. I'm going to keep saying that that is not particularly a problem. Right. Especially if as you're doing it, you're using your tools and you're doing the best you can, try to just focus on doing one minute at a time and doing it as you can. And we're not here to do it perfectly. Right? And at the end of the day, if you're someone who struggles [00:14:00] with this thought, like, am I doing it correctly or am I doing it perfectly? You can just say, "Maybe I am. Maybe I'm not. I'm also not getting caught in that trap." So I hope that that has been helpful to really get to know these traps. And for you, it mightn't be specifically these three common traps. It may be something a little different. That's okay. Your job is to catch these trends, the things that keep pulling you back into rumination, pulling you back into avoidance, pulling you back into reassurance-seeking, and identify them. Come up with another plan. Again, if you need more help with this, you can use E R P school. It's an online course. It's on demand. You can listen to it and watch it as many times as you want in your PJs. It's there for you to troubleshoot these issues. We have a whole bunch of modules talking about how to troubleshoot these issues, but I wanted to do this publicly because I knew A lot [00:15:00] of you who don't have access to care are probably struggling with the same thing. So that's it for me today. Thank you so much for being here. I love talking with you about the nitty gritty of how this can, you know the real hard stuff and I hope it's been helpful for you. Please do remember, and I say this at the end of every podcast episode, you know I'm gonna say it. It is a beautiful day to do hard things. Do not let society tell you that you're weak or that you're not supposed to. And it should be easy because that's not real life. I know it's hard to accept that, but we can shift this narrative to a narrative where we can do hard things. We can see ourselves as strong. We can see ourselves as courageous, and we will do the hard thing because in the long run, we build resilience and freedom that way. Have a wonderful day, everybody, and I can't wait to see you next week.​[00:16:00]

Aug 25, 2023

If you are interested in stopping compulsions using attention control, this is the episode for you. I am really excited for this episode. This was a deep dive into really how to fine-tune your mindfulness practice for an xiety and OCD . Today we have the amazing Max Maisel, who is an OCD and anxiety specialist here in California. He came on to talk about these really nuanced differences of mindfulness, where we might go wrong with mindfulness, how we can get a deeper understanding of mindfulness, and this idea of attentional control. The real thing that I took away from this is how beneficial it can be at reducing mental compulsions, putting our attention on the things that we value, putting our attention on what we want to put attention on, not in a compulsive way at all. In fact, we addressed that throughout the episode, and it's just so, so good. I'm so grateful to you, Max, for coming on, and I just know you guys are going to love this episode. Now, we are talking about some pretty difficult things, like things that are hard to do. I even roleplayed and explained how hard it was for me to do it. I want, as you listen to this, for you to please practice an immense amount of self-compassion and recognition and acknowledgment of just how hard it is to do these practices and how we can always learn more. Hopefully, something in this episode clicks for you and feels very true for you and is hopefully very, very beneficial. I'm going to go take you straight to the show because that's what you're here for. Have a wonderful day everybody, and enjoy this interview with Max Maisel . Kimberley: Welcome. I am so excited for this episode, mainly because I actually think I'm going to leave learning a ton. We have the amazing Max Maisel here today. Welcome. Max: Thank you, Kim. It's really good to be here. I'm super excited for our conversation. MINDFULNESS FOR OCD Kimberley: Yeah. Okay. You know I use a lot of mindfulness. I am a huge diehard mindfulness fan, but I love that you have brought to us today, and hopefully will bring to us today, some ways in which we can drop deeper into that practice or zone in, or you might say a different word, like how to focus in on that. Tell me a little bit about how you conceptualize this practice of mindfulness and what you use to make it more effective for people with anxiety and OCD. Max: Yes, for sure. So, I'm a major proponent of mindfulness practices. I use it myself in my personal life. I integrate it in the clinical work that I do with clients with OCD and anxiety. But one of the concerns that I've seen in my clinical work is that mindfulness is such a broad concept and it covers so many different types of psychological suffering. The research behind mindfulness is just like hundreds, maybe even thousands of studies. But when it comes to very specific and nuanced concerns like OCD and anxiety, it could be a little bit confusing for people sometimes to figure out, "Well, how do I apply this really healthy, beautiful, amazing tool to how my own brain is wired in terms of like sticky thoughts or just to engage in all sorts of compulsive behaviors." I like to think about mindfulness from Jon Kabat-Zinn's definition at the core—paying attention to the present moment in a way that's non-judgmental and with this curious intentionality to it. But then within that, there's some really nuanced details that we can talk more about how to make that really relevant to folks with OCD and anxiety. THE DIFFERENCE BETWEEN ATTENTION & AWARENESS Kimberley: Tell me a little bit. When we're talking about mindfulness, we often talk about this idea of awareness. Can you differentiate first—and this is using some terminology just to set the scene—can you differentiate the difference between attention, awareness, and even a lot of people talk about distraction? Can you share a little bit about how they may be used and what they may look like? Max: I love that question. I think in a good OCD treatment , people really need to have a good solid understanding of those differences. I'm actually going to borrow from a neuroscientist named Amishi Jha. She's this incredible professor at the University of Miami. In her research lab, they look at the neurological underpinnings of mindfulness, and that very much includes attention and awareness. I highly encourage anybody to look up her work. Again, it's Amishi Jha. She talks about attention or focused attention. If you imagine there's a dark room, and if you turn on a flashlight and you shine that beam of light into that room and say that beam of light hits a vase on a table, again, what happens to that vase? What's different compared to all the things in the background? Kimberley: Is that a question for me? Max: Yeah. If you imagine a beam of light, what goes on with that? Kimberley: You would see the front of the vase, maybe it's a bit shiny, or you would see the shadow of the vase. You would see the colors of the vase. The texture of the vase. Max: That's exactly right. From this vivid and detailed, you can see all the different descriptions of it and it becomes privileged above everything else in the room. That vase is that beam of light. And then somebody might take that flashlight and shine it to the right a little bit, and then it goes from the vase, let's say, to a chair next to it. All of a sudden, that vase is still there, but it's fallen into the background. We might call that our awareness, which we'll talk about in a second. But then that table that we shine on or the chair is now privileged over the vase. That's how you can think about focused attention, is this beam of light. Whereas awareness, instead of a focused beam, you can think about that more as a broad floodlight where it's effortless, it's receptive, and you're noticing what is present in the moment without privileging one thing over the next. We're not focusing or hooked on anything particular in that room, it's just observing whatever comes up in the moment. Does that make sense? WHAT IS DISTRACTION? Kimberley: It totally makes sense. Excellent. What about distraction? Max: Distraction, when we think about that broad floodlight of awareness, where again, where what's privileges the present moment, distraction is trying to get things out of that. It's trying to suppress or not think about or get something that is in your awareness, outside of your awareness. But unfortunately, the trap that people fall into is in order to get something out of your awareness, what you need to do first is shine your beam of attention onto it. Inadvertently, while it might seem like a good idea in the short term, especially if it's something really scary, that pops up in your awareness like, "Oh, I don't want this. I want to get this thing out of my awareness." But in doing that, you're literally shining your attention. That flashlight is right on the scary thing. The very act of trying to distract, trying to push it away actually keeps that thing going, which is why it can be so easy and so tricky to get stuck in these pretty severe OCD spirals by doing that. Kimberley: Right. If we were talking about mindfulness, and let's go back to that, are attention and awareness both parts of mindfulness? Give me how you would conceptualize that. Max: That's exactly right there, and that's what I was talking about where mindfulness is such a beautiful, helpful practice and term. But oftentimes when we say just mindfulness, people don't understand that there are really relevant parts of mindfulness that are actually applicable skills that we can practice getting really good and solid without shining that beam of light and focusing flexibly on aspects of our experience. We can get good at letting go of that focused attention and just being with what pops up in our awareness, which are very relevant practices when we have OCD or anxiety. But if we just say mindfulness as a whole, paying attention to the present moment, we could miss these really important nuances and actionable skills that are different parts of mindfulness. Kimberley: Let's go deeper into that. Let's say you have OCD or you have panic disorder, or you have a phobia, and your brain-- I was talking with my son who has anxiety and he was saying, "I keep having the thought. No matter how many happy thoughts I have, it just keeps thinking of the scary thought." That's just a really simple example. How might you use attention versus awareness or attention and awareness for folks who are managing these really sticky thoughts, like you said, or these really repetitive, intrusive thoughts? Max: It's such a good question. OCD, I always talk about how clever and tricky it is. In order to get through OCD, we need to be even more clever, more tricky than OCD. One of the ways OCD gets people to fall into its trap is by confusing them. It gets people to try to control things that they cannot control, which is what pops up in their awareness, but it also blinds people and gets them that they can't see that there are things that are in their control. That will be really helpful, powerful tools, and OCD gums up the works a little bit. MINDFULNESS & ATTENTION TRAINING To be more specific, there's an aspect of mindfulness that we can think of as attentional training or attentional flexibility. What that is, it's strengthening up the brain's muscles to be able to take control of that flashlight, of that beam of focused attention. OCD, what it's going to do, it steals it from you and shines it on the really scary stuff, like with your son, "Oh, here's a thought that you really don't like," or "Here's a really uncomfortable sensation." All of a sudden, that beam of light is shining there. What attention training does, it really teaches people to be able to first notice, "Oh, my beam of light is on something really scary. Okay, this is a thing. This is a moment to practice now." But then more importantly, to be able to then take power back and be able to shine that flashlight in flexible ways that are in line with people's values and goals versus are in line with OCD's agenda. But attention training, it's not only getting really good and powerful at shining that beam of light on what you want to shine, but it's also the practice of letting go of control over the stuff that's in our awareness. We're going to practice and allow those scary thoughts and feelings. I treat them like a car alarm going off where it might be annoying, might be uncomfortable, but I'm not going to focus on them. I'm not going to pay attention to it, because otherwise there's going to be front and center. It's both. It's awareness, it's being able to flexibly shift between different aspects of our experience, and it's also allowing things to go, and you're like that broader floodlight of awareness. I always find it really helpful to practice the skill of attention training on non-OCD, non-anxiety neutral stimuli. It's not too triggering. And then we can start applying that to anxiety. If it's okay with you, Kim, I would love to walk you through some quirky little easy exercises that just help you maybe understand what I'm talking about and hopefully your listeners as well. Kimberley: I was just going to say, let's do it. Max: Let's do it. Let's dive in. Kimberley: Let's roleplay this. ATTENTION TRAINING EXERCISE Max: Okay. I want you to roleplay with me and if your listeners would like to roleplay as well, more than happy to follow along too. Again, these exercises, I don't see them as like coping skills. I see them as like creating an understanding of what we can control, what we can't control, and being able to just feel what that's like in our bodies and know that this is something that we can do. For the first one, what I want you to do is put your thumb and index finger together, like you're making an okay sign. Put a little bit of pressure between your thumb and index finger, but not a whole lot of pressure. Just take a couple of seconds and see if you can put your brain into your thumb and your index finger and just notice what that feels like. Notice the sensations. Let me know when you feel like you've got a good sense of the feeling. Kimberley: Yep, I got it. Max: What I want you to try to do is shine that beam of attention. Really focus in on the pressure only from your index finger and see if you cannot think about not engage in the pressure from your thumb, allowing that to be there. See if you can really find and identify what your index finger feels like. let me know when you've got that. Again, not thinking about your thumb, just focusing on your index finger. Kimberley: Yeah, that was hard, but I got it. Max: It is hard, right? Because what we're doing is honing in that beam of light that we're paying attention to. What I want you to do now is switch. Let your index finger, let that feeling go, and switch to your thumb. Again, only focusing on the pressure from your thumb and allowing your index finger, allowing that pressure to be there without thinking about it or controlling it. Just letting it exist, and then focusing on the pressure from your thumb. Kimberley: Yeah, I got it. Max: We could do this for five, ten minutes. I won't make you do it right now, but you can see there and there's like a bump. There's a shift where you go from one to the other. It's great. It's not about getting into details, it's about noticing, "Oh, I can pay attention flexibly. I can focus on my index finger, allow the thumb feeling to be, and then I can switch to the opposite side." That's one way that people can start understanding what I'm talking about, where we can flexibly pay attention while allowing other stuff to exist in the background. Kimberley: Let me bring up my own personal experience here because, like I said, I'm here to learn. As I was pushing, I actually had some pain in my thumb. As I was trying to imagine the top finger, that index finger, that was really hard because I have a little bit of ligament pain in my thumb. I had to work really hard to think about it. What was actually getting in the way was the thoughts of, "I won't be able to do this because of the pain." What are your thoughts on people who are fighting that? Max: It's such an important piece of this because oftentimes what prevents people from practicing are these thoughts and beliefs that pop up. The belief of, "I have no control over rumination," or "I cannot pay attention." I'm saying this, and where we're stepping back and noticing these are thoughts, these are stories as well. Part of the practice is, can I see them as events of the mind? Can I see them as stories? Allow them to be in the background, just like we're maybe allowing the sensation of your index finger to be in the background while maintaining focus on that one part of your experience, your thumb. Again, we want to treat pain, thoughts, feelings, sensations as best as we can, allowing them, seeing them as mental events versus as distinct parts of who you are as a person while maintaining as best as you can that focused beam of attention on what you choose to. Kimberley: Right. This is really cool. Just so I understand this, but please don't be afraid to tell me I've got it completely wrong. As I was doing it, I was noticing the top of my index finger, doing my best, and in my awareness was the thoughts I had and the pain that I had. My attention was on the top, but there was some background awareness of all the other noise. Is that what you're saying? Max: That's exactly what I'm saying. The trick with OCD or anxiety is, can we allow the stuff in the background? Because a lot of people get annoyed or frustrated. And then as soon as you do that, that focus goes from your index finger to the stuff that you don't want versus if we can let go of control. Another way to think about it too is if you're looking out of a window. Focused attention would be, you are immensely engaging in this beautiful oak tree in your front yard. I don't have an oak tree, but hopefully, somebody does. Imagine you're really focusing on this oak tree, and that is what you're paying attention to. Now, there might be other things that come and go. There might be birds flying and bushes in the background. There might be houses and a bunny rabbit running by. You could choose to then shift your beam of light from the tree to one of those things, but you don't have to. You can keep paying attention to the tree and allowing all this other stuff to exist. That would be what we're talking about and that's the practice you could do with your fingers. And then with that same metaphor, broader just overall awareness would be looking out the window, but not intentionally focused on anything. Just letting your eyes wander to whatever is present. "Oh, I notice the tree and I notice a cloud and I notice a bird. Oh, I noticed a thought that I've been looking out this window for a very long time." We're not questioning, we're not ruminating, we're not judging, we're just simply being there with what's present. That's that broader awareness piece to this. Kimberley: Okay. I love it. For those who have probably heard me talk about this, but not using this language, or are completely new and this is the first time I've ever logged in and listened to us, how may they apply this to specific intrusive thoughts that they're having? Can you walk us through a real example of this? You could use my son if you want, or an actual case of yours or whatever. Max: Yeah, for sure. If we think about it in this way, also, it's like a little bit of a different approach than maybe how some people think about exposure and response prevention . Because in this way of doing things, there's a really hard emphasis on the response prevention piece, which in this case would be not ruminating, not engaging in the mental compulsions. It's doing the exposure, which is triggering the scary thoughts and the feelings, and then accessing awareness mode, like being with what's present. An example of that, let's just say somebody has an intrusive thought, a really scary fear that they might hurt somebody. They might be a serial killer or they might do something really bad. Let's say we want to do an exposure with that thought and we choose a triggering thought of, "I am a murderer." Normally, when they have that thought, they do all this stuff. Their focused attention is on that thought, and they're trying to convince themselves they're not a murderer. They're trying to maybe look for evidence. "Did I kill somebody? I did not." They're engaging in this thought, doing all this sort of stuff that OCD wants them to. One way that we might use this difference in attention awareness, doing exposure would be to first evoke the scary thought. Maybe really telling themselves for a couple of seconds like, "I am a murderer. I am a murderer, sitting with the fear and the dread and all the stuff that comes up." But then instead of focusing on it, then letting go of any engagement. We could just sit there and actually do nothing at all. We just watch and observe. Like you're looking out that window and that thought "I'm a murderer" might pop up, it might go away. Another thought might pop up. But we want to take this stance of, "None of my business." We're going to sit here, we're going to observe, and we're not going to mentally engage in the thoughts. It's really accessing this more of like awareness mode. We can actually do something like that. If you want to, Kim, we don't have to use an intrusive thought, but we can, again, practice with a neutral thought together and then apply what I'm talking about. Usually, what people realize is that what happens to their intrusive thoughts is what happens to 99.9% of all the thoughts they get in a day where it comes and then it just goes away when it's ready. If you think about it, we have thousands and thousands of thoughts per day. Mostly that's what happens because we're not focusing our beam of light on it, because we're not doing all this work that inadvertently keeps it around. It's exposure not only to sit with the feelings, but to practice the skill of letting go, of focusing on it, of letting go of any mental compulsive behaviors towards it. ATTENTION TRAINING VS DISTRACTON Kimberley: Right. I know this is going to be a question for people, so I'm going to ask it. How does attention training differ from distraction? Quite often, I will get really quite distressed messages from people saying, "But wait, if I'm being mindful on the tree, isn't that me distracting against my thoughts?" Can you talk about, again, differentiating this practice with distraction or avoidance? Max: Yep, absolutely. I like to think about it as an attitude that people take where we're willing to have whatever our brain pops up at us. With distraction, we're unwilling. We don't want it, we don't like it, we're turning away from it. But that's actually like, it's okay too. We call it distraction, we can call it engagement. It's okay to live your life to do stuff, but we have to first get really clear on, can I allow whatever my brain pops up to be there without then keeping that beam of attention on it? Because all mental rituals, all sorts of stuff that we do starts with focused attention. Summons, rituals are pure retention, but a lot of them like analyzing, reassurance, attention is a major part of them. If you can notice when our OCD took that beam of light and shined it, then we could practice taking the light off, allowing it to exist, allowing it to be there, but without engaging. If you want, Kim, I'm happy to maybe do another experiential exercise, not to throw too many at you today. Kimberley: No, bring it on. Max: So maybe you and your listeners can understand that piece to it. Kimberley: Yes, please. ATTENTION TRAINING EXERCISE #2 Max: Okay. Lets start with attention training exercise #2. What we're going to do is we're going to practice engaging in what we might think of as a rumination, analytical way of thinking. Again, rumination, mental compulsions, they are a behavior. They're a mental action that we're taking that we could turn on, but we can also turn off. We want to be able to turn off mental compulsions throughout the rumination, but allow any thoughts and feelings to exist without doing anything about them. I know it sounds heavy, so let me show you what I mean by that. Kimberley: Good. Max: What I want you to do is think about a vacation or a trip that you either have coming up, or it might be like a dream vacation that you really want to take, and just take a second and let me know when you got something in mind. Kimberley: I got it. Max: You got it. That was quick. That was a good thing. What I want you to do is start mentally planning out the itinerary for this vacation, thinking about what you're going to do, all the steps you're going to take, just like doing it in your mind. And then I'll tell you when to stop. Okay. Stop. Now what I want you to do is let go of that engaging analytic way of thinking and just sit here for a couple of seconds. We're not going to do really anything. If the idea of the vacation pops up in your mind, I want you to allow it to pop up. But don't think about it, don't focus on it. Allow it to be there or not to be there. Just don't do what you were just doing where you're actually actively thinking about it. Are you ready? Kimberley: Mm-hmm. Max: Okay. Again, we're just going to sit and we're going to observe. Whatever comes up, comes up. We're going to let it hover and float in your overall awareness without focusing on it. Waves washing on the beach or just letting your thoughts and feelings come and go. We're not engaging, we're not thinking about them. We're just observing. What I want you to do one last time, I want you to start thinking again, planning, going through the itinerary, thinking all the cool stuff you're going to do. As you're doing it, notice what that feels like psychologically to go from not doing to doing. And then start thinking about it, and I'll let you know when to stop again. All right. We can let go of the vacation. Again, just for five, ten seconds sitting. If the thought pops up, allow it to pop up, but don't engage in it. Don't manipulate it or actively walk through the itinerary again. Just notice what that's like. Okay, Kim. I'd love to hear your experience walking through, turning it on the analytical way of thinking, and then turning it off and playing around with it a little bit. Kimberley: Okay. Number one, I immediately was able to go into planning. I think because I do this, this is actually one of the things I do at bedtime. I've planned my 91st birthday, my 92nd birthday party. That's what I love to do, so it was very easy for me to go into that. When I went back to more awareness of just what I noticed, I was actually able to do it really easily except of the thought like, "Oh, I hope I don't have the thought. I hope I'm doing this right." Max: That's such a beautiful way, and the mind is going to do stuff like that. We're going to start thinking about thinking, and I'm curious how you respond to that thought. What you did next? Kimberley: I was just like, "Maybe I will, maybe I won't. What else?" And then I was like, "Well, there's Max and there's my microphone." That was the work. Max: Yes. That's exactly what I'm talking about. We're not like, "Don't think about this vacation." Because if we did that, what do you think that would do to you if you're just sitting there in that moment of awareness and be like, "This is not a good thought to have, I can't think about this upcoming vacation"? Kimberley: Well, I had more of them and I had distress about them. Max: Yeah, exactly. That's what I mean by we're not distracting, we're allowing, but we're also not analytically thinking about it. Now that we're talking about this, I think this is a really important piece on where mindfulness can get maybe especially confusing or even contradictory for people. Again, to preface this, I'm a huge mindfulness advocate and fan, but one of the issues about mindfulness for OCD, in particular, is that mindfulness is really in a lot of ways teaching it, it's about coming back to the present moment. I'm going to focus on my breath. I'm going to refocus to my body. I'm going to ground myself. Again, overall very healthy things to do, we should practice that. But the problem about that is if applied directly to OCD mental compulsions —and again, just to be really clear by mental compulsions, I'm talking about anything that people do to try to feel better, cope with, resolve a scary, intrusive thought. Kim, your six-part series, let's say, on mental compulsions that you did is one of the best OCD contents I've ever seen. I think everybody should go back and listen to that, whether you have OCD or not. So, all this mental stuff that we do in response to a scary thought. Mindfulness can be really helpful in noticing when we get caught up and again, like flexibly shifting. But at the end of the day, sufferers of OCD really need to understand that you don't need to focus onto the present moment to stop doing mental compulsions. Because it's analytical, it's a behavior, it's a way of thinking. Just like you did, we can simply turn it on and then we can turn it off. Now, I don't mean to say it's as easy as just don't do it. Obviously, it's not the case. This is complex stuff. There's so many psychological factors that lead people to ruminate and to do compulsions, but it's a simple idea. People need a foundation to understand that mental compulsions are a behavior that we have a lot more agency over than your OCD wants you to think. I like to think about when you look at more traditional, like contamination OCD, people might wash their hands a lot. It's the same thing where there's the behavior of washing your hands that you could do or you cannot do. Now there's entire treatment protocols helping people chip away at that to not wash their hands, so it's not just like, "Don't wash your hands." But people understand that the goal of this treatment is to, "I'm washing my hands too much and now I'm not washing my hands." If you apply the same mindful logic to rumination, it would be like, "Oh, we're going to wash your hands, but you cannot wash your hands. You're just going to have to use wet wipes forever." It's like, oh, I'll get maybe a step in the right direction. But people need to know that the goal here is to not wash your hands. Just like with more Pure O rumination type of OCD , the goal is to learn how to not ruminate. Learn how to step out of that. Kimberley: Yeah. I think you had said somewhere along the way that it's a training. It's a training that we do. What's interesting for me, I'll use this as solely example, is I am in the process of training myself to do what I call deep work, because I have two businesses, things are chaotic, and I can get messages all the time. When I sit down to do something, I'm being pinged on my phone and called on my computer and email bells, so I'm training myself to focus on doing the thing I'm doing and not give my attention to the dinging of the phone and so forth as a training. I'm trying to train myself to be able to go longer, longer, longer periods and hold my attention, which at the beginning, my attention, I could really only do like 15 minutes of that and it felt like my brain was going to explode. Would you say that this is a similar practice in that we're slowly training our brain to be able to hold attention and awareness at the same time and increase it over time? Max: Yeah, absolutely. I think everything with OCD and anxiety is a process. First, it takes awareness, and that's where mindfulness can be so helpful, where the practice of mindfulness is about being more aware. "I'm aware, I'm ruminating. I'm aware of that. I'm doing some sort of compulsion." That itself could take a very long time. I think it's all about baby steps. Now, I will say though, Kim, some people, when I explain them these differences and they're able to really feel what it's like to be ruminating, what it's like not—some people click and they can do it really fast. They're like, "Oh my gosh. I had no idea that this is something I was doing." Some people, it takes a very long time and there's a spectrum. I think everybody always needs to go at their own pace and some people are just going to need to work at it harder. Some people, it's going to come really easy and natural. There's no right or wrong way to do it. These are principles that live in the ERP lifestyle. We want to start taking little baby steps as much as we can. Kimberley: Right. For those listening and for me too, where it clicked for them, what was the shift for them specifically? Max: The shift was understanding that while it felt like rumination—again, a lot of this is like, think about OCD , there's this big unsolvable problem and they're trying to solve it. They're analyzing it, they're paying attention to it, they're focusing on it, they're thinking about it, for them to really feel that, "This is something that I am doing. I know there's reasons why I'm doing it, there's beliefs I have about the utility of ruminating, including beliefs that I can't control this, when really, we can't control it. Beliefs about how helpful it is." There's a lot of reasons why people do that, but to recognize, "Oh my gosh, this is a thing that's a lot more in my control than I thought." When they experience that stepping back and allowing their brain to throw out whatever it does without having to engage with it, game changer. Also, in terms of classic mindfulness, think about mindfulness of breath. The instructions generally are, we're going to focus on, say the breath, the rise and fall of my belly. My attention goes, I'm going to come back to it. I think if we do that with a very specific intention, it could be so relevant and so helpful for OCD. That intention is seeing your brain as a little puppy dog. When you have OCD, that puppy dog is full of energy. OCD is like this mean bully that's thrown a tennis ball and getting that puppy dog to go. What mindfulness of breath can teach you, if we're aware of this, we go into it like, "This is what I'm going to work on. This is how my OCD is getting me—it's getting me to follow these lines of thought." When you're there sitting on your breath to be able to notice where your thought goes, be able to look at it, "None of my business. Come back to my breath." To me, Kim, that is actually exposure and response prevention. You expose yourself to discomfort of not following the thought, which is really hard. For people with OCD, without OCD, that's hard to do, but like you said, that is absolutely a skill that people can get better at. STOPPING COMPULSIONS WITH ATTENTION TRAINING Kimberley: Yeah, and it's response prevention. It's the core of that. Okay, I love this. I love this. Now, as we wrap up, is there anything that you feel we haven't covered here that will bring us home and dial this in for those who are hearing this for the first time or have struggled with this in the past? Max: I think we did a pretty good job. I mean, it's very nuanced stuff. I like to see this for people that feel like their OCD is well enough managed, but there's still work to go. This is like icing on the cake. Let's really look at the nitty-gritty of how this works. Or if people are feeling really stuck and they're not knowing why, hopefully, this can shine a light on some of these less talked about principles that are really important. But I guess the one final thing, going all the way back to Amishi Jha and her neurological research on mindfulness, really fascinating studies out of her lab show that 50% of the time, 50% of her waking day, people are not aware. They're not aware of what's going on, which means 50% of this podcast, people aren't going to be paying attention to. We can't take offense to that because it's 50% of any podcast. When you have that coupled with OCD's tendency to steal that beam of focused attention on scary stuff, it can be so devastating and so stuck for people. Hopefully, some of the stuff can give a sense of what we do about that and how we can start making moves against anxiety and OCD. Kimberley: Yeah, and compassion every step of the way. Max: Oh my gosh. I think everything needs to be done, peppered with compassion . Or maybe peppered is too level like in the context of full radical compassion. That's such an important part of all of this work. Kimberley: Yeah, because it's true. I mean, even myself who has a pretty good mindfulness practice, I was even surprised how much of mine was like, "Am I doing this right? What if I don't do it right? Will this work? How will it help me?" All of the things. I think that everyone's background noise, like you said, is very normal. I so appreciate you bringing this to the conversation, because again, I talk about mindfulness a lot. One other thing is, I will say when, let's say, someone has a somatic obsession or they have panic, and so they're having a lot of physical sensations. When you say "Come to the present," they're like, "But the present sucks. I don't want to be here in the present." What are your thoughts on that? Max: Somatic OCD and panic, I think out of any themes or content when it comes to awareness and attention, those are the most relevant. If you think about somatic OCD, where people come obsessed about different parts of their perceptual experience, it's all about people trying to not be aware of things that they can't control, and then therefore they're aware of it all the time. I think this is especially spot on for those. It's helpful for all forms of anxiety, but that in particular, that's going to be-- we tend to not do exposures by hyper-focusing on what they're afraid of because that's compulsive. That's we're focusing on controlling more. This process should be effortless. When we're ruminating, when we're compulsing or paying attention, that's like you're on the treadmill. You're doing work, and just hopefully, people experience some of these exercises, all we're doing is getting off the treadmill. We want to be doing less, if anything. OCD is making you work for it. It's making you do stuff. We want to identify that and do a whole lot less. And then you'll forget about it usually until you don't. It's like, "Oh crap, here it is again." And then, "Okay, cool. I just practiced. Let me do it again," until it loses power more fully. Kimberley: Yeah. I so appreciate you. Tell us what people can hear about you. Max: I run a practice in Redondo Beach. We're called Beachfront Anxiety Specialists. We have our website. Again, my name's Max Maisel, and people can feel free to Google us and reach out at any time. Kimberley: Amazing. Thank you. We'll have all of your links in the show notes. I'm really, truly grateful. Thank you for coming on and talking about this. It is so nuanced, but so important. As I say to my patients, I could say it 10 times and sometimes you need to hear a similar thing in a different way for it to click. I'm so grateful. Hopefully, this has been really revolutionary for other people to hear it from a different perspective. I'm so grateful for your time. Max: Thank you. It's such a privilege to be here with you and your listeners and I really appreciate you having me on today. Kimberley: Thank you.

Aug 18, 2023

Welcome back, everybody. This is a last-minute episode. I usually am really on schedule with my plan for the podcast and what I want to do, but I have recently got back from vacation and I have been summoned to jury duty. For my own self-care, the idea of going to this master plan that I created for all of the other episodes that I do a lot of planning and a lot of prep and really think it through today, I was like, "I deeply need this episode to land on my own heart." This is as much for me as it is for you, and it is a community effort, which also was very helpful for me. As you may know, I'm a huge proponent of self-compassion , which isn't just having bubble baths and lighting a candle. It's actually stopping and asking, "What do you need in this moment?" And I really dropped in and I was like, "I need this to be really simple, really easy, and I need this to be also something that will land." Let's do it. Today, we're talking about the 14 things you should say to a loved one with anxiety. I asked everyone on Instagram to weigh in on what they need to hear, and the response was so beautiful, it actually brought me to tears. I am going to share with you the 14 things that you should say to a loved one with anxiety, and I'm also going to talk about, it's not just what we say. I was thinking about this the other day. When we're anxious, the advice we get can make us feel very soothed and validated, or it can feel really condescending. Saying "stop worrying" can be really condescending. It can make us enraged. But if someone so gently says, "Listen, don't worry, I got you." You know what I mean? The tone makes a huge difference. For those of you who are family members or loved ones who are listening to this, to really get some nuggets on what they can do to support their loved one, remember that the tone and the intent are really 80% of the work. That is so, so important. Here we go. Let's go through them. I AM HERE FOR YOU. The first thing you should say to a loved one with anxiety is, "I am here for you." The beauty of this is it's not saying, "How can I make your discomfort go away?" It's not saying, "What should we do to fix this and make you stop talking about it and stop having pain about it?" It's just saying, "I'm here, I'm staying in my lane and I'm going to be there to support you." It's beautiful. HOW CAN I SUPPORT YOU? The second thing you could say to a loved one with anxiety is, and this is actually my all-time favorite, this is probably the thing I say the most to my loved ones when they're anxious or going through a difficult time, "How can I support you?" It's not saying, "What can I do?" It's not saying, again, "How can I fix you?" or "Let's get rid of it." It's just saying, "What is it that you need? Because the truth is, I don't know what you need and I'm not going to pretend I do because what may have worked for you last week mightn't work this week." That's really important to remember. How can I support you? YOU ARE NOT BAD FOR EXPERIENCING THIS. The third thing you could say to a loved one with anxiety is, "You are not bad for experiencing this." So often when we are going through a hard time, we're having strong emotions. We then have secondary shame and blame and guilt for having it. We feel guilty, we feel weak, we feel silly, we feel selfish, we feel juvenile for struggling—often based on what we were told in childhood or in our early days about having emotions. We can really start to feel bad for having it. Or for you folks with OCD or intrusive thoughts, you might feel bad because of the content of your obsessions. Now let's pause here for a second and be very clear. We also have to recognize that we don't want to be providing reassurance for our loved ones with OCD and intrusive thoughts because, while giving them reassurance might make them feel better for the short term and might make you feel like you're really a great support person, it probably is reinforcing and feeding the disorder and making it worse. So in no way here am I telling you to tell your loved ones like, "You're not bad. You're not going to do the thing that you think you're going to do," or "That fear is not going to come true." We don't want to go down that road because that's going to become compulsive and high in accommodation. Those two things can really, really make your OCD and intrusive thoughts much, much, much worse. But we can validate them that having a single emotion like anxiety, shame, anger, sadness does not make them a bad person. So, so important. THINGS WILL GET BETTER... THIS WILL NOT LAST FOREVER. The fourth thing you should say to a loved one with anxiety is, "Things will get better," and another thing that the folks on Instagram said is, "This will not last forever." This was something that was said many, many times. I pulled together the main common themes here. But what I loved about this is they were bringing in the temporary nature of anxiety , which is a mindfulness concept, which is, this is a temporary experience that this anxiety will not last forever. Again, pay attention to the tone here. Telling them "This won't last long" or "This won't last forever" in a way that devalues their experience or disqualifies their experience, or invalidates their experience isn't what we're saying here. What they're saying is, they're really leading them towards a skill of recognizing that yes, this is hard, we're not denying it. Yes, this is hard, but things will get better or that this won't last forever. The thing I love about "Things will get better" is, so often when we have anxiety, and we recently did an episode about this—when you have invasive anxiety all the time, you can start to feel depressed about the future. You can start to feel helpless and hopeless about the future. Offering to them "This will get better with steps and together we'll do this and we'll support you and we'll take baby steps," that can really help reduce that depressive piece of what they're experiencing. YOU HAVE GOTTEN THROUGH THIS BEFORE. The fifth thing you should say to a loved one with anxiety is, "You have gotten through this before." Now, that reminds them of their strength and courage. Even if they've never done this scary thing before, chances are, they've done other scary things before or other really difficult things in their life. Often I'll say to patients when they're new to treatment, "Tell me about a time where you did something you actually didn't think you could do." It's usually things like, "I ran a marathon," or "I rode a bike up this really steep hill and I couldn't do it forever. And then one weekend I built up and I could," or "I never thought I would pass this one exam and I'd failed it multiple times and I finally did." It helps us to really see that you are a courageous, resilient person, that you've gotten through hard things before. Again, we're not saying it in a sense of urgency like, "Get up and do the hard things because you've done them before." We are really dropping into their experience. We're really honoring their experience. We're not rushing them too much. I have learned as a parent of a kid who hates needles, this is the biggest lesson for me because I'm an exposure therapist. I'm like, "Let's go, let's face our fear." I've learned to trust my child. When we go in to get vaccinations or immunizations, my child says, "Mama, I'm going to do it, but you have to let me do this at my pace." I was like, "Wow, you're quite the little wise one." It was so profound to me that I was pushing them too fast, going, "Let's just get it over with. Once you're done, you'll feel so much better." They really needed to slow it down and be like, "I'm going to do it. It's just going to be at my own pace." I digress. I AM PROUD OF HOW HARD YOU ARE TRYING. The sixth thing you should say to a loved one with anxiety, and you don't have to say all of these by the way, but number six is, "I am proud of how hard you are trying." I loved this because it, number one, validates that they're going through a hard thing. It also encourages and recognizes that they are trying their best. Often we make the mistake of saying, "You could be doing a little better." The truth is, yeah, you will be doing better in the future, but you're doing the best you can right now with what you have, so do really say, "I'm proud of how hard you are trying." One thing I've also learned, and I learned this from another clinician once, is this clinician taught me. She says, "I never tell my patients how proud I am of them." She says, "I always say, you must be so proud of how hard you are trying." She said that because that gives them ownership of being proud. It gives them permission to be proud. I have learned in many clinical settings with patients to say that. Not all the time, sometimes I just straight up say, "I'm so proud of you." I don't think there's anything wrong with that. But you might even want to play around with this nuanced change in this sentence of, "I'm so proud of how hard you are trying and you must be so proud of how hard you are trying." So powerful the use of words here. LET'S LISTEN TO STORIES OF OTHER PEOPLE WHO HAVE GOTTEN THROUGH THIS. The seventh thing you need to say to a loved one who has anxiety is, "Let's listen to stories of other people who have gotten through this." The person who wrote this in, I loved it because they actually gave some context of them saying, "In a moment where I don't think I can do the scary thing, sometimes hearing other stories of people who have done this work is exactly what I need to remind myself that I can do this hard thing." This is how they did it, and I have the same skills that they do. I'm the same human that they are. They're no better or worse than me. If you go back, there's tons of stories and OCD stories that you can look at on Your Anxiety Toolkit podcast or OCD stories or other podcasts, or even IOCDF live streams of other people's stories that can be inspiring to you. I WILL DO THE DISHES TONIGHT. The eighth thing you should say to a loved one with anxiety is, I loved this one, "I will do the dishes tonight." I loved this one. They actually put a smiley face emoji after it because really what they're saying is, "You need a break and I'm going to be the break you need." It's not to say, again, that we're going to accommodate you and we're going to do all your jobs and chores for you. All they're saying is, "I can see anxiety's taking a lot of space for you. As you work through that—not to do compulsions, but as you work through that and navigate that using your mindfulness and your ERP and your willingness and your act and all of the skills you have—as you do that, I'm going to take a little bit of the slack and I'm going to do the dishes tonight." I just loved this. I would never have thought to include that. I thought that was really, really cute. YOU ARE ALLOWED TO TAKE THIS TIME AND THIS SPACE. The ninth thing you should say to a loved one with anxiety is, "You are allowed to take this time and this space." I thought that was really a beautiful way. Quite a few people said something similar like, "You're allowed to struggle at this time. It's okay that you're having this discomfort. I'm going to give you some space to just feel your feelings. Be uncomfortable if that's what you're doing. Bring on the loving kindness and the compassion, and I'm actually going to give you space to do that. You're allowed to take this time. You're allowed to take up this space with these emotions." As somebody who, myself, struggles with that, I feel like I should tie my emotions up and put them in a pretty bow. I really felt this one really landed on me. It was exactly what I needed to hear as well. Thank you, guys. YOU DO NOT NEED TO SOLVE EVERYTHING RIGHT NOW. YOU CAN PACE YOURSELF THROUGH THIS. The tenth thing you should say to a loved one with anxiety is, "You do not need to solve everything right now. You can pace yourself through this." There's two amazing things I love about this, which is number one, reminding us that we can be uncertain, that we can be patient, that we can let this one sort of lay it down, sit down. We don't have to tend to it right now, we can just let it be there. We're going to go about our time. Absolutely. And that you can pace yourself in that. Often I get asked questions like, "I just want to get it all done right now. I just want to get all my exposures done and I want to face all my fears and I want to have all the emotions and get them over and done with." You can pace yourself through this. I think that's so important to remember. WHAT'S IMPORTANT TO YOU RIGHT NOW? The eleventh thing that you should say to a loved one with anxiety is—this is actually not something you'd say, it's actually something you would ask. They'd say, "I need them to ask me, what's important to you right now." I think this is beautiful because instead of supporting them, you're really just directing them towards their north star of their values. "If you're anxious, let me just be a prompt for you of, what's important to you right now." So cool. It's really helping them, especially you guys know when we're anxious, we can't think straight. It's so hard to concentrate, it's all blurry and things are confusing. Sometimes being given a prompt to help direct us back to those values is so, so important. I BELIEVE YOU. The twelfth thing that you should say to a loved one with anxiety is, "I believe you." Really what we're saying here is, "I believe that this is really hard for you. You're not trying to attention seek. I believe that you're struggling." This was a big one, especially for those people who have a chronic illness. As someone with a chronic illness, so many people kept saying, "Are you sure it's not in your head? Are you sure it's not anxiety? Maybe you're seeking attention." For people to say, "I believe you, I believe what you're experiencing. I believe that this is really hard for you," I think that that is so powerful and probably the deepest level of seeing someone authentically and vulnerably. All right, we're getting close to the end here guys. You have held in strong. YOU ARE STRONGER THAN YOU THINK AND YOU HAVE GOT THIS. The thirteenth thing you should say to a loved one with anxiety is, "You are stronger than you think and you have got this." So good. Again, similar to what we've talked about in the past, but it's reminding them of their strengths, reminding them of their courage, reminding them of their resilience. Sometimes when we're anxious, we doubt ourselves, we doubt our ability to do the hard thing. They're saying, "You've got this. Let's go. Come on, you've got this." But again, not in a way that's demeaning or condescending, or invalidating. It's a cheerleading voice. I KNOW YOU CAN RESIST THESE COMPULSIONS. The fourteenth thing you should say to a loved one with anxiety, but I do have a bonus one of course, is," I know you can resist these compulsions ." This is for the folks who have OCD and who do struggle with doing these compulsions. Or if you have an eating disorder, it might be, "I know you can resist restriction or binging or purging," or whatever the behavior is. Maybe if you have an addiction, "I know you can resist these urges." Same with hair pulling and skin picking. It's really reinforcing to them that, "I know you can do this. I know you can resist this urge or compulsion, whatever it may be." Again, it gives us a north star to remind ourselves what are we actually here to do. Because when we're anxious, our default is like, "How can I get away from this as fast as possible?" Sometimes we do need a direction change of like, "No, the goal is to reduce these safety behaviors." BONUS: IT'S A BEAUTIFUL DAY TO DO HARD THINGS. These are so beautiful. I'm going to add mine in at the end and you guys know what I'm going to say. We almost need a drum roll, but we don't need a drum roll because I'm going to say that the 15th thing that I always say to any loved one, including myself with anxiety, is, " It's a beautiful day to do hard things . It's a beautiful day to do freaking hard things. It's a beautiful day to do the hardest thing." I say that because it reminds me to look at the beauty of it, to look at the reward of it, and to remind myself that yes, we can do hard things. My friends, thank you for allowing this to be a nice, soft landing for me today. I know I have to rearrange all the schedule and my podcast editor and my executive assistant is going to have to help me with all of the mix-up and mess around. But I'm grateful for the opportunity just to slow down with you this week. Take a deep breath. Drop into what do I need. I hope you're doing that for yourself. I will see you next week back on schedule and I cannot wait to talk with you there. Have a wonderful day everybody, and talk to you soon.

Aug 11, 2023

Today, we're talking about when anxiety causes depression and vice versa. This is a topic that I get asked about all the time. It can be really confusing and a lot of time, it's one of those things that we talk about in terms of like, is it the chicken or the egg? I want to get to the bottom of that today. When anxiety causes depression , it can feel like your world is spinning and racing from one thought to another. You may feel a complete loss of interest in the things that you're doing. You may have racing thoughts, depressive thoughts, or thoughts of doom. This can be really, really overwhelming. Today, I want to talk about when anxiety causes depression and how you might target that, and also when depression causes anxiety. Let's get into it. We're going to go through a couple of things today. Number one is we're going to go through why does anxiety cause depression , how does depression cause anxiety, how common is depression and anxiety, particularly when they're together, and what to do when depression and anxiety mix. Now, stick around till the end because I'm also going to address how OCD causes depression and how social anxiety causes depression, and what to do when anxiety and depression impact your sleep, and in this case, cause insomnia. I'm so excited to do this. Let's get started. WHAT CAUSES ANXIETY AND DEPRESSION What causes anxiety and depression? Let's look at that first. What we understand is that anxiety and depression—we don't entirely know just yet to be exact, but what we know so far is that there is a combination between genetics, biology, environment, and also psychological factors. That's a big piece of what we're going to be talking about today. Now, if you want to know specifically the causes of anxiety , and that's really what you're wanting, you can actually go over to Episode 225 of Your Anxiety Toolkit . We have a whole episode there on what causes anxiety and what you can do to overcome anxiety. That might be a more in-depth understanding of that. But just in general, we do know that genetics play a huge component. However, we do know, talking about the psychological factors, that often people who do have depression, that depression does cause an increase in anxiety. A lot of people who have an anxiety disorder do notice that they feel themes of depression like hopelessness, helplessness, and worthlessness. WHY DOES ANXIETY CAUSE DEPRESSION? Now, let's first look at, why does anxiety cause depression ? The thing to remember here is, anxiety alone doesn't cause depression in all cases. There are lots of people who do have an anxiety disorder who don't experience depression. However, we do know that for those who have a lot of anxiety, maybe untreated anxiety or anxiety that is very complex and they're in the early stages of recovery or learning the tools and mastering those tools, it is common for people with anxiety or uncertainty to start to feel doom and gloom about their life. Often it comes in the form of feeling like, "Is this going to be here forever?" A lot of people will say, "What's the point really of life if I'm going to be experiencing this level of suffering with my anxiety every single day?" And that's very, very valid. When you're suffering to the degree that some of you are with very chronic anxiety disorders, very severe degrees of anxiety disorders, it makes complete sense that you would start to feel like, "What is the point? How do I get through this? No one can help me. Am I someone who can be helped?" These are very common concerns. I myself have struggled with this as well, particularly when your anxiety feels so out of control and you don't feel like you have mastery over it yet. I think that that is a very, very normal experience for people who have that degree of anxiety. This also includes other anxiety disorders like phobias, panic disorder , PTSD, and eating disorders. I know when I had my eating disorder, I felt so stuck, "How am I ever going to climb out of this deep hole that I'm in?" And that in and of itself made me feel depressed. I had what we call secondary depression. My primary condition was an eating disorder, and then I had a secondary depression because of how heavy and how overwhelming my primary condition was. If that's something that you resonate with, I first want to acknowledge and recognize that this is very normal, very common, but also very treatable, particularly if you have a mental health professional who can help you. But again, I want to go back and say, just because you have anxiety or intrusive thoughts, doesn't mean that you will be anxious and depressed for the rest of your life. With mastery and tools and recovery and practice and patience and compassion, you can actually slowly peel those layers of depression and anxiety away. WHY DOES DEPRESSION CAUSE ANXIETY? So then we move over now and look at, why does depression cause anxiety? If your primary diagnosis or your primary disorder is depression, meaning that's the first disorder you had and you didn't have an anxiety disorder before that, or that's the disorder that is the largest and the one that takes up the most space in your life. When we are depressed, often people will have anxiety about how much that depression is going to impact them in their life. Similar to the last points we made about anxiety. A lot of my patients and a lot of you folks have written in or messaged me or in my comments on Instagram talking about the overwhelming fear of relapse and the overwhelming fear of going back to those dark days when depression was so strong and you couldn't get out of bed, and it was almost traumatizing how painful and how much suffering you are experiencing. It is, again, very normal to have a large degree of anticipatory anxiety about how that may impact you. Now, in addition, depression in and of itself will say some pretty mean things. Actually, let me rephrase that—will always lie to you about who you are, your worth, your future, your place in the world. When you hear those things on repeat, of course, you're going to have anxiety about, will that come true? Is that possible? Oh my goodness, that's not what I want for my life. This is not how my life was supposed to go. The messages and the narrative of depression in and of itself can create an immense degree of anxiety. HOW COMMON IS DEPRESSION AND ANXIETY? Now, let's take a look now, as promised, to look at how common anxiety and depression are. I'm actually going to read you some statistics here that I got from some really reputable journal articles, and I will link them in the show notes. One research said that generalized anxiety disorder affects 6.8 million adults in the United States. That's 3.1% of the population, and that's just in the United States. That's not talking about the world. Yet, only 43.2% of them are receiving treatment. That's from the National Institute of Mental Health . Now, what's interesting about that, as I remember sharing before, is being untreated increases your chances of having both. Because as you can imagine, if you're having a disorder and it's not improving, you're going to feel more depressed about it and you're going to feel more anxious about that. Statistics also show that women are twice as likely to be affected as men with generalized anxiety. Generalized anxiety disorder often co-occurs with major depression. They are almost always going to go together. Now, we also know that depression is a very common illness worldwide, with an estimated 3.8% of the population affected. That's 5% for adults and 5.7% for adults older than 60 years. That's very interesting as well to see how our age can impact these disorders, and that comes directly from the Institute of Health Metrics and Evaluation . We have some really important information here to show that there is a huge overlap between the two. And then it gets murky because then, again, as I mentioned in the intro, is it the chicken or the egg? Which one do we treat? Which one do we look at? Which one came first? Which is the primary? Which is the secondary? WHAT TO DO WHEN DEPRESSION AND ANXIETY MIX? Let's talk first about what to do when depression and anxiety mix, because that's why you're here. It's important and what's cool is to recognize that we have a treatment that can target both. As you all know, I'm a Cognitive Behavioral Therapist and we have a lot of research to show that cognitive behavioral therapy or CBT can help with both. Thank goodness, it's not that you have to go to one particular treatment for one, and then you have to learn a whole other treatment for another. We actually have this one treatment that you can use to address both in different ways. Now, CBT is going to be looking at your cognition, your thoughts, which we know with anxiety and depression, there are a lot of irrational, faulty thoughts. It also looks at your behaviors and how those behaviors may actually be contributing to your anxiety and your depression. Not to say that it's your fault. I want to be really clear here. We are not saying that this is all your fault and you've got bad thoughts and you've got bad behaviors. That's why you have both and you're going to be stuck in both until you change that. Absolutely not. We're not here to blame. What we're here to do is be curious about our thoughts and about our behaviors, and then look and do experiments on what helps and what doesn't. I'll give you an example of a really basic CBT skill that I used recently, and that was that somebody I knew was talking about how difficult it is to go to bed. They get really depressed going to bed. It makes them have a lot of thoughts about how they didn't get done what they wanted to do. They would procrastinate going to bed, but before they know it, it would be 3:00 AM in the morning or even later. They still haven't yet journeyed through their night routine to go to bed. We talked about what would be effective for you, what behavior change would be effective for you to move into the direction that you want. With CBT, we are not looking at 17 different changes at once. We might make one simple change at a time and then look at your thoughts about that. This is a really important way for us to be curious and do experiments and look at what's effective and what's not effective and make small little tweaks to your behaviors. Now, some examples of this, we go through this extensively in our online course called Overcoming Depression . We also go through this extensively in our online course called Overcoming Anxiety and Panic , where we thoroughly go through your thoughts and then do an inventory of your behaviors. I give tons of examples of little ways that you can change behaviors, moving in ways that will reduce the repetition of these disorders. Let's talk a little bit about that. One really important piece for depression when we're talking about behavioral therapy is activity scheduling. The less routine you have, the more likely you are to be depressed. Often people with depression tend to lose their routine or they have lost their routine, which can actually contribute to depression. What we might do is we might look at our day and implement or add just one or two things to create some routine. Once you've got those things down, maybe you have a morning routine in the morning where you take a walk at eight o'clock, and that's it for now. Let's just try on that. And then by lunchtime, we might add in some kind of pleasurable activity. Because we know with depression, as I mentioned at the beginning, depression can take away our pleasure or interest in hobbies. We might introduce those back, even though I know that you're not going to experience as much pleasure as maybe you used to. But we're going to experiment and be curious about bringing back things into your life like paint-by-number, crochet, or whatever it might be. I personally just took up crocheting when I was in Australia. My mom insisted that I learn how to crochet and it's quite impressive to me how something so simple can be such a mindful activity. Even though I only do it for 5, 10, 15 minutes a day, that in and of itself can be an incredible shift to our mental health. Again, I want to make clear, none of these alone will snap you out of depression. It's a series of small baby changes in a direction that is right for you and is in line with your values. Now, another thing you can do when depression and anxiety mix is to consult with your doctor about antidepressant medications for anxiety & depression or what we call SSRIs. We know that research shows that a combination of CBT and medication is a really effective way to come out of that hole of depression and anxiety. If that's something you are interested in or willing to consider, please do go to a medical professional or a psychiatrist and talk with them about your particular needs. It can be incredibly helpful. I know for me, during different stages of my life, SSRIs have been so, so helpful. That's something that you could also consider. The next thing you can do when depression and anxiety mix is to consider exercise . We actually have research to show that exercise is as effective as medications or SSRIs, which blows my mind. Actually, I think it's so wonderful that we have this research. In my opinion, add it slowly to your calendar. I'm not here to say this means you have to go out and do an hour class at the gym. It could be as simple as taking a walk around the block. Actually, recently, as many of you follow me on Instagram, I am trying to get back to exercising more as I still continue to recover from my chronic illness, POTS. I don't go and do huge workouts. For me, it's first starting in baby steps, 5, 10 minutes. Or can I do a plank for 30 seconds? And that's it to start. I want to again encourage you to take baby steps here and implement just little things at a time. And then ask yourself, how does this feel? Did this help? Did this hinder? How does it feel in my body? And then if you need to, talk to a mental health professional about what would be the best step for you next. Now we also know that exercise aids relaxation, it aids over well-being. It's incredibly helpful, again, for your mental health. That's something you can consider and consult with a doctor as well. Now another thing you can consider is relaxation techniques. Now here, we're not talking about doing breathing just to get rid of anxiety. We know that that doesn't typically work, but there are ways in which you can learn to breathe as an act of self-compassion, of slowing down and acknowledging where you are and slowing down your behaviors, and checking in with yourself. This does include some mindfulness or you can even consider taking up one or two minutes of meditation a day. These techniques can be very helpful for both depression and anxiety. Again, I keep teasing this, but I keep having technical issues. We will eventually have a meditation vault for you guys that will have meditations for anxiety and depression specifically and anxiety with intrusive thoughts. I've tried my best to continue to add. We've got probably over 30 meditations already. That will be available to you soon as well, so do keep an eye out for that. HOW OCD CAUSES DEPRESSION? Now, let's talk as promised about how OCD causes depression , because I know a lot of you out there have OCD. If you don't have OCD, stick with this because I'm also going to go through here about insomnia. We do know that statistically, OCD affects 2.5 million adults. That's 1.2% of the population. That's just what we know of. That's not actually the real stats because there are so many people who haven't reported it because of stigma and shame and so forth. We know here that women are three times more likely to be affected than men. That's actually not my experience. I think I have a 50/50 in my clientele. But that's what the statistics show. Again, as you can imagine, if you have OCD and you're completely flooded with intrusive thoughts, you're doing compulsions for hours, you're stuck in a mental loop, I think the research shows 80% of people also have depression, up to 85%. Now, that is significant in the overlap and it just shows how much OCD can take you down and really target your worth and your sense of identity and your self-esteem and how much shame and guilt and blame goes along with those. When you're experiencing that, of course, you're going to experience some depression or themes of depression, as I said before, hopelessness, helplessness, and worthlessness. If this is the case for you, what we often recommend, again, especially if the primary condition is OCD and then you have depression because of that, we really want to target getting you better from OCD as soon as we can. A lot of the time, when depression is caused by the anxiety disorder, the major treatment goal needs to be getting that primary condition under control. Often once we get that primary condition under control, the depression does lift. Now, again, it's different if you're someone who's always had depression or had it throughout your life. We still want to go back and look at cognitive behavioral therapy or mindfulness-based cognitive behavioral therapy . We also want to look at maybe including a massive self-compassion practice because that is absolutely key for all of these conditions, no matter what, whether they're coexisting or not. But you can also include other modalities like acceptance and commitment therapy. You could also do other modalities such as dialectical behavioral therapy. That's particularly helpful if you're engaging in impulsive behavior or self-harm. You're having a tremendous degree of suicidal ideation, or sometimes in some cases, suicide attempts. These are other options you can add to your cognitive behavioral therapy if you require it. Because remember, we have to look at you as a person, not just you as a diagnosis. We have to really be certain that we look at all the symptoms, you have a thorough assessment, we're clear on what's the primary and secondary condition, and then we can create a treatment plan for you that targets those specific symptoms. If you have OCD and you don't have access to a mental health professional, we do have ERP School , which is an online class for OCD, it's on demand. You can watch it as many times as you want. You can go to CBTSchool.com to get any of these courses. But that is there for you. I made it specifically for people who either don't have access to mental health services, can't afford them, or have had it in the past and they just want to hear it be said in a different way. Maybe you really like my way of training and teaching and you want to hear it and how I apply it with my patients. All of the courses that I have recorded are exactly how I would treat my clients and how I would walk them through the process. They're there for you if you would like. HOW SOCIAL ANXIETY CAUSES DEPRESSION? Now let's move on to how social anxiety causes depressio n. Now, this is true for everything, and forgive me because I should have mentioned this before. One of the most common safety behaviors that come out with social anxiety is avoidance, isolation. But I should have mentioned before, that is very true of any anxiety disorder. It's very true of OCD, it's very true of post-traumatic stress disorder. When we isolate and we avoid, we do tend to feel more depressed because we have less connection in our life, we have less interaction, which can be a really great way for us to stay present. When we're in a room by ourselves with our thoughts, that can always create more anxiety and more depression. That's very common for social anxiety. The other thing to remember about social anxiety too is the voice of social anxiety is also very, very mean, just like OCD and generalized anxiety and depression. Thoughts we have when we have social anxiety are often like, "You look like an idiot. You look awkward. What's wrong with you? Why did you say that? You shouldn't have said that. They're going to think you're stupid." As you can imagine, those thoughts in and of themselves will create more anxiety, and that secondary depression, that layer of like, "I give up. I can't do this. This is too hard. What's even the point of trying?" WHAT TO DO WHEN ANXIETY AND DEPRESSION CAUSE INSOMNIA Last of all, we want to talk about what to do when anxiety and depression, or one or the other, cause insomnia. Now, it's important to recognize here that one of the core symptoms of depression is insomnia or getting too much sleep. It can go either way, but there are some people who have depression and one of their symptoms is they cannot fall asleep. They lay in bed for hours just round and round and round ruminating. That is true for any of the anxiety disorders as well. When you have anxiety and you have depression, you go to bed, you turn the lights off, and you are left with your thoughts. If your thoughts are mean, if your thoughts are catastrophic, if your thoughts are very much in the theme of hyper-responsibility or perfectionism, it's a very high chance that you're going to get stuck being completely overwhelmed with those thoughts and then have a hard time falling asleep. What happens there, as this is the theme of today, is it becomes a cycle. The less sleep you get, the more anxious you might feel. Or the more that you have anxiety, the more you might be afraid you won't fall asleep, and that anxiety in and of itself keeps you up and you're caught in a cycle. What I want to offer to you here, as we look at all of these conditions, let's wrap this up for you, is number one, if you have anxiety and/or depression, you are so not alone. I would say the majority of my patients have both. No matter what anxiety disorder, they have little inklings or massive degrees of depression. That does not mean there's anything wrong with you and it doesn't mean you cannot move into recovery. It also doesn't mean that this is your fault. I really want to emphasize here that with compassion and baby steps and PATIENCE, we can slowly come out of this place and get you back out. I strongly encourage you to reach out and have a team around you who can support you, even if you haven't got access to a mental health professional, your medical doctor, or any friends you may have, family. Maybe it's using resources like online courses or workbooks. We have, for people with OCD, The Self-Compassion Workbook for OCD . They're amazing workbooks for depression. One I strongly encourage you to consider is a book by David Burns called Feeling Good . It's an amazing resource using cognitive therapy for depression. These are things that you can bring in and gather as a part of your resources so that you can slowly find your way out. Hopefully, the clouds will separate and you can see the sky again. I truly want to recognize here that this is really hard. We're talking about two very influential conditions that bully us and can make us feel hopeless. I want to recognize that and validate you and send you a large degree of love because this is hard work. As I always say, it is a beautiful day to do hard things. I say that because if we can look for the beauty, that in and of itself is a small step to moving out of these conditions. Look for the beauty in your day, and see doing the hard things as a beautiful thing because, with each hard thing you do, you're taking one step closer to your recovery. You just focus on one hard thing at a time, and then you focus on the next hard thing and you celebrate your wins, and you of course act as kindly and as compassionately as you can. Thank you so much for being here. I hope that was helpful. We went all the way through what to do when anxiety causes depression and vice versa. I hope you took so much from today's video and podcasts. For those of you who are listening on podcast, do know that we will be introducing a lot of these on video on YouTube as well. If you want to see my face, I will be over on YouTube as well. I'm so honored that you have spent your time with me. I know how valuable your time is. I do hope that you have a wonderful day. Please do remember it is a beautiful day to do hard things and I am here cheering you on every step of the way.

Aug 4, 2023

Welcome back, everybody. It is so good to have you here talking about hyper-responsibility & hyperresponsibility OCD . A lot of you may not even know what that means and maybe have never heard it, or maybe you've heard the term but aren't quite sure what it entails. And some of you are very well acquainted with the term hyper-responsibility. I thought, given that it's a theme that's laced through so many anxiety disorders through depression that we should address it. I think that's a really great starting point. WHAT IS HYPER-RESPONSIBILITY OCD? Let's talk about first what is hyper-responsibility. Hyper-responsibility is an inflated sense of responsibility. It is feeling responsible for things that are entirely out of your control, such as accidents, how other people feel about you, how other people behave, events happening in your life. It's ultimately this overwhelming feeling that the world rests on your shoulders, that it's up to you and it's your job to keep yourself and everybody else safe. Even as we look at this definition of what hyper-responsibility is, I'm actually feeling and noticing in my body this heaviness, this weight that you're carrying, and it is an incredible weight to carry. It is an incredibly stressful role to play. If you're someone who experiences hyper-responsibility, you often will have additional exhaustion because of this. WHAT IS THE DIFFERENCE BETWEEN HYPER-RESPONSIBILITY AND RESPONSIBILITY OCD? One thing I want to clear up as we move forward is first really differentiating the difference between hyper-responsibility and responsibility OCD. When we say "hyper-responsibility," we're talking about a heightened sense of responsibility. Actually, let me back up a little bit. We do have responsibility. I am an adult. I'm responsible for my body, I'm responsible for two young children, a dog. Responsibility is one thing. You need to keep them safe, you need to take care of them, you need to show up in respectful ways. But hyper-responsibility is so much more than that. It's taking an incredible leap of responsibility and feeling responsible for all the teeny tiny things, like I said before, that are out of your control. Now, once we've determined what responsibility is, then we can also look at responsibility OCD. Now specifically for those who have responsibility OCD is where this sense of hyper-responsibility has crossed over into meeting criteria for having the obsession of hyper-responsibility that's repetitive, intrusive, unwanted, and you're also engaging in a significant degree of compulsions that, again, meet criteria for OCD. They could be mental compulsions , physical compulsions, avoidant compulsions, reassurance-seeking compulsions, and so forth. The way I like to think of it is on a spectrum. We have responsibility on one side, then in the middle, we have hyper-responsibility, and then it goes all the way over to responsibility OCD. Some people will differentiate them differently in terms of they will say, hyper-responsibility is the same thing as responsibility OCD. But I'm not here to really diagnose people, and I'm not here to tell people that they have OCD if they don't quite resonate with that. I'll use me as an example. I 100% struggle with hyper-responsibility in certain areas of my life. But the presentation of that hyper-responsibility, I don't feel, and I'm sure my therapist doesn't feel, meets criteria for me to get the diagnosis of OCD. That's why I want to make sure this is very loose so that you can decide for yourself where you fit on that spectrum. HYPER RESPONSIBILITY SYMPTOMS OR RESPONSIBILITY OCD SYMPTOMS A little bit more about hyper-responsibility symptoms or even responsibility OCD symptoms. Examples will include: when something goes wrong, you're probably likely to blame yourself and feel guilty for the fact that something went wrong. Even disregarding whether it was your fault or not, you'll feel a sense that this was your mistake, that you should have prevented it. Another hyper-responsibility symptom is you might believe that it is up to you to control the outcomes of your life. It is up to you to control the outcomes of other people's lives—your dependence, your partner, your family members, and so forth, the people at your work, the projects at your work, or at school. Another symptom of hyper-responsibility and responsibility OCD is this act of always trying to "fix" the problem. Even when you've recognized that there is no solution, you feel this need to just keep chipping away and finding the solution to prevent the bad thing from happening or being responsible for the bad thing. You may spend hours trying to prevent accidents or bad things from happening. What I mean by spending hours is it takes up a significant degree of your time, and it's usually quite distressing. It's a heavy feeling. There is a difference between responsibility and hyper-responsibility. An example might be my husband found that one of our decks was rickety and shaking, and he felt it was his responsibility to fix that. He did it in a very measured way, in a very rational way, and it was coming from a place of his genuine value and his genuine view that it's his responsibility to fix that. However, hyper-responsibility would be fixing it, but then also checking every part of it to make sure that it was safe, spending a lot of time going over all the possible scenarios on how it may not be safe, how it could have been safer, what it would mean if something bad happened, replaying. I actually shouldn't use the word "replay." It's almost like future forecasting what would happen and who would be at fault if something bad did happen. Again, if we even went further into more responsibility OCD, it might involve repetitively doing these over and over again to get a sense of relief from this hyper-responsibility or to absolutely get security and certainty that nothing bad will ever happen. Often in this case, if I was using this example, maybe they would do the avoidant compulsion of saying, no one's allowed on the deck, even though it might be a safe, secure deck. That's just one example. It's probably not the best example, but I'm trying to use it in contrast to the many ways in which this can play out, especially for those who don't have hyper-responsibility. A thing to remember is, people who don't have hyper-responsibility may look at the person with hyper-responsibility with a quite perplexed look on their face because to them, they can't understand why the person feels so heavy loaded with responsibility. And that can be very frustrating, particularly as it shows up in relationships. Now, an inflated responsibility may also present as people-pleasing, which is really an attempt to control how people feel about you. It may also present as giving a lot of money or time to charities or groups of people who are less privileged and so forth. Again, let's get really nuanced. It doesn't mean if you donate money that you have hyper-responsibility. A lot of these actions people may do from a place of value. But again, we always want to look at the intention of why they're doing it, and are they doing it to reduce or remove this feeling that they're having? Another symptom of an inflated responsibility is over-researching unlikely threats or possible scenarios. You're really doing it to try and prevent something bad from happening. Is it possible that someone could fall off a deck? Sometimes I'll explain it to you, for me personally, often it's related to the law. For me, it will show up in, "Oh, I'm a boss. I'm someone who has employees. What are all the possible scenarios that legally could impact me? Let me do a lot of research around that." Until I catch it, and I'm like, "Kimberley, you're engaging in a ton of reassurance here. Let's not try to solve problems until they're actually here and actually a problem." Another example of an inflated responsibility is keeping physical or mental lists like, did you do this? Did you do that? Did you do this? That's really an attempt to make sure nothing bad has happened. One other thing is—I remember doing this a lot when I had a baby—checking the baby over and over. I felt that it was my responsibility to keep this baby alive, and yes, it was my responsibility to keep my baby alive. But I had somehow taken it upon myself that if something happened, I would be fully at fault. That it wouldn't have been my husband's fault, who's laying right next to me, who is a fully engaged and loving dad. I had taken it on myself that 100% of the responsibility of her wellness and his wellness, my children are mine, and if something happened, 100% of the fault would be on me. I have such compassion for the moms out there who experience this responsibility weight on their shoulders. I think number one, it's societal. Number two, I think it's normal, again. But number three, it's so terrifying because often, not just for moms, for everybody here, the thing that we are worried about are often people we deeply love too. The things that we hold in high value. That's again why it can be so incredibly painful. Now, while these behaviors don't necessarily, again, mean you have hyper-responsibility or OCD. Again, I want you to think of it like it's on a spectrum. It is important to know that lots of people with OCD experience hyper-responsibility in many areas of their lives, and that hyper-responsibility shows up in many different subtypes of OCD, many themes of OCD. If you have OCD, you can really put that in your back pocket and keep an eye out and really increase your awareness of how hyper-responsibility is showing up and making it harder for you to overcome your obsessions and compulsions. We can all agree as we move forward that hyper-responsibility deeply, deeply impacts somebody's mental health and their overall well-being. My hope is now to give you some tools, some things that I've found helpful for me to manage that—things that I've had to practice over and over again. WHAT CAUSES RESPONSIBILITY OCD & HYPER RESPONSIBILITY? Now, before I do that, let's quickly check in on, often people will ask what causes responsibility OCD or hyper-responsibility. There are a couple of things to think about here. When I'm talking with patients who have OCD, I don't spend a lot of time digging deep into childhood stuff and bringing up old events and so forth. For some people, that can be incredibly helpful. I tend to find it often does become compulsive and we spend a lot of time there instead of actually targeting the behaviors that are problematic. But for the sake of today, of just giving you some education, we do know that hyper-responsibility CAN, not always, but CAN come from childhood experiences and family dynamics. Often a child may feel it's their job to take care of other people. Maybe they've been taught that. Maybe they're the eldest sibling and they were given a lot of responsibility. Maybe their parents were very, very strict, and that for them, they felt that they had to maintain that perfect demeanor and perfect school report and so forth. We do know that childhood experiences, that environment that we were raised in can impact someone's experience of hyper-responsibility. We also know that brain disorders like OCD, other anxiety disorders, or even depression, or trauma—trauma is not a brain disorder—these mental health disorders can also exacerbate the theme of hyper-responsibility in people. We also know that external pressures, societal expectations, the way our culture raises us can also add to a sense of hyper-responsibility. I know for me, as I've thought about this a lot recently, which was a part of the reason why I wanted to do this episode, I am a therapist; it's an incredible weight of responsibility to be a therapist. I'm surrounded by laws and ethics and licensing boards and all of these rules. I find that the environment of my work can very much nurture my already inclination to have hyper-responsibility. I do think too the environment we are even in as an adult can keep this going. And then the last thing I want to look at, which we'll talk about here in a second, is simply irrational beliefs and rules we keep for ourselves can very much "cause" (I don't like to use that word) and exacerbate hyper-responsibility. STRATEGIES FOR MANAGING HYPER-RESPONSIBILITY Now that we have this and we can get a feel for why someone may experience this, now let's talk about some strategies for managing hyper-responsibility. Because that's why you're here and that's what I really love to do the most. Let's talk about it. First, when I'm managing my own hyper-responsibility or I'm talking with patients about it, the first thing I do is get really clear on what is your responsibility and what is not. I often will do an exercise with my patients and say, "Okay, you are a human being. I want you to write me a job description of what you need to do to be a human being, to exist as a human being." Let's say I owned a supermarket and I hired someone to work at the register, the job description would say exactly what is your responsibility. It would say, "You need to turn up at this time, you need to leave at this time. When you come, you need to log in, you need to clock in, you need to put your uniform on. Here's the things that you need to do that are your responsibility." And then that employee has a very clear understanding of what their role entails. Now, for you as a human, and everybody's job description looks a little different, I want to first get clear on what is your responsibility. For me, I'll use an example, I'm a mom, so I do have to be responsible for the well-being of my two children. But let's get a little clearer on what that means. Does that mean I have to just keep them fed and dressed? Or does that mean for me and my values that I keep them fed and dressed and have a degree of emotional support, but to what degree? This is why I want you to get really clear on what it is for you and your values. And then once we do that, you can actually sit with a trusted person—either a family member, a therapist, a mental health provider, or a loved one—and start to question how much responsibility you're taking on. Of the things on your list, what are the things that are actually not in your control? Not in your control. Because if you have an anxious brain, remember your brain is going to tell you all of the worst-case scenarios. That's your brain's job. If you have an anxiety disorder, you're probably got a hyperactive brain that lists them off like a Rolodex, da da, da, really, really fast. All the worst-case scenarios. People with hyper-responsibility often use that Rolodex of information and just start adding that to their job description. "Oh, well, if there's a possible chance that they could run out and whatever it may be, well then I have to protect for that," even though it hasn't happened and it's highly unlikely. You can start to see, once you are looking at this list of rules you have for yourself, where you've pushed from just having a responsibility to having hyper-responsibility. Another example might be in relationships. I'll use again me as an example. My husband and I are going to be 20 years married this year. For years, I took on as my responsibility that I was supposed to keep him happy. Over and over again, I found that I was unable to do this because I'm a human being and I'm faulty and I'm going to make him mad and annoyed sometimes. But I'd taken this responsibility that it was my job to maintain his happiness. And that's not actually the job description of being a human being. Once I started to go through this with my therapist at the time, I'm starting to see, I'm trying to control things that are out of my control. The second thing I want you to think about is once you are clear on what is your responsibility, you have this great roadmap now. Now you have to think about staying in your lane. I may have talked about this on the podcast before, but I talk about this a lot with my patients. Once you've determined what is in your control, what is in line with your values, not just what anxiety's telling you, but what you believe is a healthy limit for you, then you can work at keeping yourself within those parameters and practicing not engaging in picking up responsibility outside of your lane again. We always use the metaphor of like, I'm in my car, I can control what kind of car I drive, what speed I go, that's my responsibility. But let's say my child is in the lane, metaphorical lane next to me, and they're speeding like crazy, and they're driving all over. My kids haven't got a driver's license, just stay with me for the metaphor. But let's say my kid or my partner is in their car and they're smoking and they're checking their phone and they're swaying all over and they're doing all these things. I have to then determine, if I'm going to respond to that, what is my capacity in my lane. Let's say it was my husband. I have to basically accept that he's a full-grown adult who is responsible for himself, which sucks. Believe me, I know. This drove me crazy that I had to let him be in his own lane and I had to stay in my lane. I remember having fights with my therapist, not actual fights, but conversations. I'm like, "If we were using this metaphor, he could die. He could get himself into trouble." She would say, "Yes, and you're going to have to decide what's best for you. There's no right for every one person. We're not going to treat everyone the same, but you have to take responsibility for how much you engage in trying to control the people around you, and you also have to be willing to allow this to be out of your control sometimes." You can imagine me sitting in the chair. This was way before COVID. I'm sitting back on the couch and my arms are crossed and I'm all mad because I'm just coming to terms with this idea that I can't be responsible for everything, that I'm exhausted from trying, that I'm creating a lot of relationship drama because of my attempt to take control and be hyper responsible. I had to give it up. But the giving up of it, the staying in my lane required that I had to feel some really uncomfortable feelings. Let's just take a breath for that because it was tough and it is tough. I'm sure if you are experiencing hyper-responsibility, you too are riding strong waves of guilt, regret, shame, anger, resent because of this hyper-responsibility. If this is you, what you can also do is really double down with your mindfulness practice . The biggest, most important piece of this is increasing your awareness of where it shows up in your life, in what corner, and how it creeps into little parts of your life, and noticing when it does and why it is. In that moment, maybe the question might be, what is it that I'm unwilling to feel? What am I unwilling to tolerate in this moment, and how might I increase my willingness to feel these feelings of guilt or regret or shame, or anxiety, massive degrees of uncertainty? Can I allow them without engaging in these behaviors that just keep this hyper-responsibility going? It's a huge test of awareness. And then we double down with kindness, and I'll tell you why. Because when you have hyper-responsibility, you're probably going to be plagued with guilt. You feel guilty for all the things happening with someone. We feel anxious because we didn't get it right. We couldn't keep the things straight and perfect and it's really, really heavy. In order for us to negotiate with ourselves through those emotions in a non-compulsive way, we have to have a self-compassion practice where we give ourselves permission to get it wrong sometimes. We give ourselves permission to make mistakes sometimes. We allow things to fall apart. That's the hard part, I think. It feels so wrong to not be fixing things all the time. It can feel so irresponsible to not be preventing things and we have to be willing to navigate and ride through that compassionately. Now, if you're someone who really struggles with guilt, I've got two podcast episodes that you really need to go and listen to. Number one was Episode 161, which is all about this idea that feeling guilty does not mean you have done something wrong . A lot of people with anxiety, hyper-responsibility, and OCD think and feel that if they feel guilt, it must be evidence that they did something wrong. We have a whole episode, Episode 161 again, where you can go and listen and learn about how our brains make mistakes on this one. In addition, if you are someone who has OCD and you really struggle with regret and guilt , we also have another Episode 310. It wasn't that far gone, that I talked about how regret and guilt are also obsessions. Meaning we have intrusive thoughts, we have intrusive feelings, and sometimes the intrusive feeling is guilt and regret. Please do use that resource as well. And then the last thing I would want you to think about here is, for those of you who are in the background listening, but secretly thinking, "But I have screwed up. I have made mistakes. I've made so many mistakes and I need to make sure that never happens again," number one, let me slow down for a sec—I want to first acknowledge that you are a human and you will make mistakes just like I am a human and we will continue to mess up over and over again. Let's just get that out in the open. Let's just come to a place where we can acknowledge and humble ourselves with the fact that yes, we are going to make mistakes. A part of you in this moment when you're saying, "But I've made mistakes, I've really screwed up," is that you will not accept that that is a part of being a human. That is the tax on being a human, my friend. You're going to have to come to a place of acceptance of that. Often people say, "That sucks. I don't want that," and I'm going to keep saying, "But you will." They'll say, "But I don't want to," and I'll say, "But you will." We could go all day on that one. But if you are someone who actually did screw up, it then again becomes a concept or a practice of when you screw up, how do you handle it? Do you screw up and beat yourself up for days and days and months and months and years or years? Or do you screw up and learn from it and acknowledge your humanness and learn what the mistakes are, and then do your best to pivot within the rules in which you set in what we said was your lane? Because often what happens is we do all this work, we address our job description as being a human and what's just within your line of values and what's your regular human responsibility. And then when something goes wrong, they hypercorrect and they go back to these rules that include a lot of control, a lot of preventing, a lot of ruminating, a lot of making sure, and you've gone back to being in all of everybody's lanes. If you're struggling with this, you can go to Episode 293. I did an episode called "I Screwed Up, Now What?" I really think that that was an episode where I had made a massive mistake and I was navigating through it in real-time and sharing what I thought was helpful. RESPONSIBILITY OCD TREATMENT If you're wanting to learn more about responsibility OCD treatment, I'm going to strongly encourage you to look for an exposure and response prevention therapist who will be able to identify your specific subtypes and help apply an ERP plan for you. Now, if you cannot access professional help, you can also go to CBTSchool.com . We have ERP School , which is our online course teaching you how you can practice ERP. The course is not specifically about hyper-responsibility, but it will allow you to do an inventory of your specific set of obsessions, your specific set of compulsions, and put a plan together so that you can start to target these behaviors on your own. You can very much get up and running on your own if you do not have access to professional mental health. The whole point of me having those courses isn't to replace therapy. It's there to help you get started if you haven't got any way to get started. Often people go there because they want to know more and they want to understand the cycle of OCD, and that's why we made it. My lovely friends, that is hyper-responsibility. We're talking about when you feel responsible for anything and everything and everyone. If that is you, let me leave you with this parting message: Please slow down and first recognize the weight that you're carrying. Sometimes we have to do an inventory of the costs of this hyper-responsibility because it's so easy just to keep going and keep carrying the load and pushing harder and solving more and preventing more. But I want you to slow down for you as an act of compassion and take stock of how heavy this is on you, how exhausting this is on you, and then start to move towards acknowledging that you don't have to live this way, you don't deserve to live this way. That there is another way to exist in the world compassionately and effectively without taking on that responsibility. If you need support, of course, reach out and get support because you don't have to do it alone. There are ways to crawl out of this hyper-responsibility and get you back into that lane that's healthy for you. I'm sending you so much love. I hope you're having a wonderful summer for those of you who are in the northern hemisphere. I have just gotten back from the southern hemisphere and I loved getting some sun. I'm so happy just to be here with you and keep working through this stuff with you and addressing these really cool, important topics. Have a wonderful day. Do not forget, it is a beautiful day to do hard things. Take care.

Jul 28, 2023

Kimberley: Welcome. This conversation is actually so near and close to my heart. I am so honored to have Jessie Birnbaum and Sandy Robinson here talking about Managing the anxiety of chronic illness and disability. Welcome and thank you both for being here. Sandy: Thank you for having us. Kimberley: For those of you who are listening on audio, we are three here today. We're going to be talking back and forth. I'll do my best to let you know who's talking, but if anything, you can look at the transcripts of the show if you're wondering who's saying what. But I am so happy to have you guys here. You're obviously doing some amazing work bringing awareness to those who have an anxiety disorder, specifically health anxiety OCD, panic disorder. These are all very common disorders to have alongside a chronic illness and disability. Jessie, will you go first in just telling us a little bit about your experience of managing these things? Jessie: Yeah, of course. I've had OCD since I was a little kid but wasn't diagnosed until around age 14, so it took a little while to get that diagnosis. And then was totally fine, didn't have any physical limitations, played a lot of sports. And then in 2020, which seems like it would coincide with the pandemic (I don't think it did), I started getting really physically sick. I started out with these severe headaches and has continued on and morphed into new symptoms, and has been identified as a general chronic illness. I'm still searching for an overall diagnosis, but I've seen a lot of different ways in which my OCD has made my chronic illness worse. And then my chronic illness has made my OCD worse, which is really why Sandy and I are so passionate about this topic. Kimberley: Thank you. Sandy, can you share a little about your experience? Sandy: Yeah. Just briefly, I was born really prematurely at about 14 weeks early, which was a lot. And then I was born chronically ill with a bowel condition and I also have a physical disability called [02:31 inaudible] palsy. And then I wasn't diagnosed with OCD until I was 24, but looking back now, knowing what I do about OCD, I think I would say my OCD probably started around age three or something. So, quite young as well. Kimberley: You guys are talking about illnesses or medical conditions that create a lot of uncertainty in your life, which is so much of the work of managing OCD. Let's start with you Jessie again. How do you manage the uncertainty of not having a diagnosis or trying to figure that out? Has that been a difficult process for you, or how have you managed that? Jessie: It has been such a difficult process because that's what OCD latches onto, the uncertainty of things. That's been really challenging with not having a specific diagnosis. I can't say, "Oh, I have Crohn's disease or Lyme disease," or something that gives it a name and validates the experience. I feel like I have a lot of intrusive thoughts and my OCD will latch onto not having that diagnosis. So, I'll have a lot of intrusive thoughts that maybe I'm making it up because if the blood work is coming back normal, then what is it? I'll have to often fight off those intrusive thoughts and really practice mindfulness and do a lot of ERP surrounding that to really validate my experience and not let those get in the way. Kimberley: Sandy—I can only imagine, for both of you, that is the case as well—how has your anxiety impacted your ability to manage the medical side of your symptoms? Sandy: I think that's an interesting question because I think both my OCD and my medical symptoms are linked. I think when I get really stressed and have prolonged periods of stress, my bowel condition especially gets a lot worse, so that's tricky. But I think as I've gone through ERP, and I'm now in OCD recovery, that a lot of the skills I've learned from being chronically ill and disabled my whole life, like planning, being a good self-advocate at the doctors or at the hospital and that flexibility, I think those tools really helped me to cope with the challenges of having additional anxiety on top of those medical challenges. Kimberley: Right. Of course, and I believe this to be from my own experience of having a chronic illness, the condition itself creates anxiety even for people who don't have an anxiety disorder. How have you managed that additional anxiety that you're experiencing? Is there a specific tool or skill that you want to share with people? And then I'll let Jessie chime in as well. Sandy: Yeah. I think the biggest thing is, it was realizing that my journey is my journey and it might be a little slower than other people's because of all the complicating factors, but it's still a good journey. It's my journey, so I can't really wish myself into someone else's shoes. I'm in my own shoes. I guess the biggest thing is realizing like my OCD isn't special because I have these complicating factors, even though I myself am special. My OCD is just run-of-the-mill OCD and can still be treated by ERP despite those medical issues as well. Kimberley: Right. How about you Jessie? What's your experience of that? Jessie: I'd like to add to what Sandy had said too about the skills from ERP really helping. One of the things I feel like I've gone through is there's so much waiting in chronic illness. You're waiting for the doctors to get back to you, you're waiting for test results, you're waiting for the phone schedulers to answer the phone. I feel like I've memorized the music for the waiting of all the different doctors. But there's a lot of waiting, and that's really frustrating because the waiting is uncertain. You're just waiting to get an answer, which typically in my case and probably Sandy's and yours as well, then just adds more uncertainty anyways. But I remember one of the tools that's really helped me is staying in the present, which I'm not great at. But I remember I had to get an MRI where you literally can't move. There's only the present. You're there with your thoughts, your arms are in, you can't move at all. It was really long. It was like 45 minutes long. I remember just thinking the colors. What do I see? I see blue, I see red. I thought I had to think of things because then my eyes were closed and I was thinking of different shapes of like, "Oh, in the room before, I saw there was a cylinder shape and there was a cube." That's really helped me to stay in the present, especially with those really long waiting periods Kimberley: For sure. The dreaded MRI machine, I can totally resonate with what you're saying. It's all mindfulness. It's either mindfulness or you go down a spiral, right? Jessie: Exactly. Kimberley: You guys are talking about skills. Because I think there's the anxiety of having this chronic illness or a disability or a medical condition. What about how you manage the emotions of it and what kind of emotions show up for you in living with these difficult things that you experience? Sandy, do you want to share a little about the emotional side of having a chronic illness or a disability? Sandy: Yeah. I think the first thing that shows up for me emotion-wise, or did at least when I started to process the idea that I have a disability and I have these chronic illnesses and it's going to be a lifelong thing, was I was in my undergraduate university and I really hadn't thought much about what it's like to-- I had thought about having a disability, but I hadn't thought about the fact that I needed to process that this is a lifelong thing and it's going to be challenging my whole life. I think when I started to process that, the grief really showed up because I had to grieve this life that I thought I should have of being able-bodied or medically healthy or mentally well, I guess. I had to really grieve that. But I think that grief shows up sometimes unexpectedly for me too because sometimes I feel like I moved past this thing that happened. But then because it's an ongoing process to navigate chronic illness and disability, the grief shows up again at unexpected times. I think the other thing too I've navigated was a lot of shame around the idea that I should be "normal." But of course, I can't really control how I was born and the difficulties I've had. I think something that really helps me there is bringing in the self-compassion. I do think that compassion really is an antidote to shame because when you bring something out to the forefront and say, "This is something that I've experienced, it was challenging," but I can still move forward, I think that really helps or at least it helps me. Kimberley: Yeah, I agree. Jessie, what are your experiences? Jessie: I would say the first two words I thought of were frustration and loneliness. I think there's a lot of frustration in two different ways. The first way being like, why is this happening? First, I had OCD, and then now I have this other thing that I have to deal with. As Sandy was saying before, there's a lot of self-advocacy that has to happen when you're chronically ill, or at least that I've experienced, where you have to stand up for yourself, you have to finagle your way into doctor's appointments to get the treatment that you deserve. But there's also the frustration that both OCD and my chronic illness, I guess, are invisible. I look totally fine. I look like someone else walking down the street who might be completely healthy. I often feel frustrated that as a 23-year-old, a person who is a young adult, I'm having to constantly go to these doctor's appointments and advocate for myself and practice ERP, which is not always the most fun thing to do. It's frustrating to constantly have to explain it because you don't see it. And then that goes together with the loneliness of being a young adult and being pretty much the only person in the doctor's offices and waiting rooms who isn't an older adult or who isn't elderly. And then they get confused and then I get confused. My OCD will then attack that like, "Everyone else is older. What are you doing here?" I would definitely say loneliness, and I just forgot the other thing. Loneliness and frustration. Kimberley: I resonate with what you're saying. I agree with everything both of you are saying. For me too, I had to really get used to feeling judged. I had to get good at feeling judged, even though I didn't even know if they were judging me. But that feeling that I was being judged, maybe it's more magical thinking and so forth. But that someone will say like I have to explain to someone why I can't do something. As I'm explaining it, I have a whole story of what they're thinking about me, and that was a really difficult part to get through at the beginning of like, "You're going to have to let them have their opinions about you. Who knows what they're thinking?" That was a really hard piece for me as well. I love that you both brought in the frustration and the loneliness because I think that's there. I love that we also bring in the grief, and I agree, Sandy. Jessie, do you agree in terms of that grief wave just comes at the most random times? Jessie: Absolutely. Kimberley: It can be so, so painful. Let's keep moving forward. Let's go back to talking about how this interlocking web of how anxiety causes the chronic illness to get worse sometimes, the chronic illness causes anxiety to get worse sometimes. Sandy, have you found any way that you've been able to have a better awareness of what's happening? How do you work to pull them apart or do you not worry about pulling them apart? Sandy: Oh, that's an interesting question. I think I have a few strategies. I do try to write everything down. I make notes upon notes upon notes of, this day I had these symptoms. I do automate a lot of tasks in the fact that I have a medication reminder on my phone, so it reminds me to take my pills instead of just having to remember it off the top of my head. Something that really helps is trying to remember that things that work for other people might actually also work for me too, because it's like, yeah sure, maybe me as a person, I'm unique and my medical situation is interesting or different or whatever. But a lot of good advice for other people, especially for mental health works for me too, like getting outside. Even if I feel really not great and I'm really tired or in a lot of pain, just like getting outside. Anytime I have my shoes on and I'm just outside even for five minutes, I count that as a win. Drinking a lot of water, for me, helps us too. Of course, I'm wary of saying all this because a lot of people might just say, "Oh well, Jessie and Sandy, they just need to do more yoga and that'll just cure them." Of course, it's not that simple. It's not a cure at all. But at the same time, I try to remember that at least for me, I have common medical issues that a lot of different people have so I can pull on literature and different things that I've worked for other people with my conditions. Maybe other people haven't had this exact constellation that I do, but I can still pull on the support and resources from other people too. Kimberley: How about you, Jessie? Jessie: If I could add there, I'm not as good as differentiating. I can tell, like I know when things are starting to get compulsive, which I actually appreciate that I had had so much ERP training before I got sick because I really know what's a compulsion, what's an obsession and I can tease that out. But a lot of my treatment has also been really understanding, like maybe I don't need to know if this is my chronic illness or if this is my OCD because then that gets compulsive. I've had to sit in that uncertainty of maybe it is one, maybe it is the other, but I'm not going to figure it out. Kimberley: You read my mind because as you were both talking, I was thinking the most difficult part for many people that I see in my practice is trying to figure out and balance between advocating going to the doctor when you need, but also not doing it from a place of being compulsive because health anxiety and OCD can have you into the doctor surgery every second day or every second hour. How are you guys navigating that of advocating, but at the same time, keeping an eye on that compulsivity that can show up? Sandy, do you want to go first? Sandy: Yeah. I honestly haven't figured out the perfect formula between trying to figure out like, is this anxiety around the potential that I might be getting sick again and compulsively trying to get things checked out, and the idea that I might have something actually medically going wrong that needs to be addressed. I find it still challenging to tease those things apart. But I think something that does help is trying to remind myself like, not what is normal, because I don't think normal really exists but what is in the service of my recovery. I can't have recovery from my disability or my chronic illnesses, but I can't have OCD recovery. I'm always still trying to think to myself, how can I move forward in a way that both aligns with my values and allows me to move forwards towards my recovery? Kimberley: How about you, Jessie? Jessie: It's so hard to follow that, Sandy. I love that. I would say, I think it's tough because a symptom that I have is like, I was never really a big compulsive Googler. But I know in OCD world, it's like, "Don't go to Google for medical issues. Google is not your friend." But for my chronic illness recovery or chronic illness journey, Google's been important. I've had to do a lot of research on what is it that I possibly have. And that really helps me advocate my case to the doctors because I've had some great doctors, but they're not spending hours reading medical journals and trying to figure it out to the extent that I care about it because it's my situation and I want to figure stuff out. Googling has actually helped me a lot in that regard and joining different Facebook groups and actually hearing from other people what their experiences have been. I know Sandy and I started a special interest group, which hopefully we'll talk about a little later, but someone in the group had mentioned that something that really helps them is the community of their doctors and their therapists working together of, oh, I'm going to wait two days if I have this symptom and if it's still a symptom that's really bothering me and my therapist thinks it should be checked out, then I'm going to go to the doctor. Having those people who are experts guiding you and helping you with making sure, no, this isn't compulsive, this is a real medical thing that needs to be checked out—I thought that was really smart and seemed to work for her, so I'd imagine it would work for other people as well. Sandy: I guess if I can add-- Kimberley: I have a question about that. Yes, please. Sandy: Oh, sorry. If I can add one more thing, it would just be that, while there's so many experts on OCD and ERP and your chronic medical issues or your disability or whatever it is for you, you are the only frontline expert in your own experience of your mind and your body and you are the only one who knows what it's like to exactly be in that, I guess, space. While I 100% think therapy is important, evidence-based treatments are important, I do also think like remembering when you think like, "Oh, this is really hard," or "I can't cope," actually, you can cope, you're capable and you know yourself best. I think that's challenging because I know sometimes in ERP, for people who maybe don't have other complicated medical challenges, they would say, "Don't Google." But I think, as just Jessie has explained, sometimes because we have other chronic stuff going on, we do need to do things to help ourself holistically too. Kimberley: I love that. I'll speak from my own experience and if you guys want to weigh in, please do. I had to always do a little intention check before I went down into Google like, okay, am I doing this because anxiety wants me to do it, or am I doing it because this will actually move me towards being more informed, or will this actually allow me to ask better questions to the doctor and so forth? It is a tricky line because Google is the algorithm and the websites are set to sometimes freak you out. There's always that piece at the bottom that says, "It could be this, this, or this," or "It could be cancer." That always used to freak me out because that was something that the doctors were concerned about as well. This might be beyond just Googling, but in terms of many areas, how did you make the decision on whether it was compulsive or not? Jessie? Jessie: It's tough too because then you're down the rabbit hole. You've already been Googling it and it's like, "Or this," and I'm like, "Well, I have to figure out what that is." Sometimes it does get a little compulsive and then the self-compassion, and also realizing it like, okay, now it's getting compulsive and I'm going to stop and go about my day. But another thing that I've struggled with is the relationship with doctors. Sandy and I have talked about this before with wanting to be the "perfect" patient. I worry that I'm messaging them too much or I'll often now avoid messaging them because then I don't want to be too annoying of a patient. I can't be the perfect patient if I'm messaging them all the time. It really is, like you said, the intention. Am I messaging them because I want to move forward with this and I want an answer, or am I messaging them because there's a reason to message them and I need their medical advice? There's just so much gray in it. Again, not necessarily having that specific answer, it can be very tricky. Kimberley: It truly can. How about you, Sandy? Sandy: I think the biggest thing for me, and I'm still trying to figure out the right balance for this, is weighing how urgent is this medical symptom. Am I-- I don't know, I don't want to say something that would put someone into a tailspin, but do I have a medical symptom going on right now that needs urgent attention? If so, maybe I should go to my doctors or the ER. Or is the urgency more mental health related, feeling like an OCD need to get that reassurance or need to know, and just separating the urgency of the medical issue that's going on right this second versus the urgency in my head. Kimberley: Amazing. You guys have created a special interest group and I'd like to know a little more about that. I know you have more wisdom to tell and I want to get into that here a little bit more. But before you do, share with us how important that part of creating this special interest group is, how has that benefited, what's your goals with that? Tell us a little bit about it, whoever wants to go first. Jessie: Sandy and I actually met in an online OCD support group, and I found those online groups to be really helpful for my OCD recovery and mostly with feeling less shame and stigma. Met some amazing people clearly. And then I remember Sandy had mentioned in one of the different groups that she had a chronic illness. When I was going through my chronic illness journey, I felt really alone. As I was saying before, the loneliness is one of the biggest emotions that I had to deal with. I looked online, and now online support groups are my thing. Let's just Google chronic illness support groups. I thought it would be as easy as OCD support groups, and it wasn't. It was very challenging and it was really hard to find one. I found one that was state-based. For my state, it was me and three women. I think one was in their eighties, the other two were in their nineties, and they were very sweet. But we were at very different lifestyle changes. We were going through very different experiences. I remember I reached out to Sandy and I said, "Do you have any chronic illness support groups that you've been attending?" Even in that group with the elderly women, there were so many things that they were saying that helped them with their chronic illness and my OCD would totally have latched onto all of it. I was like, "I can't do that with my OCD." There's so much overlap that it just seemed like there needed to be this dual chronic illness and OCD. Sandy had said she had the same issue, like it was really hard to find these groups. I think we're really lucky that the International OCD Foundation was such a good partner for us and they were so kind in helping us get this special interest group started. I'm interested to hear what Sandy says, but it's been so helpful for me to see that there are other people who deal with a lot of these challenges. Of course, I wouldn't want anyone else to have these experiences, but being able to talk about it, being able to share has just been so helpful. I was really quite amazed to see the outreach we had and how many people struggled with this and that there really weren't any resources. It's been pretty amazing for me and I'm really lucky that we've been able to have this experience. Kimberley: Amazing. Sandy? Sandy: Similar to Jessie, I had found some resources for OCD support groups both locally to me in Ontario and online, and that was great. The sense of community really helped my OCD recovery. But then when it came to the chronic illness disability part, there was just a gap. As Jessie said, we started this special interest group and I think it's called—Jessie, correct me if I'm wrong—Chronic Illness/Disability Plus OCD is our official title. Basically, it's for anyone who has a chronic illness or disability and OCD, or is a clinician who's interested in learning more. Our goals really are to create a community, but also create resources for the wider OCD community to help people who are struggling with chronic illness or disability and OCD or clinicians. The sense of community has been great. I think for my own recovery OCD-wise, it's been really motivating to be able to help found and facilitate this group because it's showed me that I really don't have to be in this perfect state of recovery to have something valuable to contribute. I just have to show up in an imperfect way and do my best and that is enough in itself, and that the fact that I don't have to get an A+ in recovery because that's not even a thing you can get. I just have to keep trying every single day and try to live my values. I think this SIG's been a great opportunity to embody those values as well of community and advocacy. It's just been great. Kimberley: Oh, I love it so much and it is such an important piece. I actually find the more I felt like I was in community, that in and of itself managed my anxiety. It was very interesting how just being like, "Oh, I'm not alone." For some reason, my anxiety hated this idea that I was alone in this struggle. I totally just love that you're getting this group and I'll make sure that all of the links are in the show notes so people can actually access you guys and get connected. I have one extra question before I want to round this out. How do you guys manage the—I'm going to use the word "ridiculous"— "ridiculous" advice you get from people who haven't been what you've been going through? Because I've found it actually in some cases to be quite even hilarious, the suggestions I get offered. Again, I know patients and clients have had a really difficult time because they might have been suggested an option, and then their anxiety attaches to like, "Well, you should do that," and so forth. Sandy, do you want to go first in sharing your experience with "ridiculous" advice? Sandy: I guess to give a brief example, a practitioner who I've worked with for quite a while, who I think is great and a wonderful person and wonderful practitioner, had in the last couple months suggested that maybe I should just try essential oils to manage my bowel condition. What actually was needed was hospitalization and surgery. It's that kind of advice from both well-meaning practitioners or just people in my life that can be not what you need to hear and maybe not as supportive as they're hoping it would be. I guess for me, I manage it mostly by saying, "Thank you, that's a great idea," even when it's not really a great idea. I just say to myself or maybe to a support person later, "That was not the best advice." Just debriefing it with someone I think is really helpful, someone that I trust. Jessie: Kimberley, I love this. I think, Sandy, our next SIG, we should ask this and hear all the ridiculous advice that people have been given because it's true. There's so many things that are so ridiculous. I'm going to shout out my mom here who I love more than anything in the world, but even my mom who lives with me some of the time and sees what I go through, one time she called me (she's going to kill me) and she said, "I heard there's a half-moon at 10:30 AM your time and if you stand outside, it will heal some of your rear rash." I was like, "What? That's absurd." She was like, "I know, I think it's absurd too, but you need to do this for me." With that, you see she just wants me to get better. As Sandy was saying, people really want to help and this is a way they think they can help. I've also been told like, "Oh, if you mash up garlic and then you put--" it was like this weird recipe, then you want to had it. Just ridiculous things. But people are really well-meaning and they want to help. Unfortunately, those often don't really help. But now I can laugh about it and now text my mom and be like, "You'll never guess what so-and-so said," or text Sandy and we could have a good laugh about it. But that's what's nice about community. You're like, "Wait, should I do this essential oil thing?" And then you realize from others, "No, that's probably not the best route to go." Kimberley: For me, with anxiety, self-doubt is a big piece of the puzzle. Self-doubt is one of the loudest voices. When someone would suggest that, I would have a voice that would say, "It's not going to hurt you to try." And then I would feel this immense degree of self-doubt like, "Should I? Should I not? What do you think?" "You could try. You should try." I'm like, "But I literally don't have time to go and stand in the sun and do the thing," or in your example. I would get in my head back and forth on decision-making like, "Should I or shouldn't I?" "It wouldn't hurt." "It sounds ridiculous, but maybe I should." And that was such a compulsive piece of it that would get me stuck for quite a while. It's often when it would be from a medical professional because it really would make you question yourself, so I fully resonate with that. Sometimes I wish I could do a hilarious Instagram post on all of the amazing advice I've been given throughout the time of having POTS. Some of it's been ridiculous. Let me ask you finally, what advice would you give somebody who has an anxiety disorder and is at first in the beginning stages of not having these symptoms and not knowing what they are? Jessie, will you go first? Jessie: Yeah. I would say a big thing, as we've been talking about, is finding that community whether that be reaching out to us with the SIG or whether that be finding a Facebook group or online group or whatever it may be, because it has helped me so much to reach out and be in a community with others who really understand. There's nothing like people who truly get it. And then I would say to validate like, this is really tough. Having OCD is tough. Having a chronic illness or disability is tough, and having both is very, very tough. Validate those symptoms too because I think there's a lot of people that will say, "Oh, you have an anxiety disorder, you're probably making that up," and that comes up a lot. Just validating that and really trying to find other people who are going through it because I think that's just irreplaceable. Kimberley: Sandy? Sandy: I think the biggest thing to echo Jessie would be try to find community. I think for me, for my OCD recovery journey, Instagram has particularly been great because there's so many wonderful OCD advocates or clinicians on Instagram. It's really a hub for the OCD community. I would say check out Instagram and once you follow a couple of people from the OCD community, the algorithm will show you more so it's nice that way. I think the other thing is that being disabled or having a chronic illness can really chip away your confidence. Just reminding yourself that you're doing the best you can in a really hard situation, and it may be a long-term situation, but just because your life is different than other people doesn't mean that it's not going to be a great life. Kimberley: I'm actually going to shift because I wanted to round it out then, but I actually have another question. Recently, we had Dr. Ashley Smith on talking about how to be happy during adversity. I'm curious, I'll go with you, Sandy, first because you just said, how do you create a wonderful, joyful life while managing not only an anxiety disorder, but also chronic illness or disability? What have you found to be helpful in that concoction per se? Sandy: I listened to that episode with Dr. Smith and that was a wonderful episode. If people haven't listened to it, I recommend it. I listened to it twice because I just wanted to go back and pick out the really interesting parts. But I think for me, the combination of finding things that are both meaningful from a values and an acceptance and commitment therapy (ACT) perspective, meaningfulness, finding those things that matter to me, but also finding the things that challenge me. If I'm having a really bad pain day or fatigue day, the things that challenge me might just be getting out of bed, or maybe I'm really depressed and that's why I can't get out of bed. Either or, your experience is valid, and just validating your own experience and bringing in that self-compassion and saying, what is something that can challenge me today and bring me a little closer to recovery? Even if it's going to be a long journey, what's this one small thing I can do, and break it down for yourself. Kimberley: Amazing. I love that. What about you, Jessie? Jessie: I would say I've been able to find new hobbies. I'm still the same person. I'm still doing other things that I found meaningful and this doesn't. Well, it is a big part of my life. It's not my entire life. I'm still working and hanging out with friends and doing things that regularly bring me happiness. But just a small example, I said before, I used to play sports and love being really active and that gets a little harder now. But something I found that I really love is paint by numbers because they're so easy. They're fun, they're easy, you don't have to be super artistic, which is great for me. I'm able to just sit down and do the paint by numbers. Even recently I had friends over and it was like a rainy day and we all did a craft. Even though it was a really high-pain day for me, I was in a flare of medical symptoms, I was still able to engage with things that I find meaningful and live my life. Kimberley: I love that. Thank you. That's so important, isn't it? To round your life out around the disability or the chronic illness or your anxiety. I love that. We talked about those early stages of diagnosis, any other thing that you feel we absolutely have to mention before we finish up? Sandy? Sandy: I guess to quote someone you've had on the podcast before, Rev. Katie, I find her content amazing and she's just a lovely person. But she always says, you are a special person, but your OCD is not special. Your OCD isn't fundamentally different or it's never going to get better. You got to remember that you are the special person and your OCD doesn't want you to recognize that you are the thing that's special, not it. Just be able to separate yourself from your anxiety disorder or your chronic illness or your disability, saying, "I'm still me and I'm still awesome, and these things are just one part of me." Kimberley: So true. I'm such a massive Katie fan. That's excellent advice. Jessie? Jessie: To go the other route, I think you said right with people who are first going through this. I would say we recently did a survey of our SIG, so people who have chronic illness and OCD. We haven't done all the data yet, but the thing that really stood out was we asked the question like, have you ever felt invalidated by a medical professional or mental health professional, and every single person said yes and then explained. Some people had a lot to say too. I think I've really learned in this process that you have to be a self-advocate. It's very challenging to be an advocate when you're going through a mental disorder, a physical disability, and/or both. It's required. Really standing up for yourself because it's going to be a tough journey and there's so much light in the journey too. There's so many positive things and so much "happiness" from the episode before, but there's also a lot of difficulties that can come from being in the medical world as well as the mental health world and really trying to navigate both of them and putting them together. Really try to advocate for yourself or find someone who could help you advocate for yourself and your case because I think that'll be really helpful. Kimberley: So true. You guys are so amazing. Jessie, why don't you go first, tell us where people can get resources or get in touch with you or the SIG, and then Sandy if you would follow. Jessie: We have an Instagram account where we'll post-- we're experiencing with Canva. We're really working on Canva and getting some graphics out there about the different things that come up when you have both of these conditions. And then that's where we post our updates for the special interest group. Sandy, correct me if I'm wrong. @chronically.courageous is our Instagram handle. And then in there, the link is in our bio to sign up for the special interest group. You get put on our email list and then you'll get all the emails we send with the Zoom links and everything. And then you could also go to the International OCD Foundation's website and look at the special interest groups there and you'd find ours there. Sandy: The other thing is we meet twice a month. We meet quite frequently and we'd love to have you. So, please check out our Instagram or get at our email list and we would love you to join. Kimberley: You guys, you make me so happy. Thank you for coming on the show. I'm so grateful we're having this conversation. I feel like it's way overdue, but thank you for doing the work that you're doing. Thank you so much. Jessie: Thank you. Sandy: Thanks for having us.

Jul 21, 2023

Kimberley: My tummy already hurts from laughing too much. I'm so excited to have you guys on. Today, we are talking about thriving in relationships with OCD and we have Rev. Katie O'Dunne and Ethan Smith. I'd love for you both to do a quick intro. Katie, will you go first? Katie: Yeah, absolutely. My name is Reverend Katie O'Dunne. I always like to tell folks that I always have Reverend in my title because I want individuals to know that ordained ministers and chaplains can in fact have OCD . But I am super informal and really just go by Katie. I am an individual who works at the intersection between faith and OCD, helping folks navigate what's religious scrupulosity versus what is true authentic faith. I'm also an OCD advocate on my own journey, helping individuals try to figure out what it looks like for them to move towards their values when things are really, really tough. Outside of being a chaplain and faith in OCD specialist and advocate, I'm also an ultramarathon runner, tackling 50 ultramarathons in 50 states for OCD. As we get into stuff with Ethan today, Ethan is my biggest cheerleader throughout all of those races. I'm sure we'll talk all about that too, running towards our values together. Ethan: My name is Ethan Smith . Katie is my fiancé. I'm a national advocate for the International OCD Foundation, a filmmaker by trade, and a staunch advocate of all things OCD-related disorders. Definitely, my most important role is loving Katie and being her biggest cheerleader. Katie: Since you said that, one of my things too, I am the fiancé of Ethan Smith. Sorry. Ethan: Please note that this is an afterthought. It's totally fine. Kimberley: No, she knew you were coming in with it. She knew. Ethan: Yeah, I was coming in hot. Yup, all good. WHAT IS IT LIKE BEING IN A RELATIONSHIP WITH SOMEONE WITH OCD? Kimberley: Thank you both for being on. I think that you are going to offer an opportunity for people to, number one, thriving in Relationships with OCD, but you may also bring some insight on how we can help educate our partners even if they don't have OCD and how they may be able to manage and navigate having a partner with OCD. I'm so excited to have you guys here. Thank you for being on. Can you first share, is it easier or harder to be in a relationship with someone with OCD? For you having OCD? Ethan: I'll let Katie start and then I'll end. Katie: Yes. No, I think it's both. I think there are pros and cons where I think for so long being in relationships with individuals who didn't have OCD , I desperately wanted someone to understand the things that I was going through, the things that I was experiencing, the intensity of my intrusive thoughts. I was in so many relationships where individuals felt like, well, you can just stop thinking about this, or you can just stop engaging in compulsions. That's not how it works. It has been so helpful to have a partner through my journey who understands what I'm going through that can really say, "I actually get it and I'm here with you in the midst of that." But I always like to be honest that that can also be really, really challenging where there are sometimes points, at least for me, having OCD with a partner with OCD, where if we are having a tough point at the same time, that can be really tough. It can also be really tough on a different level when I see Ethan struggling, not reassuring him even more so because I know how painful it is and I want so badly to take that away. There are times that that can feed into my own journey with OCD when I see him struggling, that my OCD latches onto his content, vice versa. There's this amazing supportive aspect, but then there's also this piece I think that we have to really be mindful of OCD feeding off of each other. Ethan: I was just making notes as you were-- no, go ahead. Kimberley: No, go ahead, Ethan. I'm curious to know your thoughts. Ethan: Katie made all great points, and I agree. I mean, on the surface, it makes a lot of sense and it seems like it's fantastic that we both can understand each other and support each other in really meaningful and value-driven ways. I always like to say that we met because of OCD, but it by no means defines our relationship or is at the heart of our relationship. It's not why we work. It's not what holds us together. I think Katie brings up two good points. First of all, when I would speak and advocate with parents and significant others and things like that, and they would say, "I'm having a really hard time not reassuring and not enabling," I'd be like, "Just don't, you're making them sicker. Just say what you got to say and be tough about it." Then I got in a serious relationship with Katie and she was suffering and hurting, and I was like, "Oh my God, I can't say hard things to her." I became that person. I suddenly understood how hard it is to not engage OCD and to say things that aren't going to make her comfortable. I struggle with that. I struggle with standing my ground after a certain amount of time and wanting to desperately give in and just make her feel better. I just want her to feel better. For me personally, I lived alone for 10 years prior to meeting Katie, and those 10 years followed my successful treatment and recovery from OCD. For me, my mother was my safe person. I learned during treatment and therapy that you don't talk about your OCD around your parents anymore. You just don't. That's not a conversation you have. I found myself, other than within therapy, not ever talking about my OCD. I mean, advocacy, yes, but my own thoughts, I never talked about it. Starting to start a relationship with Katie, I suddenly had someone that understood, which was wonderful, but it also opened up an opportunity for OCD to seek reassurance. I'm an indirect reassurance seeker. I don't ask for it as a question; I simply state what's on my mind, and just putting it out there is reassuring enough for me. For instance, like, "Oh, this food tastes funny." Whether she says it does or it doesn't, I really don't care. I just want her to know that I think that it does, and it could be bad. I think this is bad. I'm not saying, "Do you think it's bad?" I'm like, "I think it's bad. I think there's something wrong with this." I've had to really work and catch myself vocalizing my OCD symptoms because having a partner that understands has given my OCD permission to vocalize and want to talk about it. That honestly has been the biggest challenge for me in this relationship. NAVIGATING OCD REASSURANCE SEEKING IN RELATIONSHIPS Kimberley: So interesting how OCD can work its way in, isn't it? And it is true. I mean, I think about in my own marriage, at the end of the day, you do want to share with someone like, "This was hard for me today." You know what I mean? That makes it very complicated in that if you're unable to do that. That's really interesting. Let's jump straight to that reassurance seeking piece. How do you guys navigate, or do you guys create rules for the relationship? How are you thriving in Relationships with OCD related to reassurance seeking or any compulsion for that matter? Katie: A couple different things. I think part of it for us, and we by no means do this perfectly, I'd have to have conversations about it even-- yes, Ethan, you might do it perfectly, but even in the last week, we've had conversations about this where what Ethan responds well to is very different from what I respond well to. I think that is really important to note, especially when there's two partners with OCD , that it's not one size fits all. It's not because I understand OCD that I know exactly how to respond to him. It's still a conversation. For me, I respond really well if I'm seeking reassurance or I'm struggling to a lot of compassion where he doesn't respond to the content, but tells me, "I know that this is really hard. This sounds a lot like OCD right now, but let's sit with it together. I know that it sucks, but we can be in the midst of this. We aren't going to talk about it anymore, but I love you. We're going to watch a show. We're going to do whatever it is we're going to do, we're going to be in it together." I respond really well to that. Ethan, on the other hand, does not respond quite as well to that and actually responds better to me being like, "Hey, stop talking about that. We are not going to talk about this right now. I have heard this from you so many times today. No, no, no, no." He responds in a harsher tone. That's really hard for me because that is not naturally what comes out of me, nor what is helpful for me. Sometimes the compassion that I offer to Ethan becomes inherently reassuring and is just not something that's helpful for him, so we have to have these conversations. Vice versa, sometimes when I'm really struggling, he'll forget the compassion piece works for me and is like, "Hey, Katie, no. Stop doing that." I'm like, "Seriously? This is really hard." Being able to have those conversations. Kimberley: How do those conversations look, Ethan? Can you share whatever you're comfortable sharing? Ethan: Yeah. Katie hit over the head, first of all. We are definitely products of our therapists when we're struggling. For those of you that may or may not know, Katia Moritz, she is hardcore, like here's what it is, and I'm a product of that. There's like, "Nope, we're not going to do it. We're not going to have it. OCD is black and white, don't compulse, period. End of story." Katie is like, "Let's take a moment." My natural instinct on how I respond to her is very different to what she needs and vice versa. We've learned that. I would say that the rule in our household is we're a no-content household. I'm not saying we succeed at that all the time, but the general rule is we're not a content household. We don't want a no content. You can say that you're struggling. You can say that you're having a hard day. You can say that OCD is really loud today. Those are all okay things. But I don't want to hear, and Katie doesn't want to hear the details because that inevitably is reassuring and compulsy and all of those things. That's our general rule. I'll talk for me, and I don't know, Katie, I'll ask you ahead of time if it's okay to share an example of our conversation, but my stuff, like I said, it's covert reassurance seeking and she does it too. We're both very covert. We're like well-therapized and we know how to-- Katie: It's really funny because I can tell when he's sneaky OCD reassurance-seeking . Nobody else in my life has ever been able to tell when I'm secretly seeking reassurance. It's actually frustrating because he can call me on it because he's really good at it too. There's some level of accountability with that. Ethan: For sure. For me, I'll get stuck on something and I'll just start verbalizing it. That's really the biggest thing I think, unless Katie has some other insight, and she may. But for me, verbalization of my thoughts, not specifically asking for a specific answer and simply saying, "Oh, my chest feels weird. I'm sure I'm dying. My heart is about to give out." How are you going to respond to that? What are you going to say right now? And that's my system. She'll be like, "Okay, yup. You may." To be honest, I'll call Katie out, she really struggles with giving me-- she's like, "Ethan, I'm sure you're fine." I'm like, "Why did you say that?" She does. She really struggles with-- Katie: It's interesting because I work with folks with OCD all the time and I don't reassure them, but it's so interesting because it feels so different with my partner knowing how much he's struggling and I just want to be like, "You know what this is, it's fine." But yeah, working on that Kimberley: If he's struggling, then you said sometimes you will struggle, it makes sense that in that moment you're like, "You're fine, you're fine." You don't want them to have a struggle because you know it might even impact you, I'm guessing. Katie: Well, yeah. It's funny, all of Ethan's stuff is around bad things happening to him. All of my stuff is around bad things happening to other people. If Ethan's worried something bad's going to happen to him, I'm like, "No. I can't handle that. I don't want to worry that you're going to die. Let's not put that on the table." Ethan: We discovered it was true love when my OCD was worried about her. She's like, "Baby, it's about me. It's not about you." It's true love. No question. Katie: He had never had obsessions about someone else before. I was so excited. He was like, "Am I going to kill you in your sleep? Is that going to happen?" I was like, "Oh my gosh, you do love me. So sweet." Ethan: But to answer your question, conversely, when Katie is struggling, she gets loopy and she directly asks for reassurance. I can definitely get frustrated at it at a certain point. I always feel like one time is appropriate. "Do you have a question or concern? Do you think blah, blah, blah?" "No, I don't think so. I think that's totally appropriate." And then the second time, "Yeah, but do you..." I was like, okay, now we're starting to move into OCD land and I stay compassionate up to a certain point and then I'll get frustrated because it will be so obvious to me. As she said, myself is so obvious to her. I just want to be like, "Katie, can you see this makes no sense at all?" But when she's really struggling, not just the superficial high-level or low-level OCD hierarchy stuff, when she's really, really deeply struggling, it's challenging. I really struggle with not giving her the reassurance that her OCD craves because I can't stand to see her suffer. Sometimes I wish that I didn't know as much about OCD as I do because I actively know that I'm helping OCD, but giving her that instant relief in the moment, it just pains me. We've definitely changed our relationship style as we've gotten to know each other and been able to say things like, "I know this doesn't feel good. I don't want to say these things to you, but I really, really don't want to help OCD and hurt you. I really, really want to help you get better in this moment and hurt OCD and just put it to bed, so I'm not going to answer that." We've had to have those communicative conversations to be able to address it when it does cross the line. I will say we're pretty well., we do pretty good, but that's not to say that there aren't times where we can both get in a rabbit hole. To Katie's point and to your point, it gets sticky sometimes. I literally never checked an oven in my entire life till I moved in with Katie. And then now she'll mention it or I'll be closing up the lights and I'll be like, I've never looked and thought about it. But Katie talks about it and that's one of her things, and like, "It latched on. I'll take it," and like, "No, no, no. Ethan. Everything's going to burn down." Yes, moving on. Katie: Likewise, I've never checked my pills multiple times to make sure that I didn't take too many or worried that there was glass inside of my glass from hitting it. I mean, there's things that were Ethan's that I now think about. It's really interesting because I think we actively work to not give into those things, but that's definitely a process to you where they were things that I never would've gotten stuck on before. We have these conversations too of being able to call each other out. Well, actually, comedy is a really big thing in our house too, so we also like to call it out in a way of like, "Hey, you're stealing my themes. Stop it. That's mine. Come on, let me have that stomach bug thing." Kimberley: Isn't that so interesting, though? We constantly get asked what causes OCD , and we never can really answer the question. We say it's a combo of nature and nurture and you guys are touching on the nurture piece in that, yes, we are genetically predisposed to it, but that other people's anxiety around things can create anxiety for us. I actually feel the same way. There are so many things my husband is anxious about, or my kids. Now I'm hyper-vigilant about it. That's so interesting that you guys are seeing that in real life. HOW TO SUPPORT A LOVED ONE WITH OCD Ethan: Yeah, for sure. And then Katie brought up a great point, which is, I think the most challenging times, and they don't happen often, is when we're both struggling simultaneously. How do you support each other in that moment? First of all, what's very funny is we like to joke we both have OCD and we're both only children. It's one of those households. Literally, we'll cook a frozen pizza and we'll sit there and size up the half to figure out which one's bigger and then be like, "Are you sure you want that one? I want that." It's a thing. When we're both struggling, it's like, "No, you need to listen to me." "No, no, no, no. You need to listen. It's my thing. It's my thing." It's been few and far between where we've both really been significantly struggling simultaneously, but we've managed it. We learn how to be able to struggle and listen and support. It's no different than advocating when you're not feeling your best. You can still be compassionate and sympathetic and offer advice that is rooted in modalities of treatment and still be struggling at the same time. We may not get the empathy that we want because maybe we're just not in a place or we're pouring from an empty cup or whatever, but fortunately, those times aren't that frequent. But when they do happen, we've navigated and managed really well, I think. Katie: And even just-- oh, sorry. Kimberley: No, please, Katie. Go ahead. Katie: I was going to say, even with that, having conversations around it, I think, has been really helpful. We've had moments of being really honest. Particularly earlier this year, I had some tough stuff that happened and I was in a place of grief and then also OCD was coming into that. Ethan, it lined up at some points with some difficult points that you had. There were some times that you were honest about saying, "I am just not in a place to respond to this right now in this moment in a healthy way." I think that's actually one of the best things that we can do too. Of course, OCD sometimes gets frustrated at that, "Hey, why can't you talk about it right now?" But I think having those honest conversations as a couple too so that we can both offer care to ourselves and to one another in the midst of those times that we're struggling is really, really important. SETTING BOUNDARIES IN RELATIONSHIPS WITH OCD Kimberley: You answered actually exactly what I was going to say. There are times when we can't be there for our partner. When that is the case, do you guys then go to your own therapist or to a loved one? Not to get reassurance or do compulsions, but just have a sense of containment and safety. Or are you more working towards just working through that on your own? How do you guys navigate thriving in Relationships with OCD when your partner is tapped out? Katie: We both have our own therapist and that's really, really helpful. We both actually have conversations together with the other person's therapist. Ethan will meet with his therapist and we've had times when he's struggling where I'll come in for a half session to talk about, hey, what's the best way to respond to him and vice versa. I'll meet with my therapist separately, but we might bring him in for 20 or 30 minutes for him to learn, hey, what's the best way to respond to Katie right now? We both have those separate spaces to go and talk about both what we're navigating and what we need, but also how to respond to our partner and then collaborate with one another's therapist. I mean, that has been so helpful for me because there have been points where I don't know how to respond to what Ethan's navigating. To hear directly from his provider as opposed to feeling like I have to take on that role is so crucial. And then, Ethan, you meeting with my therapist earlier this year, oh my goodness, was so helpful because she had given me all this insight that I just wasn't in a place to be able to share because I was struggling. For you to hear that directly from her and what she thought that I needed I think was a huge step forward for us. Ethan: Yeah. It's nuanced. It's not a one size fits all. Yes, it's all ERP or ACT or DBT or whatever. But it's all specific to what we're all going through. I will say it's funny because as we're talking, I'm like, "I didn't ask Katie if these things I could say or not." Katie: I'm afraid to say that. You can literally say anything. I pretty much talk all the time about all this. Ethan: For sure. I think one of the things that really, really helped our relationship in terms of navigating this is, when I first met Katie and we started dating, she wasn't seeing a therapist actively. It was challenging because as someone that is well-versed in OCD , we would constantly talk about things and she would divulge a lot of information to me. I started to feel like I didn't want to take on an advocate or therapist's role with her. I wanted to be her boyfriend. I was really struggling because I really wanted to support her and I really wanted to be. That was never a question, it was not supporting her. But for the same reason that we tell parents like, "Don't police your kids, be their parents," and hear how that can backfire, it was really challenging to navigate being a significant other and also supporting her, but not becoming that person that her OCD goes to. I think her finally landing on a therapist that was right for her and good for her where she can get that objectivity that she needs and I can too learn what she needs from me as a partner, not that there was anything wrong with our relationship, but really allowed our relationship to grow and really allowed us to focus on what we should be focusing on, which is each other and who we are to each other and what's important to our lives and our family. Our therapists can handle our OCD. That doesn't mean that OCD doesn't get involved. It does. But for the most part, that was really where our relationship really got to level up. We both were able to turn to our therapists, but also include each other in treatment so we can have open and honest conversations about what's going on. DO I TELL MY PARTNER ABOUT MY OCD OBSESSIONS? The other thing I'll say is, we have no secrets. We literally have no secrets. As a first timer to a long-term relationship, because my OCD Obsessions wouldn't let me have a long-term relationship any longer than four or five months, as a first-timer in the three-year club on May 9th, I really feel like that is such a crucial piece to our relationship. We watch reality shows and it's like, "You went through my phone," and it's like, "Well, I don't care. She knows my passwords. I have nothing to hide." I always say that individuals with OCD would make the worst thieves. Could you imagine? I put myself in a position of robbing a house. There's no way I wouldn't worry that one piece of DNA was not left in that house. I find hair on my pillow all the time. There's no possible way I could ever burglarize anyone and not think I would be caught. We're not transparent because we know that that will alleviate our OCD. We're transparent because I think honesty is really important in a relationship and so is communication. We always advocate that having therapy and having access to treatment shouldn't be an exception at all. That should be the standard. It should be accessible, should be affordable, should be effective. Absolutely, no question there. But with that being said, Katie and I were both fortunate enough to have really good treatment and I think our relationship reflects that. Not to say that we're perfect all the time, but I think we're too highly therapized individuals that began our relationship with honesty and communication and have continued that through and through. I think that has enabled us to not only grow as a couple but also helped us manage our own OCD and the OCD of each other and how we interrelate. HOW TO ENCOURAGE SOMEONE WITH OCD Kimberley: Right. I think that is so true. As you're talking, I'm thinking of people who are at the very beginning stages. They didn't have any idea about OCD and they've been giving reassurance, they've been asking for reassurance, and there's tantrums because the person isn't giving the right reassurance. What would you encourage couples to do if they're newly to treatment, newly to their diagnosis, and their goal is to be thriving in Relationships with OCD? Katie: There's so many different things, and I know this is different for every person, but even if they're new to that process, getting their partner involved in therapy, meeting with their therapist, having them learn about OCD, again, Ethan talked about, not from a space of the partner becoming the therapist, but having an understanding of what the person is going through so that they're not reassuring, so that they're not accommodating. But I say this to folks all the time, again, so that you're not also being so hard and so rigid so that you can still be the person's partner in the midst of that. I think being able to understand what their triggers are, what their symptoms are, what's coming up, so that you can say, "Hey, I'm your partner. I love you. I can't answer that, but I'm here." I think figuring out what that looks like with the provider, but also with the partner is just so beyond important to have an effective relationship, one, so that you're not just closing it off so that you can't talk about it, but two, so that, as Ethan said, you don't become the therapist because that's not healthy either. I think we have in our relationship almost tried both extremes at different points of, "Hey, we're not going to talk about it at all," or "Oh, we're going to talk about everything and we're going to totally support each other through every aspect." I think with each person, it's finding that balance of how we can be a couple with open and honest communication, but we're actually still each other's partners and not each other's therapists. Kimberley: Yeah. Do you have any thoughts, Ethan? Ethan: I was just thinking. I mean, she nailed it. I don't know that I have anything to add to that, whether you both have OCD or one of you has OCD. I was actually thinking earlier on in the relationship, and about divulging your OCD and when it's appropriate. We get so many questions from so many people about, when I'm dating, when am I supposed to let them know? When am I supposed to talk about it? I have very aggressive feelings about OCD and dating, and as amazing as somebody may look and be like, "Oh my God, I would love to be in a relationship with a partner that has OCD because then I don't have to explain anything." I did not date to specifically find somebody with OCD. When I met Katie, we were friends long before we were together. Katie: We always say that, like he was my best friend that I happened to meet through the OCD community, that we fell in love during COVID because he was my best friend, and because we had so much that connected us beyond OCD. I know you said this earlier, Ethan, but we get the question all the time, "Oh, if I just had a partner with OCD..." and that is not. If all we had in common was our OCD, this would not work out because it actually can make it even more challenging. But it's what's beyond that. I always think we shouldn't be in a relationship or not in a relationship based on our diagnosis. It's about who the person is and how we can support them for who they are. Ethan: Yeah, for sure. You actually raised a good point. I was going to talk about, and we can maybe come back to it, when to talk about your OCD to your partner, when it's appropriate, when you feel it's appropriate, this difference between wanting to confess about your own OCD and feeling like they need to know right now that I have OCD so I'm not dishonest with them and I don't hit them with the big secret down the road. We can talk about that. But you raised-- wow, it was a really interesting point that I totally forgot. Katie, what did you just say? Go ahead. Katie: No, I was just talking about not being in a relationship because of the OCD and really having-- Ethan: I remember. Katie: Okay, go ahead. You got it. HOW TO HELP YOUR LOVED ONE UNDERSTAND WHAT IT'S LIKE TO HAVE OCD Ethan: Yeah. I'd be curious to Kim's thoughts. But I think with OCD individuals, whether it's a significant other or family and friends, and I've been talking about this a lot lately, we've talked about, okay, how do I get someone to understand what OCD is? How do I help them understand what I'm going through? We did a town hall on family dynamics last week for the IOCDF and we've had multiple conversations about this. I'd be curious to Kim's thoughts. I think there's a difference between having a partner or a family member, whatever, being able to support you in an effective, healthy, communicative way, and fully understanding what you're going through. I think those are two different things. I don't think that an individual needs to know and feel exactly what you're experiencing going through to be able to understand and support you. I think as individuals with OCD, we have this inherent need for our partners or people that we care about to know exactly how we feel and exactly what we're going through. "You need to know my pain to understand me." I think that is a big misnomer. I think honestly, that's a potential impossible trap for a relationship when you're dating someone or with someone that doesn't have OCD. The likelihood of that individual, while you can give them examples, the likelihood of them actually truly understanding your own OCD experience is unlikely. Just like if Katie had had cancer and went through treatment, I'll never know what that's like. But that doesn't mean that I can't be sympathetic and empathetic and support her and learn about the disease state and be able to be a really, really wonderful partner to her. I think for individuals that are in relationships with individuals that don't have OCD, if you resonate with this, being able to release this idea of like, they need to know exactly what I've gone through. Really the real thing they need to know is, how can I be a supportive partner? How can I support you in a meaningful, healthy, value-driven way so we can have the best possible relationship? I don't know if I ever said that, but Kim, I'd be open to your thoughts. Kimberley: No, I agree. Because the facts are, they won't get it. No matter how much you want them to get it, they will get it, but they won't have experienced something similar to you. But I think like anything, there's a degree of common humanity in that they can relate without completely having to go through it. They can relate in that I too know what it's like to be uncertain or I too know what it's like to have high levels of anxiety. Or even if they don't, I too can understand your need for certainty in this moment or whatever it may be. I think the other thing to know too is often when someone needs to be understood and they insist on it, that's usually a shame response. There's a degree of shame that by being understood, that may actually resolve some of that shame. If that's the case, they can take that shame to therapy and work through that and get some skills to manage that, because shame does come with mental illness. Often I find some of the biggest fights between couples were triggered by a shame emotion. They felt shame or they felt embarrassed or humiliated, or they felt less than in some way, or the boxing gloves are on. How do you handle, in this case, conflict around-- I don't know whether you have any conflict, but has conflict came up around this and how do you handle it? SHAME + GUILT IN RELATIONSHIPS WITH OCD Katie: One piece with the last component, and then I'll shift into this. I think as you were talking, the shame piece resonates with me so much. I'm definitely someone that even through the OCD experience, guilt and shame are much heavier for me than anxiety or fear or anything else, that feeling really challenging. I think that the biggest piece that helped to combat that actually had to do with my relationship with Ethan, not specifically because he knew every ounce of my themes or what I was going through, but simply because of the empathy that he showed me. I talk often about how because of shame in my OCD journey, one of the reasons I struggled to get better for a long time was I didn't feel like I deserved it. I didn't feel like I was good enough because of my intrusive thoughts. I didn't like myself very much. I hated myself actually. Ethan, by loving me, gave me (I'm going to get emotional) permission to love myself for the first time. It wasn't because he specifically knew the ins and outs of my themes, but simply because he offered empathy and loved me as a human being, and showed me that I could do that for myself. That was a huge step forward for me. I think every partner can do that. I used to talk with my students when I was in education about empathy, and I would always say you don't have to experience the exact same thing that your friend experienced to say, "Oh, I can put myself in your shoes." To your point, Kim, I know what sadness feels like. I know what this feels like. I know what that feels like. I think just showing empathy to your partner, but also showing them that they truly do deserve love in the midst of whatever they're experiencing with their OCD can be such a healing component. I just wanted to say that, and now I've forgotten the other part of your question. Ethan: Well, wait, before she asks it, can I piggyback? Kimberley: Yeah. Ethan: I'm going to just offer to Katie. Katie's shared that story before and it's really special. Always, I was just being me and seeing something beautiful in her and wanting it to shine. But something that I don't think I've ever talked about ever is what she did for me in that same context. I always saw myself as a really shiny car, and if you saw me surface, I was really desirable. I knew my first impressions were really solid. But if you got in me and started driving, I got a little less shiny as the deeper you went. It was really hard to get close to Katie and let her in. Katie and I haven't talked about this in a while, but when we started getting intimate, I would never take my shirt off with the light on. I would hold my shirt over my stomach because I was embarrassed about my body. She's an athlete. I'm not an athlete. When we would walk and I would get out of breath, the level of embarrassment and shame, I would feel like, how could this person love me? Now I'm going to get emotional, but it took me a long time to be able to-- this morning, I was downstairs making breakfast without a shirt. I didn't think about it. She taught me that the parts of myself that I thought were the ugliest could actually be loved. I had never experienced that beyond my parents. But even beyond that, I don't know that they had seen pieces of my OCD, pieces of me as a human being, as an individual. Katie taught me about unconditional pure love and that even what I deemed the most disgusting, grossest parts of myself, even seeing those. My biggest fear with Katie was her seeing me. I don't panic often, like have major panic freakouts, but there are a few things that I do. My biggest fear was her seeing me. I kept saying, "Just wait. Wait till you see this, Ethan." It comes out every now and again. "You won't love that person." Early on, I had a thing that I panicked and she was nothing but love and didn't change anything. For weeks, I was like, "How can you still love me?" It doesn't necessarily relate to your question, but I wanted to share that because I think that for so many that really see themselves as broken or cracked, I think it's real easy to look really good on the surface. But I think that being willing to be vulnerable and honest and truthful-- and Katie's the first woman I've ever done that with, where I was literally willing to go there despite what my OCD told me, despite what my head told me and my brain told me. I just think that's also created a really solid foundation for our relationship. I just wanted to share that. Kimberley: That full vulnerability is like the exposure of all exposures. To actually really let your partner see you in your perceived ugliness, not that there's ever any ugliness, but that perceived, that's the exposure of all exposures in my mind. You have to really use your skills and be willing to ride that wave, and that can be really painful. I love that you guys shared that. Thank you for sharing that, because I think that that's true for even any relationship. That is truly thriving in Relationships with OCD! Katie: Absolutely. SEEING BEYOND OCD Ethan: Yeah, for sure. OCD can definitely get sticky even with that. It'll start to question, well, does she still love me because of that? She says she does, but does she really-- even my brain now goes, "She can't possibly love my body. That doesn't make sense. That doesn't make sense." So funny thing about Katie, we were early on in our dating, we were struggling. She's laying on me. She's like, "You're the most comfortable boyfriend I've ever had." I was like, "Yeah." And then I started thinking like all she'd ever dated before me were triathletes, like washboard dudes. I was like, "Huh, thank you?" She's like, "No, no, it's a good thing. It's a good thing." I'm like, "Okay. Yeah." It's very funny, but I also loved it. Katie: I do the same thing with you. I mean, all the time, everything's still. Three years in, we're getting married in September, stuff will come up and it's like, "Wait, you saw this, this part of myself that I think is really ugly. You still love me?" Like, what? It gives me permission every time to love myself. Ethan: That's such an interesting relationship dichotomy between the two of us. I don't mean to venture away from your question, Kim, but it's so interesting. I don't see any of the things that she sees in herself. She could freak out for a week and I would still see her as this perfect individual who I couldn't love more. She feels the same about me. It's so weird because we see each other in the same light, but we don't see ourselves in that light. It is amazing and I feel a little selfish here to have a partner to be able to remind me of how I should see myself. I hope that I give Katie that same reminder and reassurance, but it really is amazing to be able to see that within our partner because I'll do something and I'll be like, "Wow." She's like, "Yeah, that didn't change anything for me." I'm like, "Really?" Because that's how I feel like, "Oh, okay." Because that's how I feel when you do. "Okay, we're on the same page." Kimberley: Let's just delete the last question because I want to follow this. I love this so much. It actually makes me a bit teary too, so we might as well just cry together. What would you say to do for those who don't understand OCD and maybe perceive it as "ugliness"? I'm sure there are those listening who are thinking, "I wish my partner could see beyond my anxiety and how I cope." What advice would you give to them? Katie: Ethan, you go first. Ethan: It's a hard question. It's a hard question to answer. It's thundering and you get it twice since we're in the same house. I think one thing I was going to say before, and maybe this will get tight, and this doesn't answer your question directly, Kim, but I'm hoping we can get to it, is when somebody asks me like, "I have OCD and I want to date and get in a relationship, well, how do I do that?" I have very strong feelings about that particular question because I don't want to dive into acceptance and commitment therapy and this whole concept of being able to do both things simultaneously, which is very value driven and we're going to feel the feels and have the ick and we don't have to wait for the perfect moment. But I've always believed that if your OCD at that time is so severe that it's going to heavily impact your relationship, and the reason that you have to tell the person that you're interested in all about your OCD is because you have expectations of that person to reassure and enable, and you're going to need that from that person, I would always say, you might not want to get in a relationship right now. That may not be the best timing for you to get in a relationship. I always would want somebody to ask themselves like, if you're in therapy and you're in treatment or wherever you are in your process and you know that you shouldn't be seeking things from somebody and reassurance, enabling and so forth and so on, then that's a different conversation. But I think at first, being honest and true to ourselves about why we're divulging, why we want them to know about our OCD, and what we're going to get out of this relationship—doing that from the beginning, I think, then trickles over into your question, Kim, about like, what if they don't understand? What if they don't get it? Because going into a relationship with this idea of, "Well, they need to know so they can keep my OCD comfortable," is very different than my OCD doesn't necessarily play a prominent role in my life, or maybe it does, but I'm in treatment and I need them to know and then they may not understand. I think that that's like a different path and trajectory. Katie? Yeah, go ahead. Katie: I think that's such an important component. It's interesting. I heard a very different side of the question. I was thinking about maybe someone who is already in, whether it's a romantic relationship or-- Ethan: No, that was the question. I didn't know what to say yet, so I was being like, "Well..." Yeah, no, that was the question. You heard that right. YOU ARE WORTHY & LOVABLE WITH OCD Katie: It was really important too. This might sound really simplistic, but I think it's so important. Just based on, oh my goodness, my experiences with feeling for such a long time, I was defined by my OCD or defined by my intrusive thoughts, or, oh, how could anybody love me in the midst of all of this? I want everybody to hear that regardless of how your OCD is making you feel right now, or how you're feeling, you are not defined by your OCD. You are not defined by your intrusive thoughts. You are not defined by your disorder. You are an amazing human being that is worthy of love in all of its forms, and you're worthy of love from yourself. You're also worthy of love from a partner. I think sometimes there's this feeling of, well, I don't deserve love because of my OCD, or I don't deserve someone to be nice to me or to treat me well. I've also seen folks fall into that trap. I've been in relationships that weren't particularly healthy because I felt like I didn't deserve someone to be kind to me because of my OCD, or like, oh, well, I'm just too much of a pain because of my obsessions or my compulsions, so of course, I don't deserve anything good in this sense. I want you to hear that wherever you are in your journey, you do deserve love and respect in all of its forms, and that the people that are around you, that truly love you, yes, there are moments that are hard just like they are for me and Ethan, where sometimes there might be frustrations. But those people that truly love you authentically, I really believe will be with you in the midst of all of those highs and lows, and continue to offer you love and respect and help you to offer yourself that same love and respect that you so deeply deserve. Kimberley: I love that. I think that that speaks to relationships in general in that they're bumpy and they're hard. I think sometimes OCD and anxiety can make us think they're supposed to be perfect too, and we forget that it's hard work. Relationships are work and it takes a lot of diligence and value-based actions. I think that that is a huge piece of what you're bringing to the table. I want to be respectful of your time. Closing out, is there anything that you feel like you want the listeners to hear in regards to relationships and yourself in a relationship? Do you want to go first, Ethan? Ethan: Sure. Yeah, I agree. Let Katie close out. She's amazing. I just want to echo, honestly, the last thing that Katie said was perfect, and I wholeheartedly agree. What would I want to bring into a relationship? I want to bring in my OCD or myself, what is going to be my contribution to a relationship, a romantic relationship. I definitely would want to bring me into it. I want to bring Ethan and not Ethan's OCD. That doesn't mean that Ethan's OCD won't tag along for the ride, but I definitely don't want Katie to be initially dating my OCD. I wanted her to date Ethan. I think what Katie said about that directly relates in the sense that love yourself, value yourself, realize your worth, know your worth. It's so hard with OCD, the shame and the stigma and just feeling like your brain is broken and you don't deserve these things, and you don't deserve love. What's wrong? It's so hard. I mean, I say it humbly. When I say go into a relationship with these things, I know it's not that simple. But I think that if you can find that place where you know what you have to offer as a human being and you know who you are and what you have to give, and it doesn't have to be specific. You don't have to figure yourself out of your life out, simply just who your heart is and what you have to give like, I don't know who I am entirely; I just know that I have a lot of love to give and I want to give it to as many people as possible—own that and don't be afraid to leave crappy relationships that are good, that because it's feels safe or comfortable, it's the devil you know in terms of how it relates to your OCD. You're not broken. You're not bad. You shouldn't feel shame. OCD is a disorder. It's a disease, and you deserve, as Katie said, a meaningful, beautiful love relationship with whomever you want that with. You deserve that for yourself. Stay true to who you are. Stay true to your values. If that's where you are now, or if it isn't where you are now, be willing to take a risk to be able to find that big, as Katie says, beautiful life that you deserve. It's out there and it's there. To Kim's point, I'm sorry, this is a very long last statement, so I apologize. But to Kim's point, relationships are hard and life is hard. I really believed when I got better from OCD that in six months, I was going to meet my soulmate, make a million dollars, and everything would be perfect. Life did not happen like that at all. It's 15 years later. But at a certain point, I was like, "I'm never meeting my person. OCD is not even in the way right now, and I'm never meeting my person. I'm never going to fall in love. I'm never going to get married." Now we're four months away from my wedding to being married to the most amazing human being. I truly believe that that exists for everyone out there in this community. Living a life that is doing things that I never would imagine in a million years. Please know that it's there and it's out there. If you put in the work, whether it happens the next day, the next year, or the next decade, it's possible and it's beautiful. Embrace it and run towards it. Kimberley: Beautiful. Katie? Katie: I feel like there isn't much I can add to that. I'm going to get teary listening to that. I think I'll just close similar to what I was sharing before for anyone listening, whether it is someone with OCD or a partner or a family member, whomever that is, that you deserve love and compassion from yourself and from every single person around you. You are not defined by your OCD. It is okay, especially if you're a partner, if you don't respond perfectly around OCD all the time, because you know what, we are in the midst of a perfectly imperfect journey, especially when it comes to romantic relationships. But if you continue to lead with love, with empathy, and with compassion, and with trusting who you are, not who the OCD says you are, I truly believe that you'll be able to continue to move towards your personal values, but also towards your relationship values, and that you so deeply deserve that. Kimberley: Oh, I feel like I got a big hug right now. Thank you, guys, for being here. I'm so grateful for you both taking the time to talk with me about this. Most of the time when someone comes to see me and we talk about like, why would you ever face your fear? Why would you ever do these scary hard things? They always say, "Because I've got this person I love," or "I want this relationship to work," or "I want to be there for my child." I do think that is what Thriving in Relationships with OCD is all about. Thank you so much for coming on the show. Katie: Thank you for having us.Ethan: Thank you for having us.

Jul 14, 2023

Welcome back, everybody. Alright, alright, alright. You may already notice the sound of my voice has shifted, the tone has shifted, and that is on purpose. Actually, I've never thought of this, but it's true. I often show up when I'm ready to do a podcast. I sit in front of my microphone, I'm in front of my desk, I take a deep breath and I just talk to you from a place of centeredness and calm, gathering as much wisdom as I can. That is a part of what I'm bringing today. But my other hope is I want to shift the tone a little bit because that's what you have to do when you're addressing this particular topic, which is motivation during depression . We're talking about how to get things done during depression. That's what we're here for today. Thank you for being here. My name is Kimberley Quinlan . I'm a marriage and family therapist. I'm an OCD and anxiety specialist, and a lot of what I do is manage depression. That is because nearly 85% of cases of an anxiety disorder also have depression. That's because anxiety is hard and it creates these feelings of depression inside us. Today, I wanted to talk about how to cultivate motivation during depression because so often when we're talking about either just managing depression or managing another mental health condition, you're usually required to do a lot of homework, use a lot of skills, and also go about daily functioning. That is really hard when you're experiencing depression. DEPRESSION MOTIVATION CYCLE One thing I wanted to talk about first is just to get you guys familiar with what we call the depression motivation cycle. This is something that I talk to my clients about. I wouldn't say it's a science-based theory, but definitely, I think a lot of us will resonate with this. What I mean by the depression motivation cycle is when you have depression, you experience symptoms of depression , which I'll share here in just a few minutes. But you experience these symptoms that cause you to then have lower motivation. But when you have lower motivation, you tend to not get to your daily functioning activities and you tend to maybe avoid some of the hard things in your life, which then causes more depression. And then once you have more depression, that often ends up leading you back into the cycle of having even less motivation because you're feeling so hopeless, and the cycle continues and continues and widens and widens and spreads throughout your life. My hope today is that we can work towards breaking that cycle. I'm not going to overpromise that we will break it today because I'm always going to be as honest and realistic as I can with you guys. I don't want to oversell that this is going to be a simple snap of the fingers, I have the solution for you. No, there's a slow, gradual breaking of this cycle. Number one, do I believe you can do this work? Absolutely. I want to heavy-load you with confidence at the front end, but also very much validating that it's a process, it's a practice. I want you to be as gentle with yourself as you can as we talk about this today. Let's take a breath, but let's also stay in our mindset. COMMON DEPRESSION SYMPTOMS & HOW TO GET MOTIVATED In understanding motivation during depression, we must consider, like I just said, common depression symptoms. We must understand them. One of the common depressive symptoms is hopelessness. Hopelessness is feeling like there is no hope for you. You might be having a lot of depressive thoughts such as, "What's the point? There's no hope. It's not getting better." These are symptoms of hopelessness. In addition to hopelessness, or maybe instead of hopelessness, if you have depression, you may experience the depression symptom of helplessness. Helplessness is where you feel like no one can help you. That your problem is different or separate to other people's or too big than everybody else's, and that there's no one out there that can help you. That's important to notice because one of the lies depression tells us is you are the only one that has this particular type of depression and you are the only one that can't be helped, and that that means something about you. There's some innate flaw about you that makes your life hopeless. It's all lies. I just want you to know that. Another common depression symptom is worthlessness—feeling like you're not enough, you're not worthy. You don't deserve to be here, to be loved, to be in connection with. Maybe you feel like you don't deserve kind, wonderful, loving things or even pleasure. Worthlessness isn't a very common piece of depression. As you can imagine, just hearing these words that I'm saying, it's a horrible feeling. It's a very deep, dark, gray place to be, and it's not your fault. Another common depression symptom is sleepless nights. You're unable to sleep or oversleeping, sleeping day and night, hitting the alarm over and over again, turning it off, going back to bed, not getting to your daily functioning. Another huge one is exhaustion. People with depression will often go from many, many medical tests because they're so exhausted and they think it must be a medical condition. You definitely should seek medical care and have an assessment always. But often it's not a medical condition; it's a common symptom of depression. In depression, no motivation to do anything is common. In depression, no motivation to eat, to exercise, to engage in daily activities is also very, very common. Often daily functioning will be depleted completely if it's a severe case of depression. My hope today, first of all, to acknowledge this for you and validate this for you and hopefully bring a ton of hope, is to also talk about concepts that can help boost your motivation during depression because it's not your fault. But there are ways we can slowly climb out of this deep, dark hole that we often can get into when we have depression. BOOSTING MOTIVATION WHEN DEPRESSED Okay, let's do it. We're going to talk about how you can increase your motivation during depression. The first thing I want to encourage you to do is to embody this idea of becoming a kind coach. Now, for those of you who have read The Self-Compassion Workbook for OCD — that's a book I wrote in 2021—it talks a lot about the kind coach. Maybe you're already familiar with it. Or recently in Episode 343, we did a whole episode about talking back to anxiety, and that was all about using the kind coach voice to help get you through these difficult times. We also talked that you could also use that skill with depression. What I mean by the kind coach is that when things are hard, when you are suffering, you tend to yourself in a way that is kind and you coach yourself forward. Often what we do is we criticize ourselves forward. Meaning we say, "Get up, you lazy thing, and just get your teeth brushed," or "You're such a loser if you don't brush your teeth," and we use self-criticism to motivate. I'm here to tell you, the science shows us that self-criticism, while it does get people to do things for the short term, it actually for the long term makes people more depressed. It reduces motivation, it increases procrastination, it lowers a person's self-esteem and their sense of wellbeing. We want to take the pedal off of using self-criticism and move our pedal and accelerator towards talking to ourselves and coaching ourselves in a way that is kind. What I'm not saying is that's saying, "You're the best, you're wonderful." That's fine. If you want to try that, you can. But the kind coach from my perspective doesn't usually talk like that. It's usually encouraging like, "Just do one thing at a time. You can do it. One more minute," and really focusing in on what are your strengths and how can we highlight those, and also what are your challenges and how can we not use those against you. We all have challenges. Let's say you're someone who has a challenge with time management. Maybe in that area, we really lean on, "What strengths do I have that I can rely on when it comes to time management," instead of just saying, "You suck at time management, there's no point." I want you to practice being a kind coach. If you want more information about that, go back to listening to Episode 343. Another way to boost motivation when depressed is what we call activity scheduling. Now this is a science-based skill that we use when we are practicing cognitive behavioral therapy, which is an evidence-based treatment for depression. Now for those of you who have taken Overcoming Depression, which is our online course for depression, if you're interested, you can go to CBTSchool.com and you can enroll in that course. It's an on-demand course where you can learn exactly the same skills that I would give my clients, but you'll be using them on your own. It's a self-led course and you have unlimited access to all of those strategies and skills. But we talk a lot about this behavioral skill of activity scheduling. What I mean by that is, one of the biggest things that takes motivation away is a lack of routine, a lack of structure in our day. What we do when we first start treating someone with depression, or we're starting to target depression, is we break the day up into sections. It might be two sections in the morning and two sections in the afternoon and one in the evening, and we'll say, "Okay, you just have to do one thing in each of those sections." You get to pick. It could be as simple as brushing your teeth, but you'll put it in your schedule and you're going to give yourself permission that that's the only thing you have to do in that section if you're unable to do that at the present. Let's say that you're more in a high functioning area and you're already doing a lot, but you're also engaging in a lot of depressive rumination. We might actually keep your schedule the same, but schedule in times during your schedule to check in, use some skills, maybe do some journaling, maybe using some mindfulness activities and so forth. But we can actually use the scheduling to reduce problematic behaviors. DEPRESSION MOTIVATION TIPS Now, one of my go-to depression meditation tips for everybody is to set realistic goals and expectations for yourself. One of the things I notice about people with depression, and I'm also including myself here because I too have struggled with depression during different seasons of my life, is that we really want to achieve a lot with our lives. We have this idea of what life should look like. We have this idea of how great it can be, which is such a wonderful quality. But the flip side of that wonderful quality is that we have such rigid expectations for ourselves, and when we don't meet them, we beat ourselves up. Often what we can do is we can check in with these expectations and these unrealistic goals. We can check and say, "Okay, is this helping me be motivated?" Almost always, it's no. Let's say I'm sitting across from a patient in my office, I might say to them, "What would be a goal that you actually feel like you can achieve this week or today or this month?" When they set the bar a little lower, all of a sudden, a tiny inkling of motivation comes into them. From that place, they start to move forward. Whereas if they set these really high goals, they can't access motivation. It's so huge, it just feels hopeless. Again, it feels helpless. They feel worthless, those themes of depression. The motivation doesn't light up inside them and they don't do any of it. They don't take even a baby step. If that's you, I don't want you to feel called out; I want you to feel understood. I want you to feel validated. I'm hoping that you can give yourself permission to set a goal that's realistic, and it's just for now. I know what you're thinking. You're thinking, "Well, geez, I'm never going to amount to anything if I set this low bar." But the truth is, we start small and then we increase it over time. Another thing to consider when addressing motivation during depression using your activity scheduling is incorporate self-care and healthy habits and whatever that means for you. If you're someone who has depression and you're not eating because of it, you're going to have a low energy. When you have low energy, you don't have any motivation to do anything. Incorporating scheduled meals, even if they're not even that healthy to start with. It could be just whatever you can tolerate for the time being. But getting that nutrition into your body may be also what helps with motivation. If you're someone who is so depressed, unable to be out in nature and exercise, which we know based on science helps with depression, maybe you could schedule three minutes where you look out the window if that's all you can do, or take a hike with a friend, or maybe just sit outside on a chair. Whatever it may be. I really don't want to put expectations on you guys. I think it's very personal, so you'll have to think for yourself, "What is one thing I could do today that would really cultivate self-care?" A really important thing when you're depressed is, it's so important. I really want to emphasize this: Finding a support group, a team of support—a loved one, a family member, a friend, a therapist—support groups, actual structured groups is so important to help with that cycle of depression too. Remember we talked about that cycle of depression and motivation? Sometimes just feeling like you're not alone in and of itself can create a little motivation, or feeling like you're not alone can reduce that depression just a little bit, which can then help with that motivation piece. One other thing to consider here, and I myself do this with my best friend, is I use her not only as support, but as an accountability buddy. I'll tell you, actually, something I've struggled with recently is, as many of you know, we've gotten a puppy and out the window went my exercise plan. My exercise plan is so important for me in managing my medical condition, but it went out the window. I messaged her and I said, "Listen, I don't want you to feel any responsibility about this, but I am just telling you, this is what I'm committing to. You don't have to do anything. I'm just telling you so that you're my accountability buddy. Every day that I do the thing I said I'm going to do, I'm going to send you a thumbs up emoji." I said, "You don't even have to do anything. I just need you to be there so I can be my sounding board." There have been other seasons in my life where I've had things that I needed to get done, and I would say to her, "Can you be my accountability? Do you have the capacity?" She's like, "Yes, of course. What do you need?" I'll say, "I need you to text me on Monday, Wednesday, and Friday to remind me to do such and such." That's fine too. Again, that doesn't make you a loser. It doesn't mean that you're weak. It doesn't mean anything. It just means we're using effective skills to get you back on the bandwagon. Now, that being said, there are some key components of getting motivated during depression and these key components, also what I would call a mindset, is leaning towards your values, getting really clear about what is it that you want out of your life. Again, let's go realistic, but let's look at the long term. Sometimes when we are depressed, the whole future looks like it's hopeless. What we want to do is kindly get in touch with your why. Like what can you bring to the table? Why are you here? What do you want? What can you bring to the table for others or for yourself? I want to slow down here a little. I get that you might have no answers to that right now, and that's okay. It might be as simple as just going, "Okay, what's one value of mine that I want to lean on during this difficult time?" Values can help us make decisions about what's best for us. Another mindset shift that I want you to move towards is, don't live your life according to what depression is telling you to do. Make choices based on the direction of your life you're wanting to go. If you used to love swimming, try swimming again. If you used to love drawing, try doing more drawing, even if you're depressed. Because what we know is that those hobbies, personal interests, more creative expression using your body, can actually create spaces for you where you're opening your mind up to other things, not just putting your attention on your depression. A lot of my patients have said that they don't want to go out and be with people or go on a hike or something, but once they're there, they deeply feel the benefit of it. Sometimes it's a matter of putting our attention on how you'll feel once you get that thing done. Try to find things that bring you some joy or some fulfillment. But again, for this first part, don't put too much pressure on that either because you mightn't feel a lot of that to start with. But over time and with repetition, you will. Another really important piece, and you're already hopefully doing it right now, is to lean on the people who are sources of inspiration for you. Hopefully, if it's me, I'm honored. For me, it's often like poetry, people who've been through it. I love Jeff Foster. He is a poet who has had depression and suicidal ideation and he's just talks about it in such a beautiful, mindful way. I find it to be a very safe landing place when you're feeling really down. And then the last thing to consider when addressing motivation for depression is, actually, after you've done any activity that you had to muster up a lot of energy to do, you celebrate. If you miss the celebrating part, you miss an opportunity to generate more motivation to keep going. If you do something hard and you go, "Whatever, it's no big deal. I should have been able to do it yesterday," you're missing an opportunity. What I want you to do is throw a mini party in your mind. Or if that's impossible, just text someone and say, "I did a hard thing today and it was..." and tell them what it was, so that you are celebrating, you are rewarding, you are congratulating yourself for taking steps towards these small victories. It's so important. And then the last thing I'm going to offer to you, which is a catchall for all of this is, don't do it alone. If you have access, like I said before, to a therapist, a support group, it doesn't even have to be a paid one; it could be a Facebook group. But being in a community, being in a group of people who get what it's like for you can be a game changer. If you do have access to professional help, absolutely go and get help because they often will bring your attention to things you weren't noticing, thought patterns that you didn't realize that you had, and that can be so incredibly beneficial. Now, with all of that said, I want to also emphasize this idea of, again, my voice hopefully is a little different and I'm trying to cheer you on. Let's go. You could totally do this. Baby steps. What I want to remind you of is, surround yourself with people who lift you up, who have a high vibe if you can. If you haven't got access to those people in real life, lean on singers and celebrities and even social media platforms that are encouraging, that are inspirational. A lot of my clients have said that Pinterest has been even helpful for them in that they go onto Pinterest and they google inspiring quotes. That could actually be something so simple that gets them up to brush their teeth. I hope that's helpful. If you are interested in looking into Overcoming Depression , our online course, talking a lot about different skills you can use, go to CBTSchool.com or reach out to a therapist in your area. I really hope that this has sparked a little teeny tiny light inside you, and if so, I will be so happy. Do not forget, it is a beautiful day to do the freaking hard things. Do not forget it. Write it on a piece of paper and read it off as many times as you need to remind yourself it's okay that it's hard, it's not a bad thing that it's hard, and that you can do those hard things. Sending you love. Have success. I'm sending you every ounce of love that I have. Talk to you soon.

Jul 7, 2023

Welcome back, everybody. Today we are talking about a topic that I commonly get asked as a clinician, I commonly get asked as an advocate for anxiety online and so forth, which is how to let go of intrusive thoughts . I think that this is such an interesting question because words matter. For those of you who know me, you're going to know that words really do matter when it comes to managing anxiety and we have to get it "right." When I say "right," what I'm really saying is our mindset about anxiety and intrusive thoughts and any emotion really that is uncomfortable, we have to approach it with a degree of skill, effectiveness, and wisdom. My hope is to help you move in that direction. I know you're already in that direction, but hopefully, this episode will be really powerful. I'm going to give you a metaphor that I hope really, really helps you. It really helps me. I've talked about it on the podcast before, but I feel like it's important so I have to talk about it again. When we talk about this idea of how to let go of intrusive thoughts, we have to ask, what do we mean by that? Often when people first start seeing me as a clinician or they start seeing my therapist—we have a private practice in Calabasas, California —we commonly will get, "Okay, just I'm here. I'm ready to do the work. Teach me how to let go of intrusive thoughts." A lot of the beginning stages of treatment is educating on how letting go, meaning not having them anymore or quickly avoiding them or distracting against that, could actually be what's making your anxiety worse. For those of you who've taken ERP School , which is our online course for OCD. If you're interested, you can go to CBTSchool.com to learn more about that course. That's where you can learn how to manage your own OCD. It's an on-demand course. But we talk a lot about understanding that trying to push thoughts away or suppress thoughts, not having them actually reinforces the problem. I also want to mention, it makes total sense that your goal is to be able to have the thoughts and have no discomfort related. Like I just want to have the thoughts and I don't want them to bother me, and I just want them to create no suffering at all. I get that. That is a very normal desire to have. But what we want to do here is, when we're talking about how to "let go" of intrusive thoughts, what we are really talking about is how we can be skillful in how we respond to them, because we know, based on science, that we can't control our intrusive thoughts. Often there are mechanisms in the brain that's making it very difficult for you to pump the brakes on thoughts, which is why you're struggling with so many of them, and they're happening so repetitively. We know this. When I first learned about mindfulness, one of the most important metaphors that just shook me to the core—it really changed the way that I learned to deal with thoughts, feelings, sensations, emotions, urges, and all the things—was to think of my thoughts like water in a stream, and that my mind is this stream of water. As you're thinking like these beautiful green banks, and there's the river in the stream, and it's flowing in one direction. What happens for us when we're experiencing our mind is we hit a rock in the stream. When we hit that rock, we want to imagine that that rock is a metaphor for an intrusive thought. Here you are, you're the water. You're just rolling over all of the banks and commandeering back and forth, and then all of a sudden you hit this very sharp, jagged rock. Of course, your reaction is to get jolted and go, "Oh my goodness, what is this? Why is this here? I'm just trying to get from A to B." Often what we do is when we hit the rock, we make a huge splash. The splash goes everywhere. We're like, "Wait, what happened?" When we do this, we actually create a lot of pandemonium for ourselves. Now, that's what we do. But if we were to think about a stream, what does the stream water normally do when it hits a rock? It hits the rock, it notices the shape of the rock, and then it gently goes around them. It doesn't stop to go, "Is this a good rock or a bad rock? How do I feel about this rock? What does this rock mean about me? Why is there a rock here? There shouldn't be a rock here." The water just notices the rock, observes that the rock's here. It doesn't make a huge splash. It doesn't try to go under it. It doesn't try to stay on the left side of the bank and avoid it. It just notices the rock and it goes around it and it moves on. Mindfulness is just that. Mindfulness is observing what shows up from a place of non-judgment, from a place of non-attachment. What I mean by that is that the water's not attached to what this rock means about them. It doesn't assign value to the rock. It doesn't say the river is bad now because we have a jagged rock, or it doesn't say the river is good because it's a small rock. It just says "rock" and it goes around it. Mindfulness is also very present. It notices it. It doesn't stop there and go, "Okay, I'm going to spend a lot of time solving this and I'll get to the end of the river in my own jolly time." It is often being moved by gravity, so it just keeps moving. It doesn't slow down too much for that rock. That's the way I want you to now practice approaching your intrusive thoughts or your emotions, if you're having other emotions, like strong waves of guilt or shame or sadness and whatever it may be. You're going to notice the obstacle or the object. Be non-judgmental, not get caught up in a story about what it means about you that there is a rock in your stream of water, and you're going to go around it. I was going to say quickly, but that's not actually the right word. You're going to go around it from a place of not gripping. Not gripping to that rock and so forth. Now, here is where the metaphor continues. For those of you who are listening, my guess is, in your stream, in your mind metaphorically, you hit one rock, you go around it, but very, very quickly comes another rock. And then you might practice that and go, "Okay, all right, I did one. I'm going to notice this rock as well. I'm not going to assign value to it. I'm just going to notice it, be aware of it, be non-judgmental of it, and do my best to go around it without making too big of a splash." You do it the second time. But then what happens? Another rock comes. Often what my patients say to me, or like I said to you at the beginning, followers on Instagram or you listeners of the podcast will say, "I get what you're saying." One of the most common questions we get in ERP School in the portal where people ask questions is, "I get what you're saying, but what happens if they just keep coming and coming and they just don't stop?" That's where I would say, again, the stream doesn't get involved in a conversation about what this mean. It just hits the rock and goes around the rock and moves to the next one and the next one and the next one, and it takes one rock at a time. What we often do—and I'm the worst at this, I have to admit—is once we've hit 4, 5, 6 rocks, we then shift our gaze not on the present moment, but we look down the stream and we go, "Oh my goodness, I see nothing but rocks. This is going to be a bad day. All I could see is my future is going to contain a lot of rocks. I can see them on the horizon, I give up," which is okay. I want to first really validate you, that is a normal human emotion, a normal human instinct to be like, "I give up, there's too many rocks." But our job isn't to be looking into the future, trying to solve the many rocks that we are going to face. Because as soon as we do that, we lose our skills, we lose our cool, we lose our motivation, we lose our resilience. Just the same as if we looked up the stream where we've been and we go, "Oh my gosh, what a terrible day. Look how many rocks I hit today. It was nothing but rocks." We could get in trouble that way as well. Mindfulness is only paying attention to one rock metaphorically at a time. Staying as present as you can. HOW TO GET RID OF INTRUSIVE THOUGHTS? Often people will say to me, "Well, how do I get rid of rocks? Isn't there a way to get rid of rocks?" I love this. What they're really asking, just in case you lost the metaphor, is they're asking, how do I get rid of intrusive thoughts? How do I get rid of them? Here is where I think the metaphor is really clever, because when you think of a stream and you think of the rocks in a stream, like the actual stream—our family spends a lot of time rafting; my husband is an amazing raft, I guess you would say, and my kids love it too—what I always think that's so interesting is when you're in rapids or ripples, the rocks actually aren't jagged anymore. Often when rocks have been hit by water enough times, the jaggedness of them gets washed away and the rocks become actually quite smooth. I think it's such an amazing metaphor here for the work that we do, which is when we are mindful, when we are non-judgmental, when we are present, when we don't attach it to what it means about us, the thoughts become less powerful, less painful, less jagged, less sharp, less of an ouch. That's true in science with actual streams on water and for us in our minds too. HOW LONG CAN INTRUSIVE THOUGHTS LAST? Now, it's not uncommon for people to be curious about how long intrusive thoughts can last. Because often when we have them, before we've learned these skills and before we've learned mindfulness, we have them. And then because we are so averse to them and we're so afraid of them and they're so painful, it can feel like they last for a very, very long time, and that's true. They can be so repetitive that it feels like you just don't get a break. But what I have found to be true, as a clinician who's watched hundreds of clients practice this, is when you start to apply mindfulness, they can be quite fleeting, these intrusive thoughts . They can pass quite quickly. I want to be really honest with you. What I'm not saying is that they will stop returning. Again, I want to really keep reinforcing because that's not our goal. Our goal isn't to say, how can we get rid of them as fast as we can, or how can we get them to not be here. I'm not saying that, but I can vouch for this in that when you do practice treating intrusive thoughts like a rock in a stream, they do tend to be less prolonged. Not always. I want to keep saying not always. There will be days where you'll have lots and lots, there'll be days when you won't. Again, we're going to practice not attributing value or judgment to that. But I have found this to be very true, that when we are really present and we're kind and we are non-judgmental, it can actually reduce the suffering so, so much HOW TO LET GO OF OCD INTRUSIVE THOUGHTS and PTSD INTRUSIVE THOUGHTS? That's the metaphor I want you to think about here in regards to how to let go of OCD intrusive thoughts . But I would even go as far as saying, this is the same metaphor I would use when talking with patients who have trauma, and they're wanting to know how to let go of their PTSD intrusive thoughts because some people with PTSD have intrusive thoughts. I would even go as far as saying that, as I've said in the beginning, you can use this skill with any adversity. HOW TO LET GO OF INTRUSIVE THOUGHTS RELATED TO DEPRESSION? You could use this skill with sadness, you could use this skill with shame, guilt, fear in general. It could be discomfort or some physical sensation of pain that you're having. We can also let go of these intrusive thoughts related to depression. Noticing a depressive negative thought, seeing it like a rock in the stream, trying to practice non-judgment around that, and moving around it with a sense of kindness and compassion and radical support. That's what I would love for you to practice. I've had patients in the past say that they changed the computer screen to a stream just to remind them of that. Or they've left a little sticky note on the side of their desk saying thoughts are like a rock in a stream or a rock in a river. There are other ways you could imagine this metaphor as well, but this is the one that I really, really resonate with. If you want to get creative, you can maybe come up with some other forms. But I find it to be so incredible how nature can really teach us about how to be mindful and manage really, really hard things. That's it, guys. That's what I wanted to share with you. I hope it was helpful. I know this is not easy, by the way. The whole reason I say it's a beautiful day to do hard things is because this is not easy. This is like hardcore work and I want you to give yourself a lot of claps and hugs and celebrations and high fives for even trying this sometimes in the day. I really do believe that one rock at a time, even though it mightn't seem very significant, it accumulates. If you have hit tens or twenties or thirties or hundreds of these rocks, you are on your way. You are doing the work, you are walking the walk, and I really want to celebrate you and honor you for that. All right, folks. I hope that was helpful. I am sending you so much love. Keep doing the work. I will see you in a week. Well, you'll hear me in a week. I hope you're having a wonderful summer if you're in the northern hemisphere. I hope you're having a wonderful winter if you're in the southern hemisphere, and I will talk to you soon.

Jun 30, 2023

TALKING BACK TO ANXIETY Welcome back, everybody. Today we're talking about talking back to anxiety, and we're really talking about the power of positive self-talk. Now I know when it comes to this idea of talking back to anxiety , it can get somewhat controversial. In fact, even talking about this idea of positive self-talk can be controversial, and I will be the first to say there is nothing worse than when you're struggling with something that's really painful. People say, "Oh, just be positive." That is not what we're talking about here today. In fact, I have a personal twist on how I like to consider a positive self-talk. You probably have heard me talk about it before, but I felt like it was time for me to revisit these concepts that I find so incredibly powerful when it comes to talking back to anxiety, or being positive, staying positive, engaging in some form of positive self-talk. WHAT DOES TALKING BACK TO ANXIETY LOOK LIKE? Let's talk about it. When we consider what we mean, when we say "talking back to anxiety," what do I really mean by that? First of all, I want to get to one of the controversies. What I'm not saying is that when you have anxiety , you tell it to go away or stop, because we know that when we do that, when we try and suppress anxiety or we try to suppress our intrusive thoughts , it usually means we have more of them. Let's just get that scientific fact out in the eye. We know that is true. But when we are talking about talking back to anxiety, when I'm talking about it, what I mean is, when you experience anxiety, whether that be in the form of sensations or in thoughts or feelings or images, how do you respond? How do you converse with your anxiety? I always make a metaphor with my clients, and I've done it here on the podcast before, that I always think of anxiety as this little short Lorax-looking guy that sits on my shoulder. For you, it might look different. But he sits on my shoulder and he's in a beach chair and he is really lazy and he is wearing sunglasses, and he just wants to mess with me as much as he can, but in the most effective, lazy way. And how does he do that? He does it by knowing exactly what bothers me and throwing that at me first. He's not going to throw some random thing at me. He's going to go straight for the thing that he knows I value, because that's where my anxiety is going to show up the most. And then when he shows up, it's up to me then to be skilled in how I respond. One of the ways we respond is how we talk back to it. The first thing I'm going to ask you is, when your anxiety tells you of the thing that you value, talks to you about the thing that scares you, that hits you right in the gut, how do you respond? Do you yell at him and say, "Get off my lawn, you horrible thing." None of this is bad, I just want you to get to know. How do you respond? You say, "No, no, no, please go away. I don't want you. I'll do whatever you say. I'll do whatever compulsion you tell me to do. I'll avoid whatever you tell me to avoid if you just quiet down." Some of this, instead of doing that, instead of yelling at anxiety, we yell at ourselves. We say, "What is wrong with you? Why are you always anxious? You're a loser. You're bad. What's wrong with you? Something is seriously broken about you. Why have you got to have anxiety all the time?" You engage in a ton of self-criticism and self-punishment . The ones I just gave you are some negative self-talk examples like, "What's wrong with you? You're a loser. You're such an idiot for having this anxiety. You're stupid." I want to remind you that you're not. This is not about your intelligence; it's not about who you are, what you are. Your anxiety has nothing to do with any of that. Some of us are just genetically prone to having more anxiety. But we use this negative self-talk. We use this criticism, this self-judgment to try and beat out the anxiety, as if we could beat it out of ourselves. But the facts are, this negative self-talk doesn't motivate us to change because we were never in control at the start. We can't control our anxiety and whether it shows up, so that doesn't work. What we do know that does work is positive self-talk. It is one of the most successful ways of motivating ourselves. When anxiety does show up, I want you to explore how you might respond differently to whatever discomfort or whatever form of suffering you're experiencing. It doesn't even have to be anxiety. It might be pain, it might be stress, it might be sadness, any emotion. We can actually use these skills with any of these emotions. WHAT POSITIVE SELF-TALK IS NOT Let's talk about what I mean by this. What does positive self-talk look like in my definition, not what you may have seen online. Number one, in my definition, positive self-talk —let's talk about what it actually isn't—it's not just positive affirmations. While that's great, and if that works for you, by all means, keep it. But for me, it never ever lands. I could say the world is safe and good things will happen, and I'm a good person. I could say that all day long and it would not land. It would do nothing for my anxiety. Literally, it just doesn't. I've tried it and it really doesn't work for me. Positive self-talk is also not just telling yourself to be happy or relaxed. That is a huge issue. Because if you're having anxiety and you're just telling yourself how you "should feel," you're only going to feel judged. You're only going to feel less in control. You're only going to feel more hopeless about the situation. HOW TO BECOME YOUR OWN KIND COACH We've talked about what it's not, and I'm sure there's other examples that I'll probably think of here in a minute, but that's what it's not. But what it is, is talking to yourself in a voice that I call the kind coach. For those of you who have read The Self-Compassion Workbook for OCD , I talk about this a lot in that workbook, but I also teach this in the course Overcoming Anxiety and Panic, which is learning how to speak to anxiety in a way that motivates us, that leads us more towards our values and our beliefs, that disarms the anxiety. Instead of fighting it, it tends to the fact that you are experiencing something really, really, really uncomfortable. These are key components of overcoming anxiety and panic. In the course, we also go through cognitive changes, behavioral changes, a lot of tools, a lot of mindfulness , a lot of self-compassion. If you're really wanting to do a deep dive, you can go and check out that course. Go to CBTSchool.com . The course specifically is called Overcoming Anxiety and Panic . But for today, let's just talk about being a kind coach. A kind coach. If you were actually thinking about a coach that you've had in the past, or an ideal coach, if you were training for something, a marathon, let's say, or a competition or something, a kind coach wouldn't berate you for struggling, because we know, as we've already talked about, that beating yourself up and criticizing, it might propel you into some change, but it also creates more anxiety. We are here to try not to make more anxiety just for the sake of making more of it. We know that self-criticism isn't beneficial. We know that telling someone of their faults and their weaknesses, that only makes us feel worse. It usually sends us into a shame response. When we go into a shame response, the normal human response is to slump over, to get really tired, to feel very unmotivated, to be stuck in this slow-moving body where everything feels heavy. That doesn't help us. That makes it worse. The kind coach knows your challenges, but it also knows your strengths, and it uses your strengths to motivate and propel you towards the thing that you want. Let's say you're having anxiety. The kind coach would talk back to anxiety by saying, "I see you're here. It's cool. It's okay that you're here. I was planning on recording this podcast today at 11 o'clock, and I know you want to tell me about all the terrible things that might happen today, but I agreed that I was going to do this, and it's really important to me that I do. You could come along, and I'm going to let you be there while I record this podcast." Now, you might hear that none of this is me saying, "I'm going to record this podcast and I'm going to be happy and I'm not going to have any problems with it, and I'm going to finish it. I'm going to feel ecstatic and free and overjoyed." That's not what I'm talking about. That's one example of positive self-talk, but that's not what I am talking about today, and that's not what I'm encouraging you to do. I'm encouraging you to learn to be the kind coach for yourself. Meaning you are the one who shows up for you when anxiety shows up. Often when we're anxious, we step out of that role and we actually go to someone else to try and make us feel better. We go to someone else to reassure us. We go to someone else to soothe us. While there's nothing wrong with that, we miss an opportunity to be there for ourselves, to be the one who soothes us, to be the one who says, "Hey, I see that you're going through something hard. I see that this is uncomfortable for you." TALKING BACK TO ANXIETY: POSITIVE SELF-TALK EXAMPLES Now, to get a little deeper here, if we were really going to talk about positive self-talk examples, we would also include the kind coach reminding us that we can do hard things. When I think of positive self-talk, I don't think of, "You're the best, you're great. Everyone loves you. You're perfect." I think of positive self-talk as being it believes in us, it believes in our ability to really settle into hard, uncomfortable things. In the world of social media, and a lot of you guys know I'm on Instagram a lot, I constantly see people saying, "The five quick tips for anxiety," or "Heal your panic attack fast." They're selling you on quick fixes and making it easy. I don't believe that that's helpful. I think positive self-talk for anxiety shouldn't be about saying it's easy and quick to get over. It should be about saying, "You can do this. You can tolerate this. You can ride this wave of discomfort out. I believe you can because you've done it before," or "I believe you can because humans are incredibly resilient. Even if you haven't done it before, it's a skill we will learn together." That's how a kind coach talks. Let's say you've always avoided something and it creates so much anxiety for you. Basically, your brain is saying, "I'll never be able to do that one thing." My kind coach, if I really listened, would say, "I know you haven't been able to do it in the past, but I have seen you in so many other areas overcome different things that you've never done, but then you were able to do it with practice and repetition and kindness and support. I do believe this is another opportunity for you to do that." That's what my kind coach would say, and this is something you can start to practice for yourself. If this is really hard for you, another way of doing it is saying, "What would a loved one say to me in this example?" And then you just practice saying it to yourself. But this is a grand gesture of self-compassion. It's a grand gesture of encouragement, motivation, positivity that isn't toxic, because we know that positivity can sometimes be so toxic and dismiss what we're going through. This is not that. Now, when we talk about talking back to anxiety, we may also have to practice this idea of talking back to depression too. What I'm going to encourage you to do here is use exactly the same tools. TALKING BACK TO DEPRESSION Let's talk about it. If you have depression, your brain is telling you these lies like, "You're terrible. Nothing good is going to happen. There's no point. You're useless." Talking back with positivity like you are the best, again, is not going to land. Saying, "You're wonderful, you're really great. Great things are going to happen," some people find that really beneficial. If that's you, by all means, keep using it. It's incredibly powerful. But for a lot of us folks, that won't land. I find it really much more beneficial to talk back to anxiety and depression with this kind coach voice, someone who coaches us through the depression while it's there, because it's going to be there. It is here. There's no point in telling ourselves just to be happy because it is here. I find it to be so incredibly helpful. TALKING BACK TO OCD Now, in addition, there is also some controversy around talking back to OCD . A lot of people say, "Doesn't that become compulsive? Doesn't that get in the way of the actual foundation of ERP?" Well, what I will say is, once again, it depends on how you're doing it. If you're talking back to OCD, which we know is a disorder of uncertainty and doubt, if you're talking back by going bad things won't happen, "No, you're fine. Nothing bad is going to happen," well then yes, you will be engaging in compulsive self-reassurance or reassurance in general. But what I'm talking about here when it comes to talking back to anxiety, specifically related to OCD, is the kind coach will say, "I believe you can handle hard things. Just a few more minutes, let's ride this wave of discomfort out. Can you tolerate another 10 minutes of uncertainty?" Instead of saying it as a question, it might say, "Let's do it. Let's try for another two minutes not engaging in that compulsion." You're talking to anxiety, you're talking to depression, you're talking to OCD, but you're not doing it in a way that dismisses how hard it is. You're not doing it in a way that overlooks the actual reality. Meaning you're not saying, "Just be happy," or "Just ignore it," or "Just think about something else." You're not doing it in a way that creates compulsive behaviors that keep you stuck. The kind coach encourages you to keep trying. It validates that you've had a hard time and that this is hard. It reminds you of your strengths, whatever that is. Maybe it tells you you're resilient or you've done it before. It might gently remind you to use your humor if humor is something that you're really good at doing. It might remind you of any strength you have. It won't use your challenges against you. It's radically, absolutely, unconditionally there for you, even on the low days. It encourages you to just go a little further, try a little bit more, but not in our "get down and give me 20 pushups" way like our mean coach would. It's saying it in a way that feels doable and motivating and kind. That's what I want you to practice. This, guys, is a skill that you have to practice. Meaning you won't do it for a couple of hours and then feel on top of the world. Again, this is not about ridding you of your reality of true discomfort. It's something we practice every day during the easy times and the hard times. This is how we talk back to anxiety. This is the power of positive self-talk when used correctly. That's it. That's what I want you to practice. What I would do with me, because I'm a little bit of a track it kind of girl, is I would encourage you to track it. To track when you were engaging in the kind coach, what did the kind coach say? I would also track when other people act as the kind coach, maybe a loved one, a family member or a boss, a colleague, a friend—really track what it is that they said to you that helped you propel yourself towards behaviors that are positive in your life and use those to help you really strengthen your own kind coach voice. You may also want to track when you get caught up in self-criticism. Because that too, sometimes when you're tracking it, it helps us be more aware of it. When we're more aware, we can catch it sooner and intervene sooner. That's what I would encourage you to do. If you don't like tracking, that's fine. I don't want to push you in a direction that doesn't work for you. As you always know, I just want you to take what's helpful here and leave what's not. But this is a skill I really hope that you do engage in and start to practice. If you're interested in any of the courses I've mentioned today, please go to CBTSchool.com . You can also go to my private practice website, which is KimberleyQuinlan-LMFT.com . I am a therapist with nine therapists who work for me, helping people with OCD and anxiety. We are in Calabasas. I would love to connect further with you there. Have a wonderful day, everybody, and remind yourself that it is a beautiful day to do hard things.

Jun 23, 2023

Welcome back, everybody. Today we're talking about sleep anxiety relief. We're talking about how to get a good night's rest. Oh, the beauty of a good night's sleep. I can't even tell you and I can't even explain for me personally how much sleep impacts my mental health and my mental health impacts my sleep. Hence why we're doing this episode today. For those of you who are new, my name is Kimberley Quinlan. I'm a marriage and family therapist in the State of California. I have a private practice. I am the developer of an online program called CBTSchool.com. I'm an author and I am the host of this podcast. A few weeks ago, a psychiatrist reached out and said, "I have been listening to you for years, not realizing that I work literally down the street from you." It made me realize that I never introduced myself on the podcast. I just talk and talk and talk and I actually don't tell people where I am and what I do and what I offer. So that was a really big lesson. Let's talk about sleep anxiety relief. I'm going to tell you a bit of a story first. For years, my daughter has been telling us that she can't sleep, that she has terrible sleep. She lays awake, staring at the roof. She said she always feels tired during the day and that she "can't get to sleep" when she tries. We have taken her to the pediatrician and we've talked to her about it and checked in, "Are you worrying about anything in particular?" She says, "No, I just worry about getting enough sleep." Again, she's saying, "When will I go back to sleep? Will I go back to sleep? Will I wake up at night?" She says she struggles to get comfortable as she settles into bed. We took the plunge and took her to a sleep specialist and we were expecting either a sleep disorder diagnosis or a sleep anxiety diagnosis. He did this thorough assessment and asked her all these questions and he was incredible. At the end, he said, "I'm going to tell you, it sounds like you're getting good sleep. You sound like you sleep very normally for a kid your age and we address some issues that may be happening." But he said, "A lot of this is about managing anxiety about sleep," because he tracked like, "You're getting enough. We will track it during the night. Everything looked good. This is actually about you managing your mind around sleep." Now I understand that may not be your experience, but this blew me off my feet. I was expecting serious bad news. I have this conversation with my patients so often and it made me feel like, let's talk about sleep anxiety relief. SLEEP ANXIETY SYMPTOMS Now, before we talk about sleep anxiety relief, let's talk about sleep anxiety symptoms because some people who don't experience this or aren't sure if they're experiencing this, I wanted to make sure you feel like you're in the right place. For those who have sleep anxiety , they experience a lot of anxiety around going to bed or when going to bed. They may report racing thoughts in bed, inability to concentrate when they're preparing to go to sleep or they're laying in bed. They might experience a lot of irritability, whether that's emotional or physical sensations in the body. A lot of jitteriness. There may be also an experience of nervousness or restlessness. They may have feelings of being overwhelmed. Some people report this impending danger or doom as they approach the bed or as they approach bedtime. They may experience a lot of anticipatory anxiety about it. There are also some physical sensations or effects of anxiety before bed and that might include some tummy troubles. Kids in particular will report before bed, "My tummy hurts," and often their tummy hurts is a sign of anxiety. This is true for adults too. They may have an increase in heart rate, which may make them feel like something bad is about to happen. They may have rapid breathing. They may experience sweating. They may experience tense muscles. They may experience trembling, even nausea. These are symptoms that could be your regular day-to-day anxiety, or it could be that you're specifically managing anxiety related to sleep. IS THERE A CURE FOR SLEEP ANXIETY? When talking about sleep anxiety relief, often people talk about this idea of a sleep anxiety cure. Now, I'm not going to give you any specific "cure" today because I don't know your exact case and you would need to be assessed by a doctor. I encourage you to go and see your doctor if you're struggling with sleep because it is so important. If you need, go and get a referral for a sleep specialist or do some research. There are some amazing books on sleep as well. Now, do I consider that we can overcome sleep anxiety? Yes, 100%. I do believe you can get to a place where you have healthy sleep. Again, I'm always very cautious about talking about the word "cure," but if we were to really address sleep anxiety relief in terms of what you need to practice, I'm going to first always do a ton of psychoeducation with my patients and with you today about sleep hygiene. WHAT IS SLEEP HYGIENE? Think of sleep hygiene as like, how clean your bedtime routine is. Clean, meaning has it got a lot of stuff that dirty up your sleep routine, or does it free up and clean up your sleep hygiene , sleep routine? I'm not talking here in terms of contamination. I don't want to get that confused. It's about making your bedtime routine something that is with ease, and even if there's anxiety, it's a routine that you follow and you are pretty consistent with it so that you can start to get better sleep. Now, how do we do that? First of all, I strongly recommend you first decide when you want to be asleep by or when you want to be in bed preparing to wind down. Pick an actual time. A lot of people miss this step. They just go, "Oh, I'm going to light candles and I'm going to read and hopefully, I'll fall asleep when I want to." That's fine and that's good. We will talk about that here in a second. But I'm going to strongly encourage you, pick a time you want to be in bed. And then from there, we work backwards. From one hour minimum, from the time you want to be in bed starting to wind down, you must turn off your tech. I know you want to turn off your podcast right now because you don't want to turn off your tech that early, but I'm going to stress to you that your phone and your device are causing havoc on your bedtime routine unless you are using it for meditation, soothing music, something that actually deeply calms you. But I'm going to say a minimum of one hour, preferably two, you turn off your tech before that time that you picked. Let's say you picked 10 PM. That's the time I pick. All phones, technology should be off by 9:00 PM, even 8:30 or 8:00 is better. What you do during that hour is that's when you start to do the wind-down routine or program. Now this doesn't have to be compulsive, it doesn't have to be exact to the minute, but what we're talking about here is now starting to implement things that bring you to a place of comfort. I understand if you're having a lot of anxiety, you might still feel it in every single part of the sleep routine. That's okay, but you're engaging in behaviors that don't make your anxiety worse. You might be reading. However, if reading is something that makes you hyper-aroused in an anxiety way, maybe it's not reading. Maybe it's meditation, maybe it's listening to an audiobook, not something that's going to, again, rev you up and get you going. Something boring, something simple, something a little more monotone. It could be listening to sounds. There are so many free YouTube videos with just sounds of the waterfall or rain or birds or waves. If you have a specific sound that you like, I'm sure you can find it. These are all great options. You may also want to engage in a wind-down routine. This is my personal routine, you don't have to follow it, but without too much being pedantic, I have a routine. I go downstairs. I brush my teeth. I floss my teeth. I wash my face. I then go plug in my devices. I go to bed. I get my Kindle out. I actually am fine with the Kindle as long as you're not reading something too overwhelming because the lighting is different on a Kindle compared to an iPad that shoots light right into your eyes. I might take a glass of water. I make my bed actually before I go to bed. Meaning it's pretty messy usually, so it's something I like to feel like the covers are all neat on me. I then allow a wind-down. That's just me. My husband doesn't do any of that. He just brushes his teeth, goes to bed, and starts reading. Not that different, but for me, I have more steps. You can do whatever you think is helpful, but sleep hygiene has to be a piece and you have to work backwards by removing the technology. Some people say, "What about if I use my phone for my alarm?" That's fine, I do too. However, if it's in your room or it's next to you, that's fine as long as you can practice some restraint of not picking it up and going on social media because you can lose hours by just picking up your phone and opening up the Instagram app. You can lose hours. One thing I'm going to encourage you to do here is consider we have a course called Time Management for Optimum Mental Health and we talk all about scheduling. I'll give you a little bit of information that I share during the Time Management course. I personally calendar a lot of my life and I have found that that has been very beneficial for my sleep. The reason being is because I have to wake up at 6:15 to get my kids to school. I used to get to bed whenever I could and then I realized I was massively sleep deprived. When I looked at the calendar and I thought, okay, if I have to be up at 6:15 and if I need a certain amount of sleep (I do better on eight hours), I have to be in bed asleep by 10:15. What am I doing? Going to bed at 10:30, I'm already setting myself up for failure. When you're scheduling, you actually look at your wake-up time and you even plan backwards for that on when you need to be in bed. And then you plan backwards from that on when you need to work on your sleep wind-down program. Again, you don't have to be pedantic, you don't have to be too hyper-controlled on this. But doing it a couple of times is life-changing in realizing, at the way I'm going, I'm never going to get enough sleep. SLEEP ANXIETY REMEDIES Now, in terms of talking about sleep anxiety help or sleep anxiety relief, there are some additional sleep anxiety remedies you may say that may help you. Let me add here, there's not a ton of research. I try to only bring research-based stuff to you. But a lot of people say things like oils or candles or deep breathing. I mean, we have research on deep breathing. It can be very beneficial. But you can bring in anything that soothes you, certain sense people love. I have a sister and family members who love those satin pillows. That really helps them. Just get a feeling for textures and sensations that also help you to wind down in the evening. SLEEP ANXIETY TREATMENT Now, if you're doing these things and you're still really struggling with sleep anxiety and getting to sleep and insomnia, I would encourage you to look into some kind of sleep anxiety treatment. We do have science-based treatments to manage sleep anxiety or even chronic insomnia. One of those things is mindfulness training. In mindfulness training, what we are doing here is we're training you to be able to get a hold of your attention. Because as you know, anxiety, if you really let anxiety lead the way, it's going to ping-pong you to all the worst-case scenarios. It's like what I said about my daughter. Will I fall asleep? Will I wake up? How long will it take? What if I don't? A lot of people also report anxiety around, "I don't like the feeling of falling asleep. I feel like I'm losing control or feel going to sleep is scary. I don't know what's going to happen." If you're someone who's very hypervigilant, being asleep can actually be very triggering for you. Mindfulness trains us to stay present and not engage in all of that drama that our brain creates around all the possible worst-case scenarios. It also allows us to practice non-judgment about the anxiety and about the sensations that we're experiencing, so we can just be present with them and practice. When I say practice, I mean over and over and over again because this is not easy. Practice being willing to be uncomfortable but keep our mind attending to the present instead of the worst-case scenarios. Another piece of this when we're talking about sleep anxiety treatment is general stress management. Now, if you have an anxiety disorder during the day that also starts to leak into the evenings, particularly if you're someone who has more anxiety in the evenings, you will need to use a lot of cognitive behavioral therapy to manage that anxiety. Or if you have a lot of stress in your life, maybe your work or your school or your relationships are very stressful in this season, CBT (cognitive behavioral therapy) can be helpful in first looking at your cognition—that's the cognitive part of CBT—and then also looking at your behaviors. Now, the cool thing is a lot of the behavior stuff, you and I have already talked about in that sleep hygiene piece. We know that the behavior of being on your phone is not helpful. In addition with sleep hygiene, getting a lot of exercise less than two hours before bed isn't really great for sleep either because your body's metabolism is all sped up from that. Those are some behavior changes. Not watching scary movies or very activating movies or books—reading those books is very important behavior changes, or having difficult conversations. For me, I have had to learn that if I work after about 7:00 PM, I can't fall asleep. I need about three to four hours to wind down from work before I can fall asleep. Now that's not always possible and I understand there's a lot of privilege that goes with these ideas sometimes, but you just can do the best that you can, and if you can change things, go ahead and try. But those are some behavioral changes you can additionally do. Now, if you are somebody who struggles with severe insomnia, in addition to sleep anxiety, because sometimes sleep anxiety goes alongside actual insomnia where biologically you don't sleep much or you can't sleep much, there is a specific type of cognitive behavioral therapy that is being scientifically proven to help called CBT-I . That is a specific form of CBT that is directed towards managing sleep anxiety and insomnia. It is really cool, it's very effective. It's very hard to get treatment, but if you do some Google searches, you might be able to find a CBT-I specialist in your area. GIVE ME SOME MORE SLEEP ANXIETY TIPS.. In general now, because I'm trying to move us through this and not give you a full-on lecture, let's just talk about some general sleep anxiety tips. As you're approaching bed, the first skill I want you to practice is not tending to the noise that your brain creates about how bad this is going to go. For me, my mindfulness mantra is "not happening now." I've done a whole episode on that in the past, not happening now. Meaning I'm not tending to something that has not yet happened. Until it happens, it does me no benefit by trying to focus on it right now. My brain is going to keep saying, "But what if you don't? What if it's bad? What if you're really tired tomorrow? How is it going to go? What if you wake up? What if you have a panic attack at night and so forth?" I'm just going to say over and over, "You know what, it's not happening now. I'm tending to what is happening." Another sleep anxiety tip I really want you to practice is compassion. Be really gentle with yourself, particularly as you start to practice these behavioral changes, and clean up your sleep hygiene. It takes time. The other thing with compassion is also be kind to yourself when you're tired because a lot of us are exhausted. You have an anxiety disorder. Maybe it's making it even harder for you to fall asleep. Then you're tired, so now you've got two problems. Be as gentle and kind as you can. Again, when it comes to self-compassion, check in with yourself. Am I doing and engaging in behaviors that are kind towards me and my long-term goal? I'll tell you what I used to do. When I had young toddlers, by two o'clock I'd be exhausted because I hadn't gotten enough sleep, so I'd have a coffee or a tea. But the tea and the coffee then prolonged how much I could get to bed, and it was made later and later. Again, reducing coffee, tea, some energy drinks is another important piece of sleep hygiene and behavioral changes that will benefit you if you struggle with sleep anxiety or insomnia. We have mindfulness, we have compassion. These are really important sleep anxiety tools or tips. Another piece here is, as I've said before, engage in things that soothe you. If you're doing exposures, if you're doing ERP, try not to do them before bed unless you've been instructed by your therapist. Sometimes that's not helpful. Now, that being said, if you have really severe anxiety around sleep, you may need to do exposures around bedtime as the exposure. That is an actual part of CBT-I. Sometimes they even have you set alarms to wake up at 2:14 in the morning and 4:45 in the morning so that you have to practice these skills over and over. That is okay and that is, again, where this can be very paradoxical, but that will be up to you to decide what's best for you. WHAT ABOUT SLEEP ANXIETY MEDICATION? Another thing to remember is that there is sleep anxiety medicine . You can talk with your doctor about medicines that can help with sleep, help staying asleep, help you regulate what time. Some people take medication a few half an hour before they go to bed so that it helps ease them into sleep. Please do speak with a psychiatrist or a medical doctor about that because I'm not a doctor, so I'm not going to be giving you medical advice about that. Now, before I wrap up, there's a couple of specific groups of people I also don't want to miss here. First, I want to address sleep anxiety in association with depression. Sometimes a symptom of depression is insomnia. If that is the case, you could use some of these skills and I encourage you to, but we don't want to miss the fact that if depression is what's causing your insomnia or your sleep anxiety, please seek out a CBT therapist because it's very important that you address that depression. One of the side effects of having depression can be sleepless nights, so I don't want to miss that. Another thing is, a lot of folks with OCD experience obsessions about sleep. Again, as I was mentioning before, it may mean that you do have to do some exposure around sleep and that would be advised to you because the best treatment for OCD is exposure and response prevention. We actually wrote an entire article about this on the website. If you want to go to KimberleyQuinlan-LMFT.com and then type in OCD and insomnia , it will be there. We did a whole article on that just a couple of weeks ago. >>> OCD AND INSOMNIA ARTICLE IS HERE That's it, guys. That's what I want you to be really looking at. Please remember, and this is the most important part, the biggest message that our sleep specialist gave my daughter was stop putting so much pressure on yourself to fall asleep because the pressure creates anxiety and the anxiety stops you from sleeping. The best sleep anxiety tip I can give you at the outset of this podcast episode is try to take the pressure off. The truth is, even if you're not sleeping as long as you're resting, that is enough. You can't force yourself to fall asleep. It usually creates more frustration, more anxiety. It just creates a lot of irritability. Try to take the pressure off. Give yourself many weeks to get this down. It may take tweaks, it may take some reworking. You may require some help from people and assistance from a medical doctor if you need to. You can also reach out to a sleep anxiety specialist or an insomnia specialist who specialize in sleep deprivation anxiety or sleep deprivation in general. If you need sleep anxiety treatment, there are specific treatments out there for sleep anxiety in adults, children, and teens. If you're wanting to come and work with us again, you can go to our website and we have some amazing therapists who can also help. My hope is, soon I will be bringing out some sleep anxiety-guided meditations for you as well. That's coming down the pipeline here very soon. Please take the pressure off. Please be gentle. Just tweak little things. Again, as we always say, it's a beautiful day to do hard, repetitive things where we practice and we practice. I hope that's been helpful. I hope you do go on to have a good night's rest here very soon. I will see you next week.

Jun 16, 2023

Welcome back, everybody. Today we are talking about Acceptance Scripts with Dr Jon Grayson. So happy to be here with you as we tie together our series on imaginals and scripts. Today, we have the amazing Dr. Jon Grayson and he is going to talk about acceptance scripts and the real importance of making sure we use acceptance when we're talking about scripts and imaginals. I'm so excited to share this episode with you. I think it really does, again, tie together the two other guests that we've had on the show in this series. For those of you who are listening to this and haven't listened to the other two episodes of the series, go back two weeks. We've got the first one with Krista Reed and she's talking about scripts and the way she uses them. Then we have Shala Nicely and she talks about her own specific way of using scripts. Again, the reason that I didn't just have one person and leave it at that is I do think for each person, we have to find specific ways in which we do these skills and tools so we can make it specific to your obsessions and your intrusive thoughts. One explanation or one version or variety of this is probably not enough. I want to really deep dive in this series so that you feel, number one, you have a good understanding of what an imaginal and a script is. Number two, you know how to use them, you know the little nuanced pieces of information that you need to help make sure OCD and your OCD-related disorder doesn't make it a compulsion because it can. I really wanted to get some groundwork so that you feel confident using imaginal and scripts in your own treatment and your own recovery. Again, for those of you who are a little lost and feel like you need a better understanding of OCD, of how OCD works, how it keeps you stuck, the cycle of OCD and you want to make your own individual OCD and ERP plan, you can go to CBTSchool.com. We have a full seven-hour course that will walk you through exactly how I do it with my patients, and you can do that at your own pace. It's an on-demand course. It is not therapy, but it will help you if you don't have access to therapy or if you're really just wanting to understand and do a deep dive and understand what ERP is and how you can use it. That is there for you. But if you are someone who is just wanting to get to the good stuff, let's go over to the episode with Dr. Jon Grayson. Thank you, Dr. Jon Grayson, for coming on the show again. Always a pleasure to have such amazing people who really know their stuff. I'll enjoy this episode with you. Let's go. Kimberley: Welcome, Dr. Jon Grayson. I'm so happy to have you back. Jon: It is always fun to be with you. Kimberley: Okay. It's funny that you are number three, because I probably need you to be number one. Almost all of the scripting I ever learned was from your book . I think that even Shala Nicely came on and spoke about how a lot of what she does is through your book as well. Let's just talk about the way in which you walk people through an imaginal or a script. Now do you call it imaginal or script? Do you think they're synonymous? Do you have a different way of explaining it? Jon: I think jargon-wise, they're synonymous. I think by definition-- I feel weird saying that by definition because we made it up. I came up with the name "script" because originally, imaginal exposure suggested I'm just dealing with all the horrors and person's just going to think about it. I changed the name to "script" because I was including both. What are you being exposed to? What might happen and why would you take this risk? Because I feel like the script is not only to get used to the material, but we remind the person, why am I doing this? What am I getting out of taking this horrible risk? Why would I want to live with that? WHAT IS AN ACCEPTANCE SCRIPTS/IMAGINALS? Integral to the Acceptance Script is the whole idea of learning acceptance. Because too often, I think the biggest problem I see in most therapists is they just jump into doing exposure without making sure the person has done level 1 acceptance, which is "I want to live with uncertainty," because to say "I want to live with uncertainty" is to say, "I am willing to cope if the worst things happen." It's not just this general idea, it's like going to the extreme. "I'm willing to live, even if this happens. I'm willing to drive a car knowing that I might get paralyzed and disfigured in a car crash." I think that's acceptance because if you're telling me you're never going to crash in a car and you know that's true, I guess that's a nice comforting thought that you might be in for a shock. We're willing to take that risk. I think across the board, it's always willing to live with the worst possible. Scripts try to encapsulate that. They're trying to help bring the person not only to confront their fear but remind them of all the ways they want to cope with it. It is not a reassurance thing because let's face it, the worst thing happening, saying "I'll cope with the worst" is not really reassuring in a sense because it's something you really don't want to happen. But I guess the goal is, first of all, if it happens, you will do something that's coping or not. I think non-acceptance-- God bless you. I'm glad we're live so people can see you were sneezing. I just didn't go into a religious ecstasy. I think we see non-acceptance insidiously all over the place without realizing it. In the beginning of the pandemic, so many people were going like, "Well, this can't last all summer. I can't deal with that." That is a statement of avoidance and non-acceptance. I was listening to that and in the back of my mind, it's like, "Let's see. Everything they've told us makes it seem like this is going on for two years because they're not finding a vaccine." Seriously, you can't take it. You're not going to do it. What are you going to do? In retrospect, everybody would have to admit, "Well, yeah, it was not fun, it was awful, but I lived through it." Acceptance would've been, "Well, how am I going to try to make the best of this?" Making the best of it isn't wonderful, which I guess brings us to the first point about acceptance because I think in the Western world, we make everything glossy and pretty and beautiful. Acceptance is just this wonderful land of zen happiness. It's like I'm accepting everything is so good and, in reality, the best way to describe acceptance is that it sucks in the short run. In the short run, acceptance means "I'm going to be willing to embrace what seems to me the second-best life. This is what I want, I can have it, I will embrace this." WHY DO WE NEED TO PRACTICE ACCEPTANCE? The prime reason to do acceptance is you don't have a choice. The other world doesn't exist. In the beginning of the pandemic, Kathy and I were doing our pandemic walk, my wife Kathy. We were doing our pandemic walk. I remember because you're terrified of everybody and you're walking looking around. Kathy says to me, "God, this would be such a great day if all this wasn't happening." I said to her, "You're wrong, Kathy," which for all the listeners should immediately cue them into the idea that being married to a psychologist is not necessarily fun. I said to her, "It is a beautiful day. We're with each other. Here we are. We're holding hands, taking a walk. It's really pretty. We're going to be spending the whole day together." The truth is, it is a great day AND it's horrible that all of this is happening. I think acceptance is always AND. We always talk about letting stuff be there as if it's very passively like, "Oh, I can just let it be there and not bother me." No, it's really horrible. Let me tell this really horrible story, which I can't remember if I've told on here, but it's a more graphic description of what acceptance looks like, if I may. A young girl was brought to me, 17, was really in terrible shape. I mean, she had been hospitalized, she had suicide attempts. So anxious, she couldn't tolerate being in a counsel's office for more than one hour when she first came in. Her meds were a mess. Over the next three months, we got her meds in line and she really worked incredibly hard considering where she was. And then in December, they asked, could she be in my support group? I said, "Well, it's not really for kids." They talked me into things, "We think she's mature." First of all, whenever she spoke up in the group, whatever she said would be brilliantly insightful that would just knock everybody out. She did not look old, but nobody could believe she was only 17. As the year went on, we were tapering off sessions. The last time I saw her in June, her parents, her and her brother were driving out to the desert outside of LA looking for a vacation getaway place. On their way there, a drunk driver in her third DUI rammed the car and killed my patient Ruby and her 14-year-old brother. I don't have to tell you how devastated the parents were. I could talk a lot of stories that are amazing about them because I saw them starting about three weeks after their loss. At which point they said, "We want to be more than the parents of dead kids, but we can't imagine anything else." I said, "Well, I can tell you what treatment will be like, but it just seems like words." They agreed it'll be just words, but it's just nice to hear there's something. They coped amazingly well. But the only good thing about coping, in this case, is it's better than not coping. Maybe that's true a lot of the time. After a year and a half, they did buy the place where they were going to that they were looking for that day. They bought it because it made them feel closer to the kids. They didn't push that away at all. After a year and a half, they were at the place. It was one night where there was a meteor shower. They go, "Oh, we're going to go out and watch the meteor shower." They go out at midnight, lay down on their backs and both immediately burst into tears because this 17-year-old, 14-year-old were actually the kind of kids they would've happily gone out there with their parents and enjoyed the whole time. I said to the dad, "Was it a pretty meteor shower?" He said, "Yeah." "Are you sorry you saw it?" "No." I said the truth, "It was a beautiful meteor shower AND it's horrible that your kids were murdered." It's a dark sense of humor and said, "Well, I thought we'd have at least a few moments. I said, "Yeah, that wasn't happening." That's acceptance. They were living in the present. They could enjoy things and there was a hole in their heart. The alternative to that is comparing life to every second of life to how much better it would be. Whenever I compare life to a fantasy, I ruin the present. I have nothing. I think the reason for acceptance is to make the best of whatever we can have. I think one of the wonderful things sometimes is that a lot of what we avoid is not something so devastating. It's maybe more in our head what we're trying to avoid. But a low probability event is not a no probability event. If that's what I'm scared of, low odds are comforting because I want no odds. Am I answering your question? Kimberley: You are. I think it's a really great opportunity for us to segue. You've talked about the first step being to familiarize yourself with uncertainty before doing scripts and acceptance. You've beautifully explained this idea. For the listeners, you can also go back. Dr. Grayson has been on the show before. You can listen to it. We've talked a lot about that, which is so beautiful and I think very much compliments what you're saying. Let's talk about the script that you're speaking of. Once you've done that work of acceptance, how would you-- Jon: I may have to call you Ms. Quinlan since you referred to me as Dr. Grayson. Kimberley: No, call me Kimberley. HOW CAN WE ACCEPT UNCERTAINTY USING SCRIPTS/IMAGINALS? Credit: https://www.instagram.com/p/CmZUliJKhQB/ Jon: When considering how to accept uncertainty , that first step, are you willing to learn to live with uncertainty? That step is variable of talking in therapy for the first session. I've had some people take three months before they agree like, it's not like I really have a choice, and that's really what we're getting. What are you losing to that? I can't remember if I just said this before, but one of the biggest things that I end up teaching therapists who have been around the field for years is do not start exposure until the person has actually agreed that they're willing to learn to do this because obviously, they can just accept uncertainty. Then we're done with session 1. It takes one session to three months. The loose measure is to accept uncertainty to say if the worst happens, I will try to live with it and I will try to cope with it. If somebody says to me, "If that happens, I'll kill myself." No, no. That's an avoidance. In this scenario, you are condemned to life. You're going to have to figure out how to cope no matter how awful. In scripting, the idea of a script is not only to provide the imaginal exposure, which is like this terrible thing might happen. Because a lot of times, people go, if you say X might happen, "I don't want to think about it." As I said to you in the beginning of the show, I can get any parent into an immediate statement of denial by saying, "What if your kids die," the response of almost every parent is, "I don't want to deal with that. I don't want to think it through." But if you're being tortured by the thought, that normal level of denial, which I don't think is the ideal way to handle it, but you already can't do it because you keep going into, "What about no, what about no, what about, no?" How to write an Acceptance Script The very first step of how to write an acceptance script is essentially asking the question, "why would I take this risk?" Because within that statement is part of your answer of why I'm going to pursue acceptance. It is not the same as acceptance, but it's why I'm being motivated to go after this. Kimberley: What would that look like? How would you word that? Jon: As to why would I take this risk? Kimberley: Uh-hmm. Jon: I'm trying to think of how horrible to go. Kimberley: Let's pick an example because I think examples are helpful. Let's say someone has relationship OCD and they're afraid they're making the wrong choice in their partner. Jon: You picked one, I think, that's not necessarily the most horribly devastating consequences on one hand compared to like, am I an old child molester? Kimberley: You go there. Jon: I have a really wonderful acceptance thing I do with that, so we will go there. But with the ROCD, I want to know, am I making this terrible mistake with my spouse? What we're asking them to accept is never knowing. Kimberley: You'd just say that in the script? Jon: No, because we'll talk to them and we'll talk about why like, why am I willing to never know for sure? Because some of it is like they're looking into a relationship with the thermometer and taking the measure every minute. What's the temperature now? What's the temperature now? There's this fantasy that I should have no questions. I mean, depending on how deep they're in, I should find no one else attractive, but every moment should be great and I should have no complaints. Well, that is a fantasy marriage. Kathy and I took a trip to France and it was an incredible trip. Of course, when you say going to Paris, everybody's eyes glaze over. We ate at a patisserie every morning, but let's face it, it's just a damn croissant. One place had the best café au lait. We were there for two days, but it was great. We saw the Catacombs where we had to wait in line for three hours in the hot sun. Went to a really fine restaurant, but we're not super foodies, so we're not necessarily going to like it. The experience can't just depend on, "This was great food," or "This is terrible, we just spent a lot of money for what." We go in knowing that. It was a great vacation. A great vacation. It's not like every second is great. Three hours in a hot sun, five-hour bus ride to go see the site, but it was still a great vacation. I think a relationship is like that, so I can't look at that now. I think for the person with ROCD , we're going to say they are not perfect. Like any relationship, we want a hundred things and we're only getting 70 of them. It should be more than 20, but we're only getting 70. Are you making a mistake? Now, most people with ROCD can say they don't want to leave right now or sometimes they want to leave because of the anxiety. It's like, then you have to stay. I don't want you talking about all your fears and confessing because if you are wrong, you're just making this person feel bad for no reason. My thought is, you can leave this relationship when you know for two weeks solid you want to leave with no question. No question. You know it is, sure, as you know you're sitting there because they generally accept that. We have to point out what are the realities of a relationship. Everyone on their wedding day thinks they're going to be married forever, but that's wrong 50% of the time. Whomever we marry, my spouse being an exception, 40 years later, they don't look as good as you did the day you married them. Technically, you were accepting second best in looks 40 years later. Kimberley: Did you know the rate of divorce is higher in therapists? Jon: Wow. So, Kathy and I are really against the odds. This is a little scary to you probably. We started dating in 1970 and this year, it'll be our 50th anniversary. Kimberley: Wow. Congratulations. Jon: Having met at the age of two and started dating then, we don't really have much significant history before that. You will get angry and there are going to be things they don't want to do. Yes, you're going to have to learn to live not knowing that. That's going to be part of the script, that you don't get to know. What if you're making a mistake? Even if you fell wildly happily in love now and you had no question, really nice feeling. If the relationship seems good, no reason to question it. Now of course, if you have ROCD, you're checking all these reasons. It's like you're not ready to leave yet. Yes, when you're answering your questions, it's maybe. Even if I feel wonderfully in love with you, it might be that next year or after 20 years ago, I discover you've been having a seven-year illicit affair. I discover, "Oh hey, guess what? You're leaving me." There are all kinds of things that could go wrong. Or I'll ask the person in this relationship, if this relationship was good and you felt constant passion affair and next year your spouse suddenly gets a dread disease that's going to make them really messed up and crippled and sick for the next years, I guess you're leaving them. Of course, everybody goes like, "No." But the bottom line is, that's good, but that's not going to be what you signed up for. How do we make the best of it? I did this one thing with one couple that worked like magic. I'm saying that worked like magic because I'd do it with everyone across the board, but usually, it doesn't work like this. This was the low probability. Oh my god, this was the killer intervention as opposed to, this is a start for most people. It was such a cute couple, but I'd given him the thing. "This weekend, when you're spending time with her, I want you to notice whenever you're having fun, and although part of you wants to compare it to what it should be, I want you to consciously just notice whatever it is, like if it's 5%." Because a lot of times, you're comparing your current feeling to what it should be. There could be good things happening and you don't even notice because it's like, "I was just thinking about this, I was just thinking about this." He had that assignment to notice it, whatever. He came back and he was like, "We had a great weekend. I still don't know if I love her or not, but if it could be like this forever, I'm good." Now, that was a rarity, but that was the beginning of acceptance for most people, just noticing, oh, I'm not miserable every second. I agree a two-minute 20% joy isn't like, oh wow, that makes it all worth it. But it's stuff that you don't notice all along. We're trying to notice the good and the other stuff. Acceptance is not a decision; trying to learn it is. But when I talk about that couple who lost two kids, when I say it was more than a year for them to get to acceptance and what acceptance means for them is they didn't compare every moment to what it would be like if their kids were still alive. In fact, I didn't know this at the time when I told them that everything goes well after a year. You'll still have a hole in your heart, but you'll stop comparing every moment to if they were still alive. They just listened. But the dad wrote a book about mourning and he also did a one-man show called Grief, which I wish I could show everyone. But in one of those places, he said that when I told them that, in his mind, he was saying, "F you! I am never going to stop wishing my kids were alive." And then he wrote that two years later, he's come to realize it doesn't do him or his kids any good to wish they were alive." He's in acceptance. He still misses them greatly. He can still cry at them, but he's no longer making that comparison. I'm mentioning it because that takes time. No one expects a couple, three weeks after their kids are murdered, to be in acceptance. The same with anything I have to accept. The person with OCD, they have this goal, but getting to that great state where "I'm living with this and it's okay, I embrace this life" is hard. Luckily, most of the time what they have to accept isn't devastating in the sense that nobody dies of AIDS. Am I with the wrong person forever? Well, maybe it's the second-best life, but that's the life I'm asking you to live for now, because all of us have no choice. Kimberley: Right. Let's break it down. Jon: I'm sorry. Kimberley: No, you're great. Jon: Okay. You're good at being back on target. Kimberley: I'm a real visual person too. I don't know if you know that about me, like if I need to see it visually-- Jon: By the way, that's fantastic because to say something and show it visually just makes it easier for everyone else around you that you're talking to. I appreciate what you're going to do. Kimberley: Okay. Walk me through the visual here. The first step is what? Jon: Why would you take this risk? Kimberley: Okay, what's the second? THE SECOND STEP OF ACCEPTANCE SCRIPTS Jon: The second step of acceptance scripts is, if I do X, here's a list of the things I'm actually scared might happen. I say actually scared because I want to go, what's their fear? I can always go beyond even more horrible things, but I need to know what is their actual worst fear. Kimberley: Right. Let's say for two if it was relationship OCD, it would be, "I find out I'm in a terrible relationship and I'm stuck with them." Or if they were having harm obsessions, it would be, "I harm and kill my wife or my grandparent or so forth." You would write that down. Jon: Yeah. "Here's what might happen." Kimberley: Okay. What's step number three? Jon: If this happens, how would I try to cope with this in a positive way? Kimberley: That's key, isn't it? How would I cope in a positive way? Jon: Right. And that will often be second best. Kimberley: Which is acceptance. Jon: Well, it's the road to acceptance. Remember, acceptance is not just this logical thing; it's this emotional thing. I have clients and they appreciate it. It's like, if we were just doing a therapy test, like say all the right stuff, they could ace therapy right away. They know how to say everything, they can do it. But feeling it takes time and behavior. I not only have to know it; I have to do the work of getting there. I have to go through all this pain. Now, I say, I think going through ERP is as painful as doing rituals. One is just an end of rituals versus endless rituals. I hate to keep going back to this couple, but what I said initially, the only good thing about coping is it was better than not coping. I had told them how well they were coping somewhere in the middle. Again, the dad said, "Wow, I hate to see the other poor bastards," which was cute. I said, "Yes, but you've been in support groups, you've seen them." He suddenly realized, "Whoa, we are coping even though this really sucks." Kimberley: In this script—and maybe I'm wrong here, please tell me—I always think of the research around athletes and when they have an injury, there's research to show that while they're in the hospital bed with their new hip replacement and whatnot, the sports psychologists are coaching them through visual, imaginal, imagery of them doing the layup again and dunking the ball or turning the corner of the sprinting track or whatever. They're doing that imagery work to help them play out how they would cope, how they would handle the pain, how they would return. Is that what this process is in step 3? Jon: No. Well, that guy or a woman who's imagining that, does their injury permit that possibility? Kimberley: Tell me more. Jon: Are they so injured that they will never be able to do a layup? Kimberley: No. In this example-- Jon: Or maybe somebody could say the odds are against them, so here's what you can try to do, and here's what to expect of how horrible it is to try." But they might have to say, "You might not get there." In a marriage, I don't care how good the marriage is, I cannot say it will definitely work out. I can't say you will definitely work out your problems. If I'm married for 20 great years, and then we have these three years at hell and I find out that you've been cheating on me the last two years, did I make a mistake? Or should I have left you four years ago, how would I know four years ago and should I have not tried, and all these questions that don't have an answer. All I know is where I am now. THE THIRD STEP OF ACCEPTANCE SCRIPTS I like to say success is not making the right decision. It's coping with the consequences of whatever decision you have made. I feel regret is cheating because regret is, again, I'm going into denial as soon as I have a regret. I should have done X. X would've been different. I don't know if it would've been better. This failed. X being better is one possibility, but there are a whole lot of other ones where maybe it wouldn't have been as good. All I can ever do is, what is next? That person in the relationship with ROCD, what do I need to do next? What have I learned? Somebody with ROCD did get divorced and gets into a relationship where they have the ROCD, but it's such a better relationship. It's not like you should have gotten out sooner because you know what, maybe if you didn't go into that other relationship, maybe you wouldn't have been ready for this one. Maybe you needed to go through your ROCD and go through all the crap to have this good one. Dumping that person sooner and getting into another relationship might have been better, or maybe you would've picked worse. We don't get to know. All we know is what is from this moment on. Part of the exposure is, okay, X might happen. What are the possibilities of coping? Again, I think I said, in my scenarios, the person can't do suicide. They're condemned to life and say, why I kill myself? That's just a way of not thinking in the present. I want you to be stuck thinking about how you would try to cope with this. A lot of times, people have been so distant from it that it just seems like a screaming wall. It is like getting a phone call that somebody you love died. The whole world stops, and that's where people stop thinking. But in the real world, something happens after you get that information. Part of the exposure is to go through what happened next, what are some possibilities? I always say to somebody, "I don't know if I can cope with the worst things that could happen to me, but I know that there are brave people who have. I don't know if I can be like them, but they're a model that I hope I will do that." What if you don't cope? Well, then I'll be in deep trouble. My current plan is, the best I can do is I hope I will cope. I don't want to be paralyzed and disfigured in a car crash. I hope I would cope. I don't have to know that I'd cope because I'm going to wait till I get there to try to find out. But I might try to imagine it. We're going to imagine what would you actually do. In this relationship, how will I live never knowing? I'm taking the ROCD, how will I live? What if this is wrong? It might be wrong. What's decent right now? What do you like? Because again, no person is perfect. How do I get into the state of that? Do I ever send people to marital counseling? If I see actual problems, I will, but I am not sending them to marital counseling to get rid of the ROCD. I'm sending them to get rid of actual problems. With or without those problems, they still have ROCD. I'm just eliminating, okay, here's some definite reasons to get out. But once they're resolved, then you're still stuck with the ROCD. THE FORTH STEP OF ACCEPTANCE SCRIPTS Kimberley: Is there a fourth step of acceptance scripts? Jon: Kind of. It's embedded in it, which is part of why I would take this risk, is what's resulting from not taking this risk? What are the graphic horrible things that keep happening to you because you keep avoiding, including the torture you feel, the hours loss, humiliation from doing things? How are you actually hurting the people you think you love? Because a lot of times in ROCD, they can say they care about the person. I'll always ask somebody, do you love your kids or love your spouse?" They'll say, "Yeah." "Will you do anything for them?" They'll say yes. I'll say, "I'm sorry, you're a liar." How do you hurt your family and loved ones with your ROCD? Not being present, yelling at them because they didn't do something, and all the other ways that one might, asking for reassurance endlessly being in pain in the neck. I will point out, you have a choice in your relationship. I'm going beyond ROCD. But you get to pick between, are you going to serve your fear or your love? You keep choosing fear over love. Part of acceptance does have to do with what my values are. Who is the person I want to be? Here's another reason I need to do acceptance, because here's life without acceptance. Most people who we see, we can say, the idea of trying to not accept and do avoid, I think you've done an amazing experiment of checking out that method. I think the results are clear, it sucks, so it's time to try this other method. It's like, why am I doing acceptance? Because I think, again, in our society we just make acceptance sounds so wonderful. But that's just an idea. Why would acceptance actually be worth it? I have to think about why would it actually be worth it. I have to be motivated to do it. And then I'm stuck with this in-between thing that a lot of the time I'm doing a separate, recognizing I am not there yet, which by the way, there's this great book that this wonderful person wrote on self-compassion, because I need self-compassion during treatment because I'm not where I want to be. It's like I'm doing this really hard work and it's not there yet. The best I get to say is, I'm working hard, I see some improvement, but yes, I'm not there yet and mourning. Learning to live the second-best life takes time. I keep saying second-best life. I don't actually mean it in some sense, but that is the feeling that when I'm working towards acceptance, that it is. I think in some cases, it's not really a second-best life. I think a lot of times, if I overcome a fear, it's like, this is great. Other times it is. I've had some people with a moral OCD about something they've done in the past and they're going through all these contortions to try to convince themself that it's not really bad even though they actually think it's bad, but maybe here's why it's not bad. Part of the acceptance is, oh yeah, that was a bad shitty thing. You feel guilty about that. What is forgiving yourself mean? Shockingly, almost nobody knows what forgiving yourself means. How are you going to get to that point? But I have to accept, yeah, that was bad. That hurt people or whatever it is by whatever standards. Again, depending on who we're talking about, it's like, "Oh, I guess we have to have you accept being as bad as everyone else." In some other cases, no, that was really bad. WHAT HAPPENS IF I REFUSE TO ACCEPT? Kimberley: It's great. The last part of the question is, what happens when I refuse to accept? What is the result of not taking this risk or even not accepting this, which is you have additional pain, right? The pain just keeps going and going and going. Jon: Right. That's right. End of pain. Endless pain. Kimberley: Yeah. If they've used these somewhat prompts and people can go to your book and work through a lot of them, I know on your website there are a lot of worksheets as well. Once they're writing these prompts, is there anything else you feel is important for them to know about this process or to be aware of or be prepared for in this process? Jon: I am pausing. The next revision of the book might be your inspiration. Well, because I know that it is way, way, way, way easier said than done. The core treatment for all OCD is the same. However, I have a completely different set of things I say depending on the presentation, because they each have their own set of things that the individual has to be focused on working to accept and live with. Although I think in my book I attempt. When I talk about each presentation, I do try to go over those and I've seen that for many people as helpful. But I also see for many people who've read the book, and even though they've read it, it ends up different for them to actually have to discuss it out loud. Sometimes it's because they haven't been able to think about it without realizing they avoid thinking about it. Sometimes because I think not all the connections are obvious, which I know is a really vague statement. I think I can go on, but I have to wait for you to ask a question. Kimberley: Okay. We're running out of time, so I want to make sure I'm respecting your time. Jon: Don't respect my time, by the way. I set aside way extra time. This is on you if we end. Kimberley: Once you do those questions, you would then walk them through the four steps that you went through with scripting as well. Jon: Yes, and some other horrible things because the horrible show, that should have been illegal. Actually, it's not on anymore. I think you can still find that on YouTube. Toddlers & Tiaras and the crazy mothers who make their little girls try to be in beauty pageants. You know what, if you look at the pictures of the kids, it's like, oh my God, they're sexualizing this eight-year-old. But when you say that word, that means you can see what they have done. You recognize the sexual aspect. You know what, if I go and take this picture apart, this horrifies people when I say it. It's like, if you look at their legs, it's like, yeah, they have good legs. Now, nobody wants to say that, and it's like, "Oh." That's our first response. But if I have POCD, I see that, "Oh my god, what's wrong with me?" It's an acceptance that we can see something and recognize a piece of it. I think the most difficult POCD is the people who "I don't want to be attracted to a 15-year-old." I can say, if I show you this picture and tell you they're 18, oh, that's okay. If I show you the same picture and tell you they're 15, no, that's okay. It's like somehow magically, I find that the picture, the attractive is the picture is right or wrong if I tell you the age, which of course makes no sense. The picture is attractive or not independent of that. It's accepting, yes, I might find a whole lot of things. Again, what we think makes us accept or not do we act on it. Kimberley: It's interesting because as you know, we just got a new puppy. It's taking over all of the Quinlan family and our lives. I had a moment where our puppy loves his belly to be scratched and right there is his genitals. I can see the projection of my mind of like, "What if you just touched that? Or what if you pulled that back?" The imagery, I could see myself doing it. Thankfully I have all these skills where I'm able to go, "Oh, there's a thought." I did feel that hot, sticky anxiety flow going through. Jon: If you don't change diapers regularly, I'm sorry, it's a weird experience and I don't care who you are, you're going to think about that. If you're changing a little person and there you are, you're pumping their genitals because you got to clean it up and wipe it, you know what you're doing and the healthy thing is like, "Okay, weird thoughts. This is normal." If I have OCD, it's like, "Why would I even think that?" Well, it's normal. Kimberley: It's funny because I was noticing myself going through some of these imaginal scripting steps myself. Instead of going, "No, no, no, no, no, you wouldn't, you wouldn't, you couldn't. That's terrible." It was like, "All right." This is the last question I want because you've given some great examples. As I was having this thought, I noticed the choice—I used the word "choice" on purpose—to get really edgy with it and try not to have it. My body language is all tight and I was gritting my teeth, or I was like, "Kimberley, just let it flow. Let the thoughts come." As you're doing this with your patients, is there any piece of you where you are bringing their attention to whether their shoulders are all tight and their jaw is all tight and their hands are all tight, or does that not matter? Jon: Nothing not matters, maybe, but that's not always true. I thought you'd enjoy that. I think it depends on how much that's part of their conscious fear response. I mean, I think if they're doing their dog and it's like, "Oh my God, am I excited by this," the answer I would be working on is, "I'm not really sure. Maybe I am in some deep way. I'm not going to play with the genitals now and that's the best I get to know." Kimberley: Yeah. Agreed. I love this. Thank you. Again, I want you to say, where are the resources that people can go to get your concrete workbooks and your worksheets? Jon: I love how you make me have so many more books and worksheets. All the paperwork that appears in my book appears for free for anybody on the site FreedomFromOCD.com . In the Kindle and audio version, they couldn't have those, so I was obsessed to have the Kindle version so I made that available. My book has most of my repertoire except about 20 minutes. Those are the main places. I hate to do this, but most of the time, when it comes to OCD books, I will say to people, there are a bunch of books that I would recommend, I think, that are roughly equal. But I think the one that most agrees with me happens to be mine, so I mention a few of the other good books. There is only one other book seriously that I tell people to get because I think it's different, and that is your book, which is amazing because generally, I hate books that label themselves "self-compassion" because it's just a version of be nice to yourself in a lot of words. I feel your book gives these not easy-to-do steps that make it work. Although as I said to you last time, it is just you used too many exclamation points. Kimberley: I will forever decline your opinion on my exclamation points and my emojis. If you ever text with me, you'll know that I over emoji and I over exclamation points. Jon: I'm okay with that in text. Kimberley: Thank you for that wonderful compliment. I do agree, yes, I have been blamed for the exclamation mark issue before, but I stand up and I stand with it. Jon: I like to warn people because I want them to know, oh no, don't worry. This isn't as you would put it all flowers and unicorns. It's a great book with too many exclamation points. Kimberley: No, it's funny because my mom helped me edit it while I was in a 14-day quarantine in a Sydney hotel for COVID. She would go through and she would add exclamation marks. She was adding e emojis and hearts and smiley faces and I was like, "Oh, we are going crazy here." Jon: Now I know where you got it from. Kimberley: We're all love. Thank you for that. It's a very huge compliment. Thank you so much for being here and talking about this. Again, I love having you on talking just a little deeper into the topic and a bit more abstract, which I think is helpful too. Is there anything else you want to conclude on here? Jon: I would love to have some really cool, all-summarizing conclusion. The truth is, I can just talk endlessly. I'm just going to thank you for having me on and I am always willing to come talk with you. Kimberley: I would say, the point that I love that you made today, which I will add for you, is the word AND. The word AND is so important in this conversation. Jon: That's a great summary because I think so many of our ideas, it's not like they're new, they get refined with time. In a way, something we've been saying all along and suddenly there's this very slightly different way of saying it, but it summarizes it in a way that makes it more understandable, and AND I think does that for a lot of understanding mindfulness and acceptance. Kimberley: Yeah. Thank you so much.Jon: You take care.

Jun 9, 2023

Today we are talking all about ERP Scripting with Shala Nicely. Welcome back, everybody. We are on Week 2 of the Imaginals and Script Series. This week, we have the amazing Shala Nicely on the show. She's been on before. She's one of my closest friends and I'm so honored to have her on. For those of you who are listening to this and haven't listened to any of the previous episodes, I do encourage you to go back to last week's episode because that is where we introduce the incredible Krista Reed and she talks about how to use scripts and imaginals. I give a more detailed intro to what we're here talking about if this is new for you. This will be a little bit of a steep learning curve if you're new to exposure and response prevention. Let me just quickly explain. I myself, I'm an ERP-trained therapist, I am an OCD Specialist , and a part of the treatment of OCD and OCD-related disorders involve exposing yourself to your fear and then practicing response prevention, which is reducing any of the safety behaviors or compulsions you do in effort to reduce or remove whatever discomfort or uncertainty that you feel. Now, often when we go to expose ourselves to certain things, we can't because they're not something we can face on a daily basis or they're often very creative things in our mind. This is where imaginals and scripts can come in and can be incredibly helpful. If you want a more detailed understanding of the steps that we take regarding ERP, you can go to CBTSchool.com , which is where we have all our online courses. There is a course called ERP School that will really do a lot of the back work in you really understanding today's session. You don't have to have taken the course to get the benefits of today's session because a lot of you I know already have had ERP or are in ERP as we speak, or your clinicians learning about ERP and I love that you're here. Honestly, it brings me so much joy. But that is there for you if you're completely lost on what's going on today, and that will help fill you in on the gold standard treatment for OCD and the evidence-based treatment for OCD and OCD-related disorders. That being said, let's get on with the good stuff. We have the amazing Shala Nicely. I am so honored again to have you on. You are going to love how applicable and useful her skills and tools are. Let's just get straight over to Shala. Kimberley: Welcome, Shala. I am so happy to have you back. I know we have a pretty direct agenda today to talk about imaginals versus scripting in your way in which you do it. I'd love to hear a little bit about, first, do you call it imaginals or do you call it scripting? Can you give me an example or a definition of what you consider them to be? SHALA'S STORY OF ERP SCRIPTING Shala: Sure. Well, thank you very much for having me on. Love to be here as always. I'll go back to how I learned about exposure when I first became a therapist. I learned about exposure being two different things. It was either in vivo exposure, so in life. Meaning, you go out and do the thing that your OCD is afraid of that you want to do, or it was imaginals where you imagine doing the thing that you want to do that your OCD is afraid to do. Research shows us that the in vivo is more effective, but sometimes imaginals is necessary because you can't go do the thing for whatever reason. But I don't think about it like that anymore. That's how I learned it, but it's not how I practice it. To help describe what I do, I'll take you back to when I had untreated OCD or when I was just learning how to do ERP for myself because I think that would help it make sense what I do. When I was doing ERP, I would obviously go out and do all the things that I wanted to do and my OCD didn't want me to do. What I found was that I could do those things, but my OCD was still in my head, getting me to have a conversation about what we were doing in my mind. I might go pick up a discarded Coke can on the side of the road because it's "contaminated," and I would then go either put it in the trash, which would be another exposure because that would be not recycling. There are layers of exposures here. But my OCD could be in my head going, "Well, I don't think that one is contaminated. It doesn't look all that contaminated because it's pretty clean and this looks like a clean area so I'm sure it's not contaminated. What do you think, Shala?" "Oh, I agree with you." "Well, we threw it away, but I bet you, these people, they're going to get wherever we threw it. They're actually going to sort it out and it's going to get recycled anyway." There was this carnival in my head of information about what was going on. I determined what I was doing because I was doing the exposure, but I wasn't really getting all that much better. I was getting somewhat better but not all that much better. What I realized I was doing is that I'm having these conversations in my head, which are compulsive. In my recovery journey, what I was doing was I was going to a lot of trainings, I was reading a ton of books, and I talk about this in Is Fred in the Refrigerator? , my memoir, because this was a pretty pivotal moment for me when I read Dr. Jonathan Grayson's book, Freedom from Obsessive Compulsive Disorder . I know you're having him on this series as well. I read his book and he talks so much in there about writing scripts to deal with the OCD—writing scripts about what might happen, the worst-case scenario, living with uncertainty, and all that kind of stuff. That really resonated with me and I thought, "Aha, this is what I need to be doing. I need to be doing ERP scripting instead of having that conversation in my head with the OCD. Because when I'm doing exposure and I'm having a conversation with OCD in my head, I'm doing exposure and partial response prevention. I am preventing the physical response, but I'm not at all preventing the mental response, and this was slowing down my recovery." The way I like to think of imaginals—you think about imagine like imagination—is that the way I do imaginal exposures, which I just call ERP scripting, is that I'm dealing with OCD's imagination. People with OCD are exceptionally creative. If you're listening to this and you think, "Well, not me," for proof, all you have to do is look at what your OCD comes up with and look how creative it is. You guys share the same brain, therefore, you are creative too. All that creativity. When you have untreated OCD, it goes into coming up with these monstrous scenarios of how you're harming others or harming yourself. You're not ever going to be able to handle this anxiety or uncertainty or icky feeling or whatever, and it builds these scary stories that get us stuck. WHAT IS ERP SCRIPTING? What I'm trying to do with imaginal exposure or scripting is I'm trying to deal with OCD's imagination because in the example I gave, I was picking up the Coke can and my OCD was using its imagination to try to reassure me all the ways this Coke can was going to be okay or all the ways this Coke can was going to eventually get recycled. I needed to deal with that. Really, the way I do ERP Scripting for myself and for my clients is I'm helping people deal with OCD's imagination in a non-compulsive way. For me, it is not a choice of in vivo or imaginal; it is in vivo with imaginal, almost always, because most people that I see anyway are doing what I did. They are doing physical compulsions or avoidance and they're up in their head having a conversation with their OCD about it. I'm almost always doing in vivo and imaginals together because I'm having people approach the thing that they want to do that OCD doesn't want them to do, and I'm having them do scripts. The Coke can may or may not be contaminated. The fact that it's sitting here and it looks pretty clean may or may not mean that it's got invisible germs on it. I don't know. The Coke can may or may not get recycled, it may or may not end up in recycling, but somehow contaminate the whole recycling thing that has to throw all that other recycling away because it touched it. I'm trying to use my imagination to make it even worse for the OCD so that we're really facing these fears. That's how I conceptualize imaginal exposure. It's not an AND/OR it's an AND for me. Some people don't need it and if they don't need it, fine. But I find it's very helpful to make sure that people are doing full response prevention in that they're permitting both the physical and the mental compulsive response. DOES EVERYONE NEED ERP SCRIPTING? Kimberley: Does everyone need ERP scripting? When you say some people don't need it, what would the presentation of those people be? Shala: That for whatever reason, they are good at not having the conversation with OCD in their heads. This is the minority of people anyway that I work with. Most people are pretty good at having compulsive conversations with OCD because the longer you have untreated OCD, the more you end up taking your physical compulsions and pulling them inward and making the mental compulsion so that you can survive. If you can't really do all that physical checking at your office because people are going to see you, you do mental checking. That's certainly what I did. People become good at doing this stuff in their head and it becomes second nature. It can be going on. I talk about this a lot in Fred , I could do compulsions while I was doing anything else because I could do them in my head. Most people are doing that and most people have been doing that for long enough by the time they see somebody like me that if I just say, "Well, stop doing that," I mean I'm never going to see them again. They're not going to come back because they can't stop doing that. That's the whole reason they called me. I'm giving them something else to do instead. It's a competing response to the mental compulsions because they don't know how to stop that. They're not aware of what they're doing, they don't know how to stop the process, so I'm giving them something to do instead of that until they build the mental muscles to be able to recognize OCD trying to get them to have a conversation and just not answer that question in their head. But it takes a long time to develop that skill. It took me a long time anyway. Some people, for whatever reason though, are good at that. If they don't need to do the scripting, great. I think that's wonderful. They don't have to do it. The strongest response you can ever have to OCD is to ignore it completely, both physically and mentally. If you can truly ignore it in your head, you don't even need to do the scripting. It's a stronger response to just do what you want to do that upsets OCD and just go on with your day. HOW TO DO ERP SCRIPTING? Kimberley: Amazing. So How do you do ERP Scripting ? If you're not one of those people and OCD loves to come up with creative ideas of all the things, what would be your approach? You talked about imaginals versus scripting. Can you play out and show us how you do it? Shala: I mean, I guess imaginals in the traditional way that it is defined versus scripting. The way I would do it is we would design the client and I would design whatever their first exposure is going to be. Let's say that it would be touching doorknobs. They're going to be in their location and I'm going to be in my location. They're going to be wherever we've decided they're going to touch the doorknobs. Maybe it's to the outside of their house, for instance. I'm there on video with them and we have them touch the doorknob. And then I asked them, "Well, what is OCD saying about that?" "Well, OCD says that I need to go wash my hands." I will say, "Well, are you going to go do that?" "No." I'm like, "Well, let's tell OCD that." "Okay, OCD, I'm not going to wash my hands." "Now what's OCD saying?" "Well, OCD is saying that I'm contaminated." "Well, let's say I may or may not be contaminated." So far, we've got, "I'm not washing my hands and I may or may not be contaminated." Okay, now I'll ask them their anxiety level. When they say, "Gosh, I'm at a four," I'll say, "Is that good?" They'll often say, "No, I wish it were zero." I'll be like, "I'm sorry, what? What did you say? You want your anxiety to be zero? I must have misheard that. Is four good?" Finally, they understand, "Oh, well, four is not good because we could be higher." "What would be better than four?" "Anything above a four." I'm working with them on that. We might start to throw some things in the script. I want to be anxious because this is how I beat my OCD, so bring it on. I'll ask again, "What's your OCD saying?" "Well, it's saying that I'm going to get some terrible disease." "Well, you may not get a terrible disease." I'm questioning back and forth the client as we're working on this, until we've got enough of a dialogue about what's going on in their head that we can then create a script. A script might look something like, "Well, I may or may not be contaminated. I may or may not get a dread disease, but I'm not washing my hands and I'm going to do this because I want my life back. It makes me anxious and I may or may not get a dread disease." And then we'll focus in on what's bothering OCD most. Maybe it's, at the beginning, the dread disease. "Well, I may or may not get a drug disease. I may or may not get a dread disease. I may or may not get a dread disease. I may or may not get a dread disease." We might sing it, we say it over and over and over and over and over again, and look for what the reaction from the OCD is. If the OCD is still upset, then we still go after that. If it starts moving, "Well, what's OCD saying now?" "Well, OCD is saying now that if I get a dread disease, then I won't be able to do this thing that I have coming up that I really want to do." "Well, okay, I may or may not get a dread disease and I may or may not miss this important event as a result." We add that in. We do that and do that and do that and do that for whatever the period is that we've decided is going to be our exposure period. And then we stop and then we talk about it. What did we learn? What was that like and what did you learn? Really focusing on how we did more than we thought we could do. We withstood more anxiety than we thought we could withstand. What did we learn about what the OCD is doing? I'm not so concerned about what the anxiety is doing. I mean, I want it to go up. That's my concern. I'm not all that concerned about whether it comes down or not. I do want it to go up. We talk about what we learned about the anxiety that gosh, you can push it up enough and you can handle a lot more than you thought you did. That would be our exposure. And then we would plan homework and then they would do that daily, hopefully. I have forms on my website that people can then send me their daily experience doing these exposures and I send them feedback on it, and that's what we're working on. We're working on doing the thing that OCD doesn't want you to do that you want to do, and then working on getting better and better at addressing all of the mental gymnastics in your head. Now, if somebody touches the doorknob and they're like, "Okay, I can do this," and then their anxiety comes up and comes back down and they can do it without saying anything, great, go touch doorknobs. You don't need to do scripting. Often, I don't know if somebody needs to do that until we start working on it. If they don't need to do the scripting, great. We don't do the scripting. Makes things easier. But often people do need to. That's generally how I do it. Obviously, lots of variations on that based on what the client is experiencing. Kimberley: This is all thing, you're not writing it down. Again, when you go back to our original training, for me, it was a worksheet and you print it out, you'd fill out the prompts. Are you doing any of this written or is this a counter to the mental compulsions in your head? Shala: None of this is written. The only time I would write it out is after that first session. When you're really anxious, your prefrontal cortex isn't working all that well, so you may have trouble remembering what we did, remembering the specific things that we said, or pulling it up for yourself. When you're doing your exposure, you're so anxious. I might type out some of what we said, the main things, send it to the clients, and have that. But really to me, scripting is an interactive exercise and I want my clients to be listening to what the OCD is saying for the sole purpose of knowing what we're going to say. Because when we start doing exposure, what we're often trying to do is keep pace with the OCD because it's got a little imagination engine running and it's going to go crazy with all the things that it's going to come up with. We're trying to stay on that level and make sure we're meeting all its imagination with our own imagination. As we get better and better at this, then I'm teaching people how to one-up the OCD and how to get better than the OCD as it goes along. But it's a dynamic process. I don't have people read scripts because the script that we wrote was for what was going on whenever we wrote the script. Different things might be going on this time. What we're trying to do is listen to the OCD in a different way. I don't want people listening to it in a compulsive way. I want people listening to it in a, "I've got to understand my foe here and what my foe is upset about so I can use it against it." That's what we're doing. There might be key things, little pieces we write down, but I'm not having people write and read it over and over. Now, there's nothing wrong with that. It's just not what I do. Everybody has a different way to approach this. This is just my way. Kimberley: Right. I was thinking as you were talking, in ERP School, I talk about the game of one-up and I actually do that game with clients before I do any scripting or imaginals or exposures too. They tell me what their fear is, I try and make it worse. And then I ask them to make it even worse, then I make it even worse, because I'm trying to model to them like, we're going here. We're going to go all the way and even beyond. If we can get ahead of OCD and get even more creative, that's better. Let's play it back and forward. You talked about touching a doorknob and all of the catastrophic things that can happen there. What about if someone were to say their thoughts are about harming somebody and they have this feeling of like, I've been trained, society has trained me not to have thoughts about harming people or sexual thoughts and so forth? There's this societal OCD stigmatizing like we don't think those things. We should be practicing not thinking those things. What would you give as advice to somebody in that situation? Shala: I would talk a lot about the science about our thoughts, that the more that you try to push a thought away, the more it's going to be there. Because every time you push a thought away, your brain puts a post-it note on it that says, "Ooh, she pushed this thought away. This must be dangerous. Therefore, I need to bring it up again to make sure we solve it." Because humans' competitive advantage—we don't have fur, we don't have fangs, we don't have claws, we don't run very fast—our competitive advantage is problem-solving. The way we stay alive is for cave people looking out onto savannah and we can see that there are berries here, there, and yawn. But that one berry patch over there, gosh, you saw something waving in the grass by it and you're like, "I'm going to notice that and I'm going to remember that because that was different, but I also don't want to go over there." Your brain is going to remember that like, "Hmm, there was something about that berry patch over there. Grass waving could be a tiger. We need to remember that. Remember that thing, we're not going to go over there." We're interacting with thoughts in that way because that's what kept us alive. When we get an intrusive thought nowadays and we go, "Ooh, that was a bad thought. I don't know. I should stay away from that," our brain is like, "Oh, post a note on that one. That one is like the scary tiger thought. We're going to bring that up again just to make sure." Every time we try to push a thought away, we're going to make it come back. We talk a lot about that. We talk a lot about society's norms are whatever they are, but a lot of society's norms are great in principle, not that awesome in practice. We don't have any control over what we think about. The TV is filled with sex and gore, and violence. Of course, you're thinking those things. You can't get away from those images. I think society has very paradoxically conflicting rules about this stuff. Don't think about it but also watch our TV show about it. I would talk about that to try to help people recognize that these standards and rules that we put on ourselves as humans are often unrealistic and shame-inducing and to help people recognize that everybody has these thoughts. We have 40, 60, 80,000 thoughts a day. I got that number at some conference somewhere years ago. We don't have control over those. I would really help them understand the process of what's going on in their brain to destigmatize it by helping them understand really thoughts are chemical, neuronal, whatever impulses in our brain. We don't have a lot of control over that and we need to deal with them in a way that our brain understands and recognizes. We need to have those thoughts be present and have a different reaction to those thoughts so your brain eventually takes the post-it note off of them and just lets them cycle through like all the other thoughts because it recognizes it's not dangerous. HOW FAR CAN YOU GO IN ER SCRIPTING? Kimberley: Right. I agree. But how far can you go in ERP Scripting? Let's push a little harder then. This just happened recently actually. I was doing a session with a client and he was having some sexual pedophilia OCD obsessions playing up, "I'll do this to this person," as you were doing like I may or may not statements and so forth. And then we played with the idea of doing one up. I actually went to use some very graphic words and his face dropped. It wasn't a drop of shock in terms of like, "Oh my gosh, Kimberley used that naughty word." It was more of like, "Oh, you are in my brain, you know what I'm thinking." And then I had to slow down and ask him, "Are there any thoughts you actually aren't admitting to having?" Because I could see he was going at 80% of where OCD took him, but he was really holding back with the really graphic, very sexual words—words that societally we may actually encourage our children and our men and women not to say. Do you encourage them to be using the graphic language that their OCD is coming up with? Shala: Absolutely. I'm personally a big swearer. That's another thing I talk about in-- Kimberley: Potty mouth. Shala: I'll ask clients, "What's your favorite swear word? Let's throw swear words in here." I want to use the language that their OCD is using. If I can tell that's the language their OCD is using, well, let's use that language. Let's not be afraid of it. The other thing I do before I start ERP with anyone is I go through what I consider the three risks of ERP so they understand that what happens during our experience together is normal. I explain that it's likely we're going to make their anxiety worse in the weeks following exposure because we're taking away the compulsions bit by bit, and the compulsions are artificially holding back the anxiety. I explained that their OCD is not going to roll over because they're doing ERP therapy now. Nobody's OCD is going to go, "Oh gosh, Shala is in ERP. I think I'll just leave her alone now." No, the OCD is going to ratchet it up. You're not doing what you're supposed to do, you're not doing your compulsions, so let's make things scarier. Let's make things more compelling. Let me be louder. Your OCD can get quite a bit worse once you start doing ERP because it's trying to get you back in line. When somebody is in an exposure session and their OCD is actually going places, they never even expected them to go, and I'll say that's what we're talking about, "That's just the OCD getting worse, that's what we wanted. This is what we knew was going to happen." We're going to use that against the OCD to help normalize it. Then I also explain to people that people with OCD don't like negative emotions more than your average bear, and we tend to press all the negative emotions down under the anxiety. When you start letting the anxiety out and not doing compulsions, then you can also get a lot more emotions than you're used to experiencing so that people recognize if they cry during the exposures, if it's a lot scarier than they thought, if they have regret or guilt or other feelings, that's just a normal part of it. I explain all that. When things inevitably go places where the client isn't anticipating they're going to go like in a first exposure, then they feel this is just part of the process. I think it makes it so that it's easier to go those graphic places because you're like, "Yeah, we expected OCD to go the graphic place because it's mad at you." Kimberley: It normalizes it, doesn't it? Shala: Yeah. Then we go to the graphic place too. I tell clients that specifically because this is a game and I really want them to understand this is what your opponent is likely to do so that they feel empowered so we can go there too and trying some to take the shame out of it. When you said the graphic word and your client had a look on their face and it was because how did you even know that was in my head, because you were validating that it's okay to have this thought because you knew it was going to be there. I think that's a really important part of exposure too. HOW LONG DO YOU USE ERP SCRIPTING FOR? Kimberley: So, how long do you do ERP Scripting for? Let's say they're doing this in your session or they're at home doing their assigned homework. Let's say they do it for a certain amount of time and then they have to get back to work or they're going to do something. But those voices, the OCD comes back with a vengeance. What would you have them do after that period of time? Would they continue with this action or is there a transition action or activity you would have them do? Shala: That's a great question. It depends a lot on really the stage of therapy that somebody is in and what is available to them based on what they're going to be doing. Oftentimes, what I will ask people to do is to try to do the exposure for long enough that you've done enough response prevention that you can then leave the exposure environment and not be up in your head compulsively ruminating. Because if you were doing exposure for 20 minutes, you've done a great job, but then you leave that exposure and you are at a high enough anxiety level where it feels compelling. Now you have to fix the problem in your head even though you just did this great exposure. Then we're just going to undo the work you just did. I try to help people plan as much as they can to not get themselves in a situation where they're going to end up compulsively ruminating or doing other compulsions after they finish. But obviously, we can't be perfect. Life happens. I think some of the ways you can deal with that, if you know it's going to happen, sometimes they'll ask people to make recordings on their phone and they just put in their earpieces or their earbuds or whatever and they can just listen to a script while they're doing whatever they're doing. Nobody has to know what they're doing because so many people walk around with EarPods in their ears all the time anyway. That's one way to deal with it. Another way to deal with it is to try to do the murmuring out in your head as best as you can. That's really hard because they're likely to just get mixed up with compulsive thoughts. You can try to focus your attention as much as you possibly can on what you're doing. That's going to be the strongest response. It's hard for people though when they get started to do that. But if you can do that, I think that's fine, and I think just being compassionate with yourself. "Okay, so I am now sitting here doing some rituals in my head. I'm doing the best I can." If you're not in a situation where you can fully implement response prevention in your head because you're in a meeting and you got to do other stuff and you've got this compulsive stuff running in the background, just do the best you can. And then when you're at a place where you can do some scripting, some more exposure to get yourself back on top of the OCD, then do that. But be really compassionate. I try to stress this to all my clients. We are not trying to do ERP perfectly because if you try to do it perfectly, you're doing ERP in an OCD way, which isn't going to work. Just be kind to yourself and recognize this is hard and nobody is going to do it perfectly. If you end up in a situation where you end up doing some compulsions afterwards, well, that's good information for us. We'll try to do it differently or better next time, but don't beat yourself up. Kimberley: It's funny you brought that up because I was just about to ask you that question. Often clients will do their scripting or their imaginal and then they have an obsession, "What if I keep doing compulsions and it's not good to do compulsions?" Would you do scripting for that? Shala: Oh yeah. I may or may not do more compulsions than I used to be doing. I may or may not get really worse doing this. I may or may not have double the OCD that I had when I started seeing trauma. This may or may not become so bad that they have to create a hospital just to help me all by myself. We try to just create stuff to deal with that. But also, I'm injecting one up in the OCD, I'm injecting some humor, how outlandish can we make these things? I try to have "fun" with it. Now I say "fun" in quotes because I know it's not necessarily fun when you're trying to do this, but we're trying to make this content that OCD is turning into a scary story. We're trying to make it into a weapon to use against the OCD and to make this into a game as much as we can. Kimberley: I love it. I'm so grateful for you coming on. Is there anything that you want the listeners to know as a final piece for this work that you're doing? Shala: Sure. I think that there are so many different ways to do exposure therapy. This is the way that I do it. It's not the only way, it's not necessarily the right way; it's just the way I do it and it's changed over the years. If we were to record this podcast in five years or 10 years, I probably will be doing something slightly different. If your therapist is doing something differently or you're doing something differently, it's totally fine. I think that finding ERP in a way that works for you, like finding how it works for you and what works best for you is the most important thing. It's not going to be the same for everybody. Everybody has a slightly different approach and that's okay. One thing that people with OCD can get stuck on, and I know this because I have OCD too, is we can be black and white and say there's one right way. Well, she does it this way and he does it that way and this is wrong and this is right. No, if you're doing ERP, there are all sorts of ways to do it, so don't let your OCD get into the, "Well, I don't think you're doing this right because you're not doing this, that, or the other." Just work with your therapist to find out what works best for you. If what I've described works well for you, great. And if it doesn't, you don't have to do it. These are just ideas. Being really kind and being really open to figuring out what works best for you and being very kind to yourself I think is most important. Kimberley: Amazing. Tell us where people can get more information about you. Tell us about your book. I know you've been on the podcast before, but tell us where they can get hold of you. Shala: Sure. They can get a hold of me on my website, ShalaNicely.com . I have a newsletter I send out once a month that they can sign up for called Shoulders Back! Tips & Resources for Taming OCD . In it, I feature blogs that I write or podcast episodes, other things that I'm doing. It's all free where I'm talking about tips and resources for taming OCD. I have two books: Everyday Mindfulness for OCD that I co-wrote with Jon Hershfield and Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life , which is my memoir. It is written somewhat like a suspense novel because as all of you know who have OCD, living with untreated OCD is a bit like living in a suspense novel. My OCD is actually a character in the book. It is the villain, so to speak. The whole book is about me trying to understand exactly what is this villain I'm working against. Then once I figure out what it is, well, how am I going to beat it? And then how am I going to live with it long term? Because it's not like you're going to kill the villain in this book. The OCD is going to be there. How do I learn to live in a world of uncertainty and be happy anyway, which is something that I stole from Jon Grayson years ago. I stole a lot from him. That's what the book is about. Kimberley: It's a beautiful book and it's so inspiring. It's a handbook as much as it is a memoir, so I'm so grateful that you wrote it. It's such a great resource for people with OCD and for family members I think who don't really get what it's like to be in the head of someone with OCD. A lot of my client's family members said how it was actually the first time it clicked for them of like, "Oh, I get it now. That's what they're going through." I just wanted to share that. Thank you so much for being on the show. I'm so grateful to have you on again. Shala: Thank you so much for having me. It was fun.

Jun 2, 2023

Welcome back, everybody. Thank you for joining me again this week. I'm actually really excited to dive into another topic that I really felt was important that we address. For those of you who are new, this actually might be a very steep learning curve because we are specifically talking about a treatment skill or a tool that we commonly use in CBT (Cognitive Behavioral Therapy) and even more specifically, Exposure and Response Prevention. And that is the use of imaginals or what we otherwise call scripts. Some people also use flooding. We are going to talk about this because there are a couple of reasons. Number one, for those of you who don't know, I have an online course called ERP School. In ERP School , it's for people with OCD , and we talk about how to really get an ERP plan for yourself. It's not therapy; it's a course that I created for those who don't have access to therapy or are not yet ready to dive into therapy, where they can really learn how to understand the cycle of OCD, how to get themselves out of it, and gives you a bunch of skills that you can go and try. Very commonly, we have questions about how to use imaginals and scripts, when to use them, how often to use them, when to stop using them, when they become compulsive and so forth. In addition to that, as many of you may not know, I have nine highly skilled licensed therapists who work for me in the state of California and Arizona, where we treat face-to-face clients. We're actually in Los Angeles. We treat patients with anxiety disorders. I also notice that during my supervision when I'm with my staff, they have questions about how to use imaginals and scripts with the specific clients. Instead of just teaching them and teaching my students, I thought this was another wonderful opportunity to help teach you as well how to use imaginals and why some people misuse imaginals or how they misuse it. I think even in the OCD community, there has been a little bit of a bad rap on using scripts and imaginals, and I have found using scripts and imaginals to be one of the most helpful tools for clients and give them really great success with their anxiety and uncertainty and their intrusive thoughts. Here we are today, it is again a start of another very short series. This is just a three-week series, talking about different ways we can approach imaginals and scripts and how you can use it to help manage your intrusive thoughts, and how you can use it to reduce your compulsions. It is going to be three weeks, as I said. Today, we are starting off with the amazing Krista Reed. She's been on the show before and she was actually the one who inspired this after we did the last episode together. She said, "I would love to talk more about imaginals and scripts." I was like, "Actually, I would too, and I actually would love to get some different perspectives." Today, we're talking with Krista Reed . Next week, we have the amazing Shala Nicely. You guys already know about Shala Nicely . I'm so happy to have her very individual approach, which I use all the time as well. And then finally, we have Dr. Jon Grayson coming in, talking about acceptance with imaginals and scripts. He does a lot of work with imaginals and scripts using acceptance, and I wanted to make sure we rounded it out with his perspective. One thing I want you to think about as we move into this series or three-part episode of the podcast is these are approaches that you should try and experiment with and take what you need. I have found that some scripts work really well with some clients and others don't work so well with other clients. I have found that some scripts do really well with one specific obsession, and that doesn't do a lot of impact on another obsession that they may have. I want you just to be curious and open and be ready to learn and take what works for you because I think all of these approaches are incredibly powerful. Again, in ERP School, we have specific training on how to do three different types of scripts. One is an uncertainty script, one is a worst-case scenario script, and the last is an acceptance script. If you're really wanting to learn a very structured way of doing these, head on over to CBTSchool.com and you can sign up for ERP School there. But I hope this gets you familiar with it and helps really answer any questions that you may have. Alright, let's get over to the show. Here is Krista Reed. Kimberley: Welcome back, Krista Reed. I am so happy to have you back on the show. Krista: Thank you. I am elated to be able to chat with you again. This is going to be great. Kimberley: Yeah. The cool thing is you are the inspiration for this series. Krista: Which is so flattering. Thank you. IMAGINAL OR SCRIPT? Kimberley: After our last episode, Krista and I were having a whole conversation and you were saying how much you love this topic. I was like, "Light bulb, this is what we need to do," because I think the beautiful piece of this is there are different ways in which you can do imaginals, and I wanted to have some people come on and just share how they're doing it. You can compare and contrast and see what works for you. That being said, number one, do you call it an imaginal, do you call it a script, do you think they're the same thing, or do you consider them different? Krista: I do consider them differently because when I think about script, I mean, just the word script is it's writing, it's handwriting in my opinion. I mean, scripture is spoken. That's something a little bit different, but scripting is writing. When I think of an imaginal, that is your imagination. I know that I already shared with you how much I love imaginals because in reality, humans communicate through stories. When we can, using our own imagination, create a story to combat something as challenging as OCD, what a powerful concept. That's exactly why I just simply love imaginals. Kimberley: I can feel it and I do too. There's such an important piece of ERP or OCD recovery or anxiety recovery where it fills in some gaps, right? Krista: Yes, because imaginals, the whole point, as we know, it's to imagine the feared object or situation. It could evoke distress, anxiety, disgust. Yet, by us telling those stories, we're poking the bear of OCD. We're getting to some of that nitty gritty. Of course, as we know that, not every obsession we can have a real-life or an in vivo exposure. We just simply can't because of the laws of science, or let's be real, it might be illegal. But imaginals are also nice for some people that the real-life exposure maybe is too intense and they need a little bit of a warmup or a buy-in to be able to do the in vivo exposure. Imaginal, man, I freaking love them. They're great. Kimberley: They're the bomb. Krista: They really are. HOW TO DO IMAGINALS FOR OCD Kimberley: You inspired this. You had said, "I love to walk your listeners through how to do them effectively. I think I remember you saying, but correct me if I'm wrong, that you had seen some people do them very incorrectly. That you were very passionate because of the fact that some people weren't being trained well in this. Is that true or did I get that wrong? Krista: No, you absolutely got it right. Correct and incorrect, I think maybe that is opinion. I'll say that in my way, I don't do it that way. That's a preference. But this is an inception. We're not putting stories into our clients' minds. The OCD is putting these stories into our clients' minds. If you already have a written-out idea of a script, of like fill in the blanks, you are working on some kind of inception, in my opinion. You are saying that this is how your story is supposed to be. That's so silly. I'm not going to tell you how your story is supposed to be. I don't know how your imagination works. When we think of just imagination, there's so many different levels of imagination. Let's say for instance, if I have somebody who comes into my office who is by trade a creative writer, that imaginal is probably going to be very descriptive, have a lot of heavy adjectives. Just the way it's going to be put together is going to be probably like an art in itself because this is what that person does. If you have somebody who comes in and creativity is not something that is part of a personality trait, and then I have a written fill-in-the-blank thing for them, it's not going to be authentic for their experience. They're going to potentially want to do what I, the therapist, might want them to do. It's not for me to decide how creative or how deep that person is to go. They need to recognize within themselves, is this the most challenging? Is this the best way that you could actually describe that situation? If that answer is yes, it's my job as a therapist to just say okay. Kimberley: How would one know if it's the most descriptive they could be? Is it by just listening to what OCD has to say and letting OCD write the story, but not in a compulsive way? Share with me your thoughts. Krista: I think that that's almost like a double-edged sword because that of itself can almost go meta. How do I know that my story is intense enough? Well, on the surface we can say, "Is it a hard thing to say." They might say yes, and then we can work through. But if I'm really assessing like, "Is it hard enough, is it hard enough," and almost begging for them to provide some type of self-reassurance, they might get stuck in that cycle of, is this good enough? Is this good enough? Can it be even more challenging? Another thing I love about imaginals is the limit doesn't exist, because the limit is just however far your imagination can take you. Let's say that I have a session with a client today and they're creating an imaginal. I'm just going to give a totally random obsession. Maybe their obsession is, "I am afraid that I'm going to murder my husband in his sleep," harm OCD type stuff, pretty common stuff that we do with imaginals. They do the imaginal and they're able in session to work through it. It sounds like it was good. In the session, what they provided was satisfactory to treatment. And then they come back and say, "I got bored with the story," which a lot of people think that that's a bad thing. That's actually a good thing because that's letting you know that you're not in OCD's control of that feared response and you're actually doing the work. However, they might still have the obsession. I was like, "Okay, so you were able to work through this habituate or get bored of that. Now, let's create another imaginal with this obsession." Because it's all imagination, the stories, you can create as many as you possibly can or as you possibly want to. I'm actually going to give you a quote. He's a current professor right now at Harvard. He is a professor of Cognitive and Educational Studies. If you look this guy up, his name is Dr. Howard Gardner—his work is brilliant. He has this fantastic quote that I think is just a bomb when it comes to imaginal stuff. His quote is: "Stories constitute the single most powerful weapon in a leader's arsenal." Think about that. What a powerful statement that is. Isn't that just fantastic? Because we can hear that as the stories OCD tells us as being hard. Okay, cool story, bro, that is your weapon OCD, but guess what? I'm smarter than you and I brought a way bigger gun and this gun isn't imaginal and I'm going to go ahead and one up you. If I come back that next week in my therapist's office and I'm able to get bored with that, I can make a bigger gun. Kimberley: I love that. It's true, isn't it? I often will say, "That's a good story. Let me show you what I've got." It is so powerful. Oh my gosh. Let's actually do it. Can you walk us through how you would do an imaginal? Krista: This is actually something that I created on my own taken from just multiple trainings and ERP learning about imaginals, because one of the things that I was realizing that a lot of clients were really struggling with is almost over-preparing just to do the imaginal. Sometimes they would write out the imaginal and then we would work through that. But what I was finding is sometimes clients were almost too fixated on words, reading it right, being perfect, that they were almost missing out on the fact that these are supposed to be movies in our mind. Kimberley: Yeah. They intellectualize it. Krista: Exactly. I created a super simple format. I mean, we really don't have a lot of setup here. It's basically along the lines of the Five Ws. What is your obsession and what is your compulsion? Who is going to be in your story? Who is involved? Where is your story taking place? When is your story taking place? And when is already one of those that's already set because I tell people we can't do anything in the past; the past has already existed. You really need to be as present as possible. But the thing is that you can also think. For instance, if my obsession is I'm going to murder my husband in his sleep tonight, part of that might be tonight, but part of that might also be, what is going to be my consequence? What is that bad thing that's going to happen? Because maybe the bad thing isn't necessarily right now. Maybe that bad thing is going to be I'm not going to have a relationship with my children and what if they have grandchildren? Or what if I'm going to go to hell? That might not necessarily exist in the here and now, but you're able to incorporate that in the story. When is an interesting thing, but again, never in the past, needs to start in the present, and then move forward. And then also, I ask how. How is where I want people to be as descriptive as possible. For instance, if I say, and this is going to sound gritty, you're fearful that you're going to murder your husband tonight. Be specific. How are you going to murder your husband? Because that's one of the things that OCD might want us to do. Maybe it is just hard enough to say, "I'm going to murder my husband." But again, we're packing an arsenal here. Do you want to just say that? Because I can almost guarantee you OCD is already telling you multiple different ways that it might happen. Which one of those seems like it might be the hardest? Well, the hardest one for me is smothering my husband with a pillow. Okay, that's going to be it. That's literally my setup. That's literally my setup, is I say that. Actually, I have one more thing that I have to include. I have all that as a setup and then I say, "Okay, at the very end, you are going to say this line, and it's, 'All of this happened because I did not do the compulsion.'" If I were going along with the story of I murdered my husband, I suffocated him with a pillow, and in my mind, the worst thing to happen is I don't have a relationship with my kids and grandchildren, and the compulsion might be to pray—I'll just throw that out—the last line might be, "And now, I don't have a relationship with my children or grandchildren all because I decided to not pray when the thought of murdering my husband came up in my mind." That is the entire setup. And then I have my clients get their phones out and push record. They don't have to do a video, just an audio is perfectly fine. I know some therapists that'll do it just once, but I actually do it over and over again. Sometimes it could be a five-minute recording, it could be a 20-minute recording, it could be a 40-minute recording. The reason for that being is if we stop just after one, we might be creating accommodation for that client, because I want my clients to be in that experience. That first time they tell that story after that very brief setup, they're still piecing together the story. Honestly, it's really not until about the third or fourth time that they've repeated that exact same story that they're really in it. I am just there and every time they finish—I'll know they finish because they say, "And this happened all because da da da da da"—I say, "Okay, what's your number?" That means what's your SUDS? And they tell me they're SUDS. I might make a little bit, very, very minimal recommendations. For instance, if they say, "I murdered my husband," I say, "Okay, so this time I want you to tell me how you murdered your husband." Again, they say the exact same story, closing their eyes all over again, this time adding in the little bit that I asked for. We do that over and over and over again until we reach 50% habituation. Then they stop recording. That is what they use throughout the week as their homework, and you can add it in so many different ways. Again, keeping along with this obsession of "I'm afraid I'm going to kill my husband tonight," I want you to listen to that with, as you probably have heard this as well, just one AirPod in, earbud, whatever, keep your other ear outside to the world. This is its way to talk back to OCD. Just something along the lines of that. I want you to the "while you're getting ready for bed." Because if the fear exists at night and your compulsions exist at night, I want you to listen to that story before you go to bed. It's already on your mind. You're already in it, you're already poking the bear of OCD . It's like, "Okay, OCD, you're going to tell me I'm going to kill my husband tonight? Well, I'm going to hear a story about me killing my husband tonight." Guess what? The bad thing's going to happen over and over and over again. It's such a powerful, powerful, powerful thing. Because it's recorded, you can literally listen to it in your car. You can listen to it on a plane. You can listen to it in a waiting room. I mean, there's no limit. Kimberley: It's funny because, for those of you who are on social media, there was this really big trend not long ago where they're like what they think I'm listening to versus what I'm actually listening to, and they have this audio of like, "And then she stabbed her with the knife." It's exactly that. Everyone thinks you're just listening to Britney Spears, but you're listening to your exposure and it's so effective. It's so, so effective. I love this. Okay, let's do it again because I want this to be as powerful as possible. You did a harm exposure. In other episodes, we've done a relationship one, we've done a pedophile one. Let's pick another one. Do you have any ideas? Krista: What about scrupulosity? Kimberley: I was just going to say, what about scrupulosity? Krista: That one is such a common one for imaginals. We hear it very frequently, "I'm going to go to hell," or even thinking about different other religions like, "Maybe I'm not going to be reincarnated into something that has meaning," or "It's going to be a bad thing. Maybe I'm insulting my ancestors," or just whatever that might be. Let's say the obsession is—I already mentioned praying—maybe if I don't read the Bible correctly, I'm going to go to hell. I don't know. Something along the lines of that. If that's their obsession, chances are, there's probably somebody that maybe they have a time where they're reading the Bible or maybe that we have to add in an in vivo where they're going to be reading or something like that. A setup could potentially be, what is your obsession? "I'm afraid that any time I read my Bible, I'm not reading it correctly and I'm going to go to hell." What is your compulsion? "Well, my compulsion is I read it over and over and over again and I reassure myself that I understand it, I'm reading it correctly." Who's going to be in your story? This one you might hear just, "Oh, it's just me." Really, OCD doesn't necessarily care too much if anybody else is in this story. Where are you? "I'm in my living room. It's nighttime. That's when I read my Bible." When is this taking place? "Oh, we can do it tonight." Let's say it's tonight. Interestingly enough, when you have stuff that's going to go to hell, that means, well, how are you getting to hell to begin with? Because that's not just something that can happen. Sometimes in these imaginals, the person has to die in order to get there, or they have to create some type of fantastical way of them getting to hell. I actually had a situation, this was several years ago, where the person was like, "Well, death doesn't scare me, but going to hell scares me," because, in some cultures and some religions, it's believed that there are demons living amongst us and so forth. "It's really scary to think about, what if a demon approaches me and takes me immediately to hell and I don't get to say goodbye to my family, my family doesn't know." Just even like that thought. We were able to incorporate something very similar to that. Just to make up an imaginal on the spot, it could be, I'm reading my Bible. I'm in my living room, I'm reading my Bible, and the thought pops up in my brain of, did you read that last verse correctly? I decide to just move on and not worry about reading my Bible correctly. Well then, all of a sudden, I get a knock at the door and there's these strange men that I've never seen in my life, and they tell me that they're all demons, and that because I didn't review the Bible correctly, I'm going to go to hell. I would go on and on and probably describe a little bit more about my family not missing me, I don't get to see my kids grow up, I don't get to experience life, the travel, and the stuff that's really important to me, incorporate some of those values. I don't get to live my value-based life. And then at the very end, I was summoned and taken to hell by demons, all because I had the thought of reading my bible correctly and I decided not to." Kimberley: I love it, and I love what I will point out. I think you use the same model as me. We use a lot of "I" statements like "I did this and I did that, and then this happened and then I died," and so forth. The other thing that we do is always have it in present tense. Instead of going, "And then this happens, and then that happens," you're saying as if it's happening. Krista: Yeah. Because you want it to feel real to the person. In all honesty, and I wonder what your experience has been, I find some of the most difficult people to do imaginals with our children. Even though you would think, "Oh, they're so imaginative anyways," one of the biggest things I really have to remind kids is, I want you to be literally imagining yourself in that moment. Again, I see this with kids more than adults, but I think it just depends on context and perspective. We'll say, "Well, I know that I'm in my living room," or "I know that I'm in your office, so this isn't actually happening to me in this moment." You almost have to really work them up and figure out, what's the barrier here? What are you resisting? Kimberley: That's a good question. I would say 10 to 20% of clients of mine will report, "I don't feel anything." I'll do a Q and A at the end of this series with common questions, but I'm curious to know what your response is to a client who reads like, "I kill my baby," or "I hurt my mom," or "I go to hell," or "I cheat on my husband," or whatever it is, but it doesn't land. What are your thoughts on what to do then? Krista: A couple of things pop up. One, it makes me wonder what mental compulsions they're doing. And then it also makes me wonder, are we going in the right direction with the story? Because again, like I mentioned before, if a client comes back and they've habituated to one thing, but they're still having the obsession, well, guess what? We're just telling stories. Because the OCD narrative is typically not just laser-focused—I mean, it can be laser-focused, but usually, it has branches—you can pick and choose. I'm going to go ahead and guarantee, that person who is terrified of killing their husband ensure they're not going to see their grandchildren and children. I'm going to go ahead and waiver that there's probably other things that they're afraid of missing. Kimberley: Yes. That's what I find too, is maybe we haven't gotten to the actual consequence that bothers them. I know when I've written these for myself, we tend to fall into normal traps of subtypes, like the fear that you'll harm somebody or so forth. But often clients will reveal like, "I'm actually not so afraid that I'll harm somebody. I'm really afraid of what my colleagues and family would think of me if I did." So, we have to include that. Or "I'm afraid of having to make the call to my mom if I did the one thing." I think that that's a really important piece to it, is to really double down on the consequence. Do you agree? Krista: Oh, I agree a hundred percent. You got to figure out what is that core fear. What are you really, really trying to avoid? With harming somebody, is it the consequences that might happen afterwards? Is it the feeling of potentially snapping or losing control? Or is it just knowing that you just flat out, took the life of somebody and that that was something that you were capable of? I mean, there's so many different themes, looking at what does that feared self like, what does that look like, and maybe we didn't hit it last time. Kimberley: Right. Krista: I know this is going to sound silly and I tell my clients this every once in a while, is I'm not a mind reader. What I'm asking you, is that the most challenging you can go and you're telling me yes, I'm going to trust you. I tell them, if you are not pushing yourself in therapy to where you can grow, I'm still going to go to bed home and sleep tonight just fine. But I want you to also go home and go to bed and sleep just fine. But if you are not pushing yourself, because we know sleep gets affected super bad, not just sleep, but other areas, you're probably going to struggle and you might even come back next week with a little bit more guilt or even some shame. I don't want anybody to have that. I want people to win. I want people to do well in this. I know this stuff is scary, but I'm going to quote somebody. You might know her. Her name is Kimberley Quinlan. She says, "It's a beautiful day to do hard things." I like to quote her in my practice every once in a while. Kimberley: I love her. Yes, I agree with this. The way you explained it is so beautiful and it's logical the way you're explaining it too. It makes sense. I have one more question for you. Recently, I was doing some imaginals with a client and they were very embarrassed about the content of their thoughts. Ashamed and guilty, and horrified by their thoughts. I could see that they were having a hard time, so I gave them a little inch and I went first. I was like, "Alright, I'm going to make an assumption about what yours is just to break the ice." They were like, "Oh yeah, that's exactly what it is." There was a relief on their face in that I had covered the bases. We did all of the imaginal and we recorded it and it was all set. And then at the end I said, "Is there anything that we didn't include?" They reported, "Yeah, my OCD actually uses much more graphic words than what you use." I think what was so interesting to me in that moment was, okay, I did them the favor by starting the conversation, but I think they felt that that's as far as we could go. How far do you go? Krista: As far as we need. Kimberley: Tell me what that means. Krista: Like I mentioned before, the limit does not exist and I mean, the limit does not exist. This is going to sound so silly. I want you to be like a young Stephen King before he wrote his first novel and push it. Push it and then go there. Guess what? If that novel just doesn't quite hit it, write another one, and then another one, and let's see how far you can go. Because OCD is essentially a disorder of the imagination, and you get to take back your imagination by creating the stories that OCD is telling us and twisting it. I mean, what an amazing and powerful thing to be able to do. I'm sure you're the same in that you know that there's a lot of specialists that don't believe in imaginals, don't like imaginals, especially when it comes to issues with pedophilia OCD . I think we also need to not remind our clients because that would be reassurance, but to tell these specialists, we're not putting anything into our client's heads that aren't there to begin with. Just like you said, if your client is thinking like real sick, nasty core, whatever, guess what? We're going to be going there. Are you cutting off the heads of babies in your head? Well, we're going to be talking about stories where you're cutting off the heads of babies. If that's what's going on, we're going to go there. Kimberley: What's really interesting, and this was the example, is we were talking about genitals and sexual organs and so forth. We're using the politically correct term for them in the imaginal. Great. Such a great exposure. Vagina and penis, great. Until again, they were like, "But my OCD uses much more graphic words for them." I'm like, "Well, we need to include those words." Would you agree your imaginals don't need to be PC? Krista: I hope my clients watch this, and matter of fact, I'm going to send this to them, just to be like, no, no. Krista's imaginals with her clients. Well, not my imaginals. Imaginals that are with my clients. Woah, sometimes I'm saying bye to my client. I'm like, "I think I need a shower." Kimberley: Again, when people say they don't like imaginals or they think that it's not a good practice, I feel like, like you said, if OCD is going to come up with it, it gives an opportunity to empower them, to get ahead of the game, to go there before it gets there so that you can go, "Okay, I can handle it." I would often say to my clients, "Let's go as far as we can go, as far as you can go, so that you know that there's nothing it can come up with that you can't handle." Krista: I think that where it gets even more complex is when we're hitting some of the taboo stuff. Not only pedophilia, but something like right now that I'm seeing a lot more of in my office is stuff relating to cancel culture. This fear that what if I don't use somebody's pronouns correctly? What if I accidentally say an inappropriate racial slur? I will ask in session and I'll be super real. It's hard for me to hear this stuff because this goes outside of my values. Of course, it goes outside of their values. OCD knows that. That's why it's messing with them. I'll say, "Okay, so what is the racial slur?" My clients are always like, "You really want me to say it?" I said, "We're going to say it in the imaginal." I realized how hard that is to stomach for therapists. But in my brain, the narrative that OCD is pushing, whether it is what society views as OCD or taboo OCD, it doesn't matter. We still have to get it out. It is still hard for that client. If that's hard for that client to think of an imaginal or a racial slur, it is almost the exact same amount of distress for somebody maybe with an imaginal that I'm afraid I'm getting food poisoning. We, as clinicians, just because we're very caring and loving people, sometimes we can unintentionally put a hierarchy of distress upon our clients like, okay, I can do this imaginal because this falls with my values, but I don't know if I can do this imaginal because pedophilia is something that's hard for me to do and I don't want to put my client through that. Well, guess what? Your client is already being put through that, whether you like it or not. It's called OCD. Kimberley: Right. Suppressing it makes it come on stronger anyway. Love that. I think that the beauty of that is there is a respectful value-based way of doing this work, but still getting ahead of OCD. Is that what you're saying? Krista: Absolutely. OCD tries to mess with us and think, what if you could be this person? Well, like I mentioned before, if a story is like a weapon, well, I'm going to tell a story to attack OCD because it's already doing it to me. Kimberley: Yeah. Tell us where people can hear more from you, get your resources because this is such great stuff. Krista: Thank you. I'd say probably the best way to find me and my silly videos would be on my Instagram @anxiouslybalance. Kimberley: Amazing. And your private practice? Krista: My private practice, it's A Peaceful Balance in Wichita, Kansas. The website is apbwichita.com. Kimberley: Thank you so much. I'm very grateful for you for inspiring this whole series and for also being here as a big piece of the puzzle. Krista: Thank you. I'm grateful for you that you don't mind me just like this. I'm grateful for you for letting me talk even though clearly, I'm not very good at it right now. You're amazing. Kimberley: No, you're amazing. Thank you. Really, these are hard topics. Just the fact that you can talk about it with such respect and grace and compassion and education and experience is gold. Krista: Thank you. At the end of the day, I really truly want people to get better. I know you truly want people to get better. Isn't that just the goal? Kimberley: Yeah. It's beautiful. Krista: Thank you.

May 26, 2023

Welcome back, everybody. Today, we are going to have a discussion, and yes, I understand that I am here recording on my own in my room by myself, so it's not really a discussion. But I wanted to give you an inside look into a discussion I had, and include you hopefully, on Instagram about a post I made about being busy. Now, let me tell you a little bit of the backstory here. What we're really looking at here is, is being busy a compulsion or an effective behavior? Here's the backstory. I am an anxious person. Nice to meet you. Everybody knows it, I'm an anxious person. That's what my natural default is. I have all the tools and practice using all the tools and continue to work on this as a process in my life. Not an end goal, but just a process that I'm always on, and I do feel like I handle it really, really well. In the grand scheme of things, of course, everyone makes mistakes and recovery is an up-and-down climb. We all know that. But one thing I have found over and over and over and over again is my inclination to rely on busyness to manage my anxiety. The reason I tell you this over and over is it's a default to me. When I'm struggling with anything, I tend to busy myself. Even when I had the beginning of an eating disorder, that quickly became a compulsive exercise activity because trying to manage my eating disorder created a lot of anxiety, and one way I could avoid that anxiety and check the eating disorder box was to exercise, move my body. Even though I fully recovered from that, and even though I consider myself to be doing really well mentally overall, I still catch myself relying on work and busyness as a compulsion, as a safety behavior to reduce or remove or avoid my anxiety. I made a post on this and it had overwhelming positive responses. Meaning, I agree, there was a lot of like, "Oh, I feel called out or hashtag truth." A lot of people were resonating with this idea that being busy can be a very sneaky compulsion that we do to run away from fear or uncertainty or discomfort or sadness and so forth. But then some of my followers, my wonderful followers came in hot—when I say "hot," like really well—with this beautiful perspective on this topic and I really feel like it was valid and important for us to discuss here today. Let's talk about that, because I love a good discussion and I love seeing it from both sides. I love getting into the nitty gritty and determining what is what. Let's talk about me just because it's easy for me to use an example. Let's say I have a thought or a feeling of anxiety. Something is bothering me. I'm having anticipatory anxiety or uncertainty about something. My brain wants to solve it, but because I have all these mindfulness tools and CBT tools, I know there's no point in me trying to solve it. I know there's no point in me ruminating on it. I'm not going to change it or figure it out. I have that awareness, so I go, "Okay, now I'm going to get back to life," which is a really wonderful tool. But what I find that I do is I don't just get back to life. I, with a sense of urgency, will start typing, cleaning, folding laundry, whatever it is, even reading. I will notice this shift in me to do it fast, to do it urgently, to try and get the discomfort to be masked, to be reduced. And then, of course, I want to share with you, what I then do is when I catch that is I go, "Okay." I feel the rev inside me and then I ease up on it. I pump the brakes and I try to return back to that activity without that urgency, without that resistance to the anxiety, or without that hustle mentality. But it is a default that I go to that often I don't catch until later on down the track. It's usually until I start to feel a little dizzy, I feel a little lost, a little bit overwhelmed. And then I'm like, "Oh, okay, I'm overusing busyness to manage my anxiety." The perspective that I loved was people saying, and one in particular said, "I want us to be really careful around that message because I think that some people can hear this idea that being busy is a compulsion and then start to question their own normal busyness throughout the day." I'll use the exact terms because I thought it was so beautifully said. They said, "You have to be pretty careful with how you explain this to some people with OCD because we're told to lean into our values or live a 'value-based' life, and that does require us to be busy," and I wholeheartedly agree. I think that's where I'm coming from. I want to offer to you guys that I want you to just check in and see if you're using busyness, this urgent, rushing movement, or frantic experience in your body to avoid discomfort. And if so, that's good to know. Let's not judge that. Let's not beat you up. Let's not be unkind. Let's just acknowledge that that is a normal response to having anxiety. In fact, it's a big part of what's kept us alive for all these years. That's true. And we can return back. Once we catch that we're doing those behaviors, we can return back to staying effective in our skills. But I don't want you guys to worry that you are overusing busyness. I think that the discussion I had online was to say, isn't this a wonderful opportunity for us to see how anxiety or OCD or any anxiety disorder can make a really healthy behavior into a compulsive behavior? You might flip between the two, it mightn't be all or nothing. An example of that might be prayer. Prayer is a beautiful practice for those who are spiritual. However, we can sometimes overuse prayer in a compulsive manner in this urgent, frantic, trying to get anxiety to go away manner, and then it's being misused. There may be sometimes you use prayer in this beautiful non-compulsive way and there'll be other times when you're absolutely using it as a safety behavior. Same goes for cleaning, same goes for thinking through your problems. There will be times when thinking through problems and solutions is a very effective behavior. However, there will be other times if you're doing it with a sense of urgency to make the discomfort go away or you're doing it to try and figure out something that you know you won't figure out because there's really no solution to it—that's something for us to keep an eye out for. There are so many ways in which this can get blurred. Asking for help and reassurance. It's not a problem to go to your loved ones and say, "I have this really huge presentation at work, would you let me rehearse it to you and you can give me feedback?" That's an effective behavior. However, if we are doing that repetitively and we are doing it coming from this desperate place of urgency to get certainty and removal of discomfort, that's how we may determine whether the behavior is a safety behavior that we want to start to reduce. I want to just offer this to you. If we're being honest, this episode isn't really about just the busyness. It's being able to, again, for yourself, determine are the behaviors you're doing being done because they line up with your values? Are they being done with a degree of willingness to also bring anxiety with you? I think that's a huge piece of the work that I have to catch, which is, okay, I'm rushing, I'm hustling, I'm engaging in busyness just for the sake of trying to get rid of that discomfort. Can I pause and return back to that behavior? Because it might be a behavior or an activity I need to get done. But can I do it with an increased sense of willingness to bring anxiety along for the ride? Can I do it with a sense where I'm not trying to train my brain that anxiety is bad? Can I just say, "Yeah, it's cool. Anxiety is here, let's bring it along"? I want to, again, reinforce to you guys, it's okay that you haven't figured this out because it's probably ever-changing. There will be times when you are engaging in compulsive busyness and there'll be other many times in which you're not. What I would encourage you to do is not to spend too much time trying to figure out which is which, because that can become a compulsion as well. A lot of this is just accepting that nothing is perfect and just moving one step at a time moving forward as you can kindly and compassionately. The only other thing I want to address here is this idea of a good distraction and a bad distraction. I think that this has been an argument or a complex discussion in the anxiety field for a long time. When I first was trained as an anxiety specialist, there were all these articles that talked about bad distraction, that distraction is bad and we shouldn't do it, and we should just have our anxiety and let it be there and then focus on it and so forth. I actually don't agree with that. In fact, I would go as far as to say, a real mindful practice would be taking the judgment out of destruction in general and saying that distraction is neither good nor bad. What distraction is, is up to you to decide whether it's helping you and is helpful behavior that brings you closer to your recovery goals or not. I don't want you to spend too much time trying to figure it out either, again, because I think it gets us caught in this mental loop of, am I doing recovery right? Am I doing my treatment right? Am I using the skills perfectly? I think when we get to that point, we're too far in the weeds and we have to pause and let it be imperfect and let it be uncertain and do our best not to try and solve that one, because often how would we know? There isn't actually an answer to what's bad and what's good. I wouldn't encourage you to place good and bad labels on those kinds of things because that usually will just keep you in a loop of anxiety anyway. That's just a few ideas on this idea of being overly busy being a compulsion. I really want to make sure I say one more time. I think there is absolutely an opportunity for us to consider that busyness is also neither good nor bad. It just is, and that you for yourself can determine whether it's helpful for you to stay busy or not. What I will say—and I will use this as an example, I think I actually did a podcast episode on this—not long ago, my parents were voyaging across the Drake Passage, which is a very dangerous body of water that takes you from South America to Antarctica. It's usually very, very calm or it can be incredibly dangerous to pass the Drake Passage. For the 18 hours that they were passing that, I engaged in a lot of busyness. I would say it wasn't compulsive either. It was, I knew they were doing something scary. I knew that it would be probably fine, but it was still uncertain. I knew that there was nothing I would do to make my anxiety go down during that 18 hours. I knew I probably wouldn't get a good sleep because I love them dearly and I want them to have a safe trip. I just said to myself, "I'm going to mindfully go from one activity to another. Because I don't want to engage in a bunch of mental rumination, I'm just going to gently stay busy." I think that's fine. I think that that is effective. In fact, I was very proud of how I handled that. I was able to resist the urge to text them at two in the morning and be like, "Take a photo of the waves. I want to see that you're okay." You know what I mean? I want to just offer to you that to check in whether your busyness is compulsive, be gentle with yourself either way to discuss with your mental health provider on what is a great way for you to engage in this kind of behaviors and for you to come up with your own protocol on how to determine when you've crossed over from being busy into compulsive busyness. That's it. I think that from there, you can be gentle with yourself and practice being uncertain about what's right and wrong. I hope that was helpful. I'm very much just chatting to you. I didn't do a whole ton of prep for this. I just wanted to include you in the conversation on "Is being overly busy a compulsion?" I wanted to give you some ideas and things to look out for and I hope that it helps you move forward towards the recovery that you're looking for. Have a wonderful, wonderful day. If you guys want additional resources from me, you can head over to CBTSchool.com . We have all kinds of online options there for you. If you're looking for one-on-one therapy, if you live in the state of California or Arizona, you can go to www.kimberleyquinlan-lmft.com and I look forward to chatting with you next week.

May 19, 2023

Hello and welcome back, everybody. We have an amazing guest today. This is actually somebody I have followed, sort of half known for a long time through a very, very close friend, Shala Nicely, who's been on the show quite a few times, and she connected me with Dr. Ashley Smith. Today, we are talking about happiness and what makes a "good life" regardless of anxiety or of challenges you may be going through. Dr. Ashley Smith is a Licensed Clinical Psychologist. She's the co-founder of Peak Mind , which is The Center for Psychological Strength. She's a speaker, author, and entrepreneur. She has her own TED Talk , which I think really shows how epic and skilled she is. Today, we talk about how to be happy. What is happiness? How do you get there? Is it even attainable? What is the definition of happiness? Do we actually want it or is it the goal or is it not the goal? I think that this is an episode I needed to hear so much. In fact, since hearing this episode as we recorded it, I basically changed quite a few things. I will be honest with you, I didn't actually change things related to me, but I changed things in relation to how I parented my children. I realized midway through this episode that I was pushing them into the hamster wheel of life. Ashley really helped me to acknowledge and understand that it's not about success, it's not about winning things, it's not about achievement so much, while they are very important. She talks about these specific things that science and research have shown to actually improve happiness. I'm going to leave it at that. I'm going to go right over to the show. Thank you, Dr. Ashley Smith , for coming on. For those who want to know more about her, click the links in the show notes, and I cannot wait to listen back to this with you all. Have a great day, everybody. Kimberley: Welcome, Dr. Ashley Smith. I'm so happy to have you here. Dr. Ashley: I am excited to be here today. I've wanted to be on your podcast for years, so thank you for this. Kimberley: Same. Actually, we have joint friends and it's so good when you meet people through people that you trust. I have actually followed you for a very long time. I'm very excited to have you on, particularly talking about what we're talking about. It's a topic we probably should visit more regularly here on the show. We had discussed the idea of happiness and what makes a good life. Can you give me a brief understanding of what that means or what your idea about that is? Dr. Ashley: Yeah. Oh, this is a topic that I love to talk about. When I think about it, I have a little bit of a soapbox, which is that I think our approach to mental health is broken. I say that as someone who is a mental health practitioner, and I really love my job and I love working with people and helping. But what I mean by that is our traditional approach has been, "Let's reduce symptoms. Let's correct the stuff that's 'wrong' with someone." When it comes to anxiety or depression, it's how do we reduce that? And that's great. Those are really important skills, but we've got this whole other side that I think we need to be focusing on. And that is the question of how do we get more of the good stuff. More happiness, more well-being. How do we create lives that are worth living? That's not the same as how do we get rid or reduce anxiety and depression. In the field of psychology, there's this branch of it called Positive Psychology. I stumbled on that 20 years ago as a grad student and thought, "This is amazing. People are actually studying happiness. There's a science to this." I looked at happiness and optimism and social anxiety and depression and how those were all connected. Fast forward, 15 years or so, I really hit a point with my professional life and my personal life where I was recognizing, "Wait a minute, I need more. I need more as an individual. The clients I work with need more. How do we get more of this good stuff?" This is the longest preamble to say, I did a deep dive into the science of happiness and learned a lot over the years, and I want to be really clear about a couple of things. When we talk about happiness, a lot of people think pleasure. "I want good experiences, I want to enjoy this." That's a part of it, this positive emotion that we all call happiness or joy. But that's only a piece of it. There's actually this whole backfiring process that can happen when we chase that. If I'm just chasing the next pleasant event, what that actually does is set me up to not have a happy life. Think about it. I mean, I love chocolate, and if I eat that unchecked because it brings me pleasure, at some point, it's going to take a toll on my health. What does that actually do to my well-being and happiness? What was really interesting getting into this area was, it's not just this transient state of pleasure or enjoyment, but they're the other factors that contribute to a good life. It's things like relationships. It's things like meaning and purpose. It's engagement. It's achievement even. It's these things that are not always pleasant in the moment, but that really contribute to this sense of satisfaction with life or contentment with life. I think it's really important that we need to be looking at what are the ingredients that really make a good life. WHAT IS CONSIDERED A GOOD LIFE? Kimberley: I love this, and I love a good recipe too. I like following recipes and ingredients. It's funny, I'm actually in the process of getting good at cooking and I'm realizing for the first time in my life that following instructions and ingredients is actually a really important thing, because I'm not that person. First of all, what is a good life? When I looked at that, I actually put it in quote marks. What is a good life? What do you think? You explained it; it's not chasing pleasure. We know that doesn't work, otherwise, you just buy a bunch of stuff you don't want and behave in ways that aren't helpful. Not to also villainize pleasure, it's a great thing, but what would you describe as a good life? Dr. Ashley: On the one hand, it's the million-dollar question. Philosophers and scientists and religious leaders and all kinds of people have been trying to answer that question for eons. I don't know that I have it nailed down. I think I'm humble enough to say I have my own ideas about it. To me, what makes a good life, it's really when the way we spend our time lines up with what's important to us, when we're living in accordance with our values to use some psych buzzwords, but when we're doing the things that really matter. I think also part of a good life is having daily rhythms and lifestyle habits that support us as biological creatures. I want to contrast that with the demands of modern life, which are that we should be productive 24/7, that we should be multitasking. People sacrifice sleep and movement and leisure time and stillness. I think all of that compromises us. It impacts us on a neurological level. Our brains are part of our system. If we're not taking care of our system, they're not going to function optimally. That gets in the way of a good life. When we're sacrificing relationships, when I look at all of the research, when I look at my own experience, a huge component of a good life is having quality relationships. Not quantity, quality. Trusting ones that are full of belonging and acceptance that are two-way support streets, those are really important. I think a lot of times, modern life compromises that. We get pulled in all of these other directions. Kimberley: Yeah. Oh my gosh, there's so many things. I also think that anxiety and depression pull us away from those things too. You are anxious or you're depressed and so, therefore, you don't go to the party or the family event or the church service. That's an interesting idea. I love this. Tell us about this idea of meaning. How do we find meaning? I'll just share with you a little bit of my own personal experience. I remember when I was actually going through a very difficult time with my chronic illness and I know I was depressed at the time. It was the first time in my life where I started to have thoughts like, "What's the point?" Not that I was saying I was suicidal, but I was more like, "I just don't understand why am I doing all this." I think that that's common. What are your thoughts on this idea of the meaning behind in life? Dr. Ashley: That's a fantastic question. I have a vision impairment, so I'm legally blind. It's a really rare thing and it's unpredictable. I don't know how much sight I will lose. Ultimately, the doctors can't tell me there's no treatment options. It's just I go along and every so often, there's a shift and I see less. For me, I hit that same point you were talking about back in 2014 when I had to stop driving. I was anxious and I would say depressed and really wallowing in this, "What does this mean for my life? I can't be independent. People aren't going to associate with me personally or professionally when they see this flaw." It was a dark point. For me, that's when I went back to the science of happiness when I finally got tired of being stuck and I realized my anxiety skills and my depression skills. They're helpful and I practice what I preach, but it wasn't enough. And that's really what propelled me back into this science of happiness where I figured, you know what, someone has to have done this. I did come across this theory of well-being called the PERMA factors. These are like the ingredients that we need. I'm getting back to that because the M in this is meaning. With this, the PERMA factors, P is positive emotion. That's the pleasure, the joy, the happiness. Cool. I know some strategies for boosting that. E is engagement. Are you really involved and engaged in what you're doing? Are you present? Are you hitting that state of flow? R is the relationships, A (skipping ahead) is achievement, but M is this meaning, and it's a hard one to figure out. I remember then, this started what I was calling my blind quest for happiness where I started to think about, what do I need to do? How do I experiment? How do I live a happy life despite these cards I've been dealt? We don't get to choose them. You've got a chronic illness, I have a vision impairment, listeners have anxiety and depression, and we get these cards. I think of it like if life is a poker game, we don't get to choose the cards we're dealt, but by golly, we get to choose how to play them, and that's important. I think a lot of times people can turn adversity into meaning. For me, I'm now at a point where it's not that I don't care about my vision, it's just I really accepted it. It is what it is, it's going to do what it's going to do, and I'm focusing on the things I can control. That has given me a sense of meaning. I want to help other people live better lives. I want to help other people crack the code of how our brains work against us and how do we play our cards well. If we go to all of this, "meaning" is really just finding something that's bigger than you are, finding something to pursue or contribute to that's bigger than you. I think when we look at anxiety and depression, the nature of those experiences is that they make us very self-involved. I mean, people with anxiety and depression, in my experience, have giant hearts, tons of empathy, but it locks our thinking into our experience and what's going on in these unhelpful thoughts. When we can connect with something bigger than us, it gets us outside of that. If I go back to grad school, writing my dissertation was decidedly not a fun experience. Would I do it again? Yes. Because it was worth it on this path to my reason for being—helping people live better lives. Sometimes I think when we have this meaning, this purpose, this greater good, it helps us endure the things that I want to say suck. Kimberley: You can say suck. Dr. Ashley: Yeah. That's where it's not just about how do I get rid of anxiety or depression. Sometimes we can't. Chronic health conditions, anxiety is chronic. My vision is chronic. I'm not getting rid of this, but how do I live a good life despite that? I think there are a ton of examples throughout history and currently of people doing amazing things despite some hardship. Kimberley: Yeah. I love this idea. It's funny, you talk about being outside yourself. When I'm having a bad day, I usually go, there's like a 10 minutes' drive from us that looks over Los Angeles. If let's say I'm having a day where I'm in my head only looking at my problems, and then I see LA, I'm like, "Oh honey, there is a whole world out there that you haven't thought about." I'm not saying that in a critical way, just like it gives me perspective. Dr. Ashley: I think that's so important, to realize there's so much more. When it does shrink our problems, all of a sudden, it's manageable. Kimberley: Right. Let's talk about just one more question about meaning. I'm guessing more about people finding what's your why and so forth. What would you encourage for people who are very unhappy, have been chasing this idea of reducing anxiety, reducing depression, chasing pleasure, and feeling very stuck between those? Let's say I really have no idea what my meaning is. What would be your advice to start that process? Dr. Ashley: Experimentation. I think experimenting is a lifestyle that I wish everyone would adopt, because what happens is we want to think. We are thinkers. That's what our minds were designed to do. That's awesome and sometimes it's really helpful, but I don't think we're going to think our way into passion or meaning or a good life. I think we have to start trying things. What will happen, if you notice, is your mind is going to have a lot of commentary. It's going to say, "That's dumb. That's not going to work. Who are you to try that? You can't do that." It's all just noise that if we look at what is it doing, it's keeping you stuck. With the experimentation, I'm just a big fan of go try it. Whether you think it's going to work or not, you don't know. We want to trust our experience, not what our mind tells us. Trust your actual experience. For me, I remember getting my first self-help book. It was actually called Go Find Your Passion and Purpose . Because I was at this crossroads, I had been doing anxiety work for a long time, had plateaued, and was feeling a little bored, and that coincided with the stopping driving. My whole personal world was just in disarray and I was like, "I'm going to go hike part of the Appalachian Trail while I can. While I do that, I'm going to find my purpose in life." I did not find it, but it was an experiment. I go and I get this experience and I can say, "Okay, I'm not going to be someone who does a six-month hike. I made it four days. Awesome." But go and experiment with things. I never thought that I would really want to write and I started a blog, and that has turned out to be such a positive experience. Prior to that, my writing experience had been very academic where it was a chore. Now, this is something I really enjoy, or talking to people. I would say experiment and continue to seek out those new experiences. One, seeking out new experiences helps on the anxiety side because you're continually putting yourself into uncertain and new, so your confidence level is going to grow, your tolerance for not knowing grows, and your tolerance for awkward grows. That's my plug for go try new things, period. Somewhere along the way, you're going to find something that sparks an interest or that sparks this sense of, "Yeah, this is me." Notice that. I know you talk a lot about mindfulness, we need to notice what was my actual experience, not what did my head tell me. What did I actually feel? And keep experimenting until you find something. I think that's really the key. Kimberley: I love that you said your tolerance for awkwardness. I think that is a big piece of the work because it is a big piece. We talk about tolerating discomfort, tolerating uncertainty, but I think that's a very key point, especially when it comes to relationships, which I know is one of the factors. Tolerate the awkwardness is key. Dr. Ashley: Yeah. I think it's huge. I've been seeking out new experiences since 2017. This is going to be my New Year's resolution. It was such a transformational experience over the course of the year that I've just continued it, and I'm trying to get everybody to join me because it's such an expansive practice. I think it's great for anxiety and depression, it's great for humans, it's been great for me on this quest for a good life. But with this, it means I have put myself into some awkward situations on purpose. Sometimes I know going into it, sometimes I don't. I went to this one, it was called Nia. I practice yoga. That's cool. That's very much in my comfort zone. This was yoga adjacent, but it was also an interpretive dance with sound effects. You had to make eye contact with people and dance in these weird ways. I distinctly remember having this conversation with myself when I showed up, "What did you just get yourself into?" And then it was immediately, "Okay, you have two choices here. You can grit your teeth and hate the next hour, or you can embrace the awkward and dance at a three. Because she said, you can dance at a one, itty bitty, at a two or at a three and really go for it." That for me was my, "All right, let's just do this." I embrace the awkward, and that was a turning point. That was amazing. And then now, when I think about good life, I feel like so many doors are opened because I'm not afraid of, "This is going to be awkward." It's going to be and you're going to be okay or it's going to make a hilarious story. I said, "Go for it." Kimberley: You're here to tell the story. I love it. You didn't die from awkwardness. Dr. Ashley: No. Kimberley: Can you tell me about the P? Can you go through them and just give us a little bit more information? Because I think that's really important. Dr. Ashley: Yeah. I love this theory because you can think about it as like, how are my PERMA factors doing? When you're low, raise them. You know that those are the ingredients for a good life. The P is positive emotion. That is, we do need to spend time in positive emotional states. The more time we're in the positive emotional states, the better compared to the negative ones like anxiety or sadness, or anger. Now that said, we know if we try to only pursue pleasure, it's going to backfire. If I'm trying to avoid anxiety, I'm actually going to get more anxiety. But this is where behavioral activation comes in. Do things that are theoretically enjoyable and see if it puts you in a positive state. Again, theoretically enjoyable, because if you're in the throes of depression, nothing feels enjoyable, do it anyways. And then notice, did it bring on a pleasurable emotional state? Cool. We want to do those things. E is engagement. This is when people talk about finding flow or being in the zone. These are the activities that you're fully engaged in it. Self-consciousness goes away. You lose track of time because you're just in it. We know that the more consistently we are able to put ourselves in states of flow, the higher our well-being tends to be. Athletes will talk about this a lot. When they're on the field, they're in the zone. Musicians, artists. But there are other ways to do this. This is a place for me personally, I didn't know. I was like, "Well, okay, great. I need E, I need engagement. What puts me in a state of flow?" It took experimentation and noticing. For me, writing does it. Web design, I'm not techy, but when I start to do design projects, I get in that state of flow. It has to be this perfect apex, this perfect joining of skill and pleasure, like enjoyment. If it's too easy, you will not go into a state of flow. That's just the P. If it's too hard, we go into a state of stress or anxiety, so that's not flow. We have to be right on the cusp of our skillset. It's hard work, but we're into it. That's the E. R is relationships. We need quality relationships where we are being open, where we are being vulnerable, we're really connecting with other people. That is huge. I mean, if we look at what's the best predictor of life satisfaction, it's quality relationships. This also is doing things for other people. Altruism, ugh, I love this side note. The act of kindness thing hits on three different factors. It feels good to do something good for other people. If you want a mood boost, go do an act of kindness. That reliably boosts our mood. It also improves relationships and it can tap into that meaning. I love that as just a practice. The M we talked about, that's meaning. And then the A, that's achievement for achievement's sake. As humans, it feels good to conquer goals. It feels good to accomplish things. And that contributes to our well-being independently of the positive feelings that we get from it, or the meaning in the relationships or the engagement. I'm also a really big fan of set goals and then crush them. It can be silly little things like, I'm going to hold my breath for two minutes. Okay, cool. That's a silly little thing, but then it feels good to do it. Or it could be something huge like crossing those bucket list things off your list. Kimberley: You know what's funny around achievement? I've got a couple of questions, but first I want to tell you your stories. Last year, I was struggling to do a couple of things that were really important to me for my medical health. I found an app called Streaks. Have you heard of Streaks? It's a $5 app. But when you do the action, and for me it was taking my medicine, it does this little spiral and then it's like, "You've done this for three days in a row." And then tomorrow you click it and then it says, "You've done it for four days in a row." You would think that the benefits of taking my medicine would be enough. But for me, it's actually knowing I get that little positive reinforcement of like, "Look at me, I've taken my medicine for 47 days in a row, or now are like 300 days in a row." I don't think I deserve a medal for being able to take my medicine. But for me, that little bit of reward center on the achievement was a huge shift for me. And then it became, how many days did you practice your Spanish in a row? Even like, how many days did you do your Kegels? I've got all of the streaks happening and it's really incredible how that little achievement piece does boost your mood. Dr. Ashley: Yeah. But what I love about this is you're also talking about how to hack the system. We're talking about our brains and this is the stuff that just lights me up, because oftentimes our minds will say, "Well, you should just take your medication. You should just do these things." Well, that's not how it works. There's a million reasons why we don't do the things we know we should do. But can we figure out how to hack the system? Yeah. Our brains love streaks. They love streaks. it taps our reward centers, like you're saying, and so let's use the tools that work. That got you if your goal is to take your medication consistently. Using our brain's glitchy wiring to our own advantage is something that's huge. That did it. And then it does feel good. And then you get some momentum going and then you create a habit around that and it's fantastic. Kimberley: Yeah. What about those who are overachieving to the point that it's bringing their happiness down? What would we do there? Dr. Ashley: Yeah. I think that's a great question and it's something that comes up a lot, especially when we look at anxiety and perfectionism. At least the way I think about it is coming back to what's driving this. Is this being driven by fear? Is this being driven by values? For me, I almost think of it as—I'm going to try to make sense with it—is it the -ing or the -ed? Meaning, the doING (I-N-G) or the -ed as in I did this past tense. What I mean by this is, I notice for me when I'm approaching something, say a big goal, like I want to write a book this year. If I can approach that from a place of, "I am doing this because this is important to me, I feel driven to get this message out into the world," the -ing, the process of doing it, that feels like it's going to boost my wellbeing when I start to get pulled into the thoughts of the outcome. I'm going to write this book and how many people are going to read it and is it going to sell? I'm really looking at all of this, and underneath that is fear. What if it doesn't sell? What if people judge it? What if they think it's stupid? Then I'm focusing on the outcome, kind of when it's done. That I think is actually going to detract from my well-being because it's not coming from a valued place; it's coming from this feared place. A lot of times with overachieving, we're chasing this other people's expectations or we're chasing this promise of happiness. When you do this, then you'll be happy. It's not going to work like that. It may be for a moment and then the bar just changes again. Now you've got another target. We have to come back to this, I think the process or the journey. Are you doing this because it matters to you, or are you doing this because some sort of fear is compelling you? Kimberley: Right. I'm just asking questions based on the questions I would've had when I was struggling the most. I remember hearing something that blew my mind and I actually want your honest opinion about it. I remember I used to chase happiness, like you talked about, even though I was doing all these things. I was doing all these things, but there was that anxious drive behind it. I remember hearing somebody saying life is 50/50. Even though you're doing all these things, you're still going to have 50% great and 50% hard. For me, that was actually very relieving. I think I was caught in and I think a lot of people experienced this like, "Okay, I'm at 50%, how can I get to 55? How can I get to 56?" What are your thoughts on also accepting that you won't be happy all the time, or what are your thoughts on balancing this goal for happiness or this lifelong playfulness around happiness? Dr. Ashley: I agree with you completely. I think we have this cultural myth that we should be happy all the time. If you're not happy, there must be something wrong. You're doing something wrong. It sets up even this idea that being happy all the time is possible. It isn't. If we look at, again, happiness, what people mean by that is a pleasurable or enjoyable state, an emotion that we like. Humans are wired. Two-thirds of our emotions would be under that negative category. Just by the way we're wired, we're more likely to have negative emotions, and they're just messengers. They're just designed to give us information about a situation. Some of them are going to be dangerous, so we're going to feel anxious. Or we're going to lose something we care about, so we're going to be sad. We're going to mess up, so we're going to feel guilty. It's unrealistic to expect to not have those emotions. I think that is a hundred percent something that we need to work on, just accepting happiness all the time is not possible and pursuing it is like playing a rigged game. The other thing, you know how on the anxiety side we talk about facing fears because then you habituate or you get used to them. But that habituation process happens on the pleasurable side too. This is why when we chase happiness, we end up on this hedonic treadmill where it's, "Oh, I'm going to go buy this thing. And then I'm going to feel really happy," and you are. And then you're going to habituate. Your body goes back to baseline so that happiness fades. If you're looking to an external source, you're going to get caught up in this always chasing something bigger and better, not sustainable. I like to look at happiness as the side effect of living a good life. Do the things that we know matter. Take care of your health and wellbeing. Sleep, eat well, move your body, practice mindfulness, the PERMA factors that we talked about, and live in line with your values. If you're doing those things, happiness is the side effect of that. Kimberley: To make that the goal, not happiness the goal. Dr. Ashley: Yeah. Kimberley: I think that's very, very true. Again, for me, it was a massive relief. I remember this weight falling off of like, "Oh," because I think social media makes it so easy to assume that everyone is just happy, happy, happy content, to feel all the things. It was delightful to be like, "Oh no, everyone's got a 50/50." Dr. Ashley: Exactly. When we know that's normal, then all of a sudden, you can accept it. Like, I'm anxious for now, I'm sad for now. To do that, it does keep us from piling on extra. I have this saying that I love, "Just because life gives you a cactus doesn't mean you have to sit on it." A lot of times, we sit on it because we're ruminating or I don't want to feel this way and we're fighting it. And that's just amplifying it and making it a lot harder. When we can say, "Oh, this is where I'm at today. I'm still going to choose to do the things that I know are good for me, that are part of me, living a good life by my standards or my terms," that's going to be the side effect, is I'm going to end up with more happiness down the road, but not chasing it in that moment. Kimberley: I love this. Thank you for coming on and talking about this. I think this has been enlightening and so joyful to have these conversations. I feel a little lighter, even myself, after chatting with you, so thank you. Tell me how people can hear from you, get in touch with you, learn about your work. Dr. Ashley: Yeah, absolutely. I have a blog that I publish every week, so if you're interested in that, you can subscribe at PeakMindPsychology.com/subscribe, o you can just check out all of the blog posts. That's probably the best way to follow me and follow my work. I also have a TEDx Talk that came out pretty recently and you can watch that as well. It's called Is Your Brain Deceiving You , and talk a little bit about learning to play my cards well. Kimberley: I love the TED Talk. Congratulations on that. It was so cool. Dr. Ashley: Thank you. Kimberley: Thank you again for coming on. This has been just delightful. Really it has. Dr. Ashley: I appreciate you having me.

May 12, 2023

Hello and welcome back, everybody. I'm so happy to be here with you. This is not the normal format in which we do Your Anxiety Toolkit podcast, but I wanted to really address a question that came up in ERP School about how to manage 10 out of 10 anxiety. For those of you who don't know, over at CBTSchool.com , we have a whole array of courses—courses for depression , generalized anxiety, panic , OCD, hair pulling , time management, mindfulness. We have a whole vault of courses. In fact, we have a new one coming out in just a couple of weeks, which is a meditation vault. It will have over 30 different meditations. The whole point of this is, often people say to me that the meditations that they listen to online can become very compulsive. It's things like, "Oh, just let go of your fear or make your fear go. Cleanse away and dissolve," and all the things. That's all good. It's just, it's hard for people with severe anxiety to conceptualize that. That whole vault will be coming out very, very soon. But this is actually a question directly from ERP School . Under each video of all the courses, there is always a place you can ask questions, and I do my best to respond to them as soon as I can. But I did say to this student, I will actually do an entire podcast on your question because I think it's so important. Here is what they said: "Hi Kimberley, I love all the information you give us. I get so much more out of this than I do with a therapy session for one hour once a week. That being said, I'm feeling a little bit overwhelmed. There is just so much information and so many tools." Yes guys, I admit to that. I do tend to heavy-dose all of my courses with all the science. I can bring in as many tools as I can with the point being that I want you to feel like you have a tool belt of tools, in which you can then choose which one you want to use, so I totally get what they're saying here. They said: "When I'm at a 10 out of 10, I'm hardly able to function and it all seems to go out the window. It either seems that noticing works as I run through my list of tools or I can't even think straight enough to check in with myself or even think about the tools I could use. So, where do I even start in those terrible moments?" This is a really good question, and I think every single one of my clients in my history of being a therapist has asked this question. I know I have asked this question to my therapist because even as a therapist who has all the tools in those moments, it can feel overwhelming. What I did here is I pulled all of my followers on Instagram and asked them to give me their tools that they find helpful, and then I'm going to weigh in myself, and then I'm going to encourage you to just practice any of them. Now, often what happens—and this is the case for what obviously someone's bought a course from me—is when you have all of these options, we fall into the trap of thinking there is a "right" tool to use, and I want to reframe that. In addition, there's another myth that that one tool will make all your discomfort go away or that will be the tool of all tools for recovery. I want to really normalize that there is no one tool. The whole reason that I do Your Anxiety Toolkit is to remind you that you're going to have to practice multiple different things, you can't put all your eggs in one basket, and it's okay if it's not a 10 out of 10 win. Meaning, it's okay if it's not perfect. Often I'll say to clients, use the tools, even if it's 50% effective. That's still 50% effective more than what it would be in the past, which might be 0% effective or 1% effective. We take any wins we can take and we use it not as a fact that you're a failure if it didn't work, but more as just data on what to use for the next time. At the end of the day, the goals are: Did it give me a 1 or 2% improvement on how I handled it the last time? 1 or 2%, folks. That's all I'm goaling for here. Was I kind as I practiced it? And, did it move me towards the five-year you, or the three-year you, or the one-month you? The you who's in one month, does it move you towards that person that you're trying to be? I often will think about me through the terms of, what would the five-year me do in this situation? What would the three-year me do? What would the three-month me do? It might be different, and then I just pick one. Knowing it's probably not perfect, but that's okay. I have polled a whole bunch of people on Instagram because I honestly feel like folks who were in the thick of it actually are better at giving tools than even I am as a trained clinician who's been through it. Of all of the different responses we got, I've actually broken it down into two separate sections per se. We've got mindset shifts and tools and actions. Again, these may actually feel again like, "Oh my gosh, now I have even more tools," which is not a bad problem. TAKE ONE MOMENT AT A TIME But I want you in the moment that you're at a 10 out of 10 to just pick one and be curious about it. I'm going to say here that the one I loved the most—I'm going to just actually give you one of the tools and actions first—is somebody (multiple people wrote this, in fact) said, just take one moment at a time. I have to say at a 10 out of 10 anxiety, that has been the most helpful for myself and for my clients. That when you slow down and you make it really simple, that's actually the best way to respond. We have these bigger concepts like ERP and habit reversal training and mindfulness and all these big concepts. What's the saying? The rubber hits the road or something like that. When it gets really hard, simplify things, go back to basics, slow down, and just go, "Okay, all I have to do is get through this minute. What can I do in this one minute?" Slow it down. That's one of the tools and actions. BE AN OBSERVER The second tool and action is somebody says, "I notice my five senses," which is a more tactical skill of being present (be an observer) and in the moment, which is your mindfulness skill. For them it might be: What do you see? What do you smell, what do you taste? Some people play games with this. A lot of my clients have said, "When I'm at a 10 out of 10 and I've just faced my biggest fear, or I've been triggered, I find six different colors." You're not doing that to suppress your thoughts or make the fear go away. You're doing it because that's response prevention. You're not engaging in catastrophization and mental rumination. Instead, you're just being an observer of what's in your present moment. BREATHE A lot of you folks said, " Breathe , that the only thing I do is breathe." Again, I love this because it's simple. Now, does that mean we have to breathe a certain way? A lot of people said three breath-in and four counts out, or box breathing. It doesn't matter. Please don't put pressure on yourself. For me, I just really put attention on my breath in and my breath out. I say to myself, "I'm breathing in knowing that I'm breathing in and I breathe out knowing I'm breathing out." Very, very simple. DO NOTHING! ACCEPT IT IS HERE A next person said, "It feels awful, but I do nothing more than just talk to it, accept that it's here, and breathe." Again. These are really simple things. What I'm going to encourage you guys to do is just pick one of these things and play with it for a day or a couple of days, whatever it feels good. And then check in and be like, "How did that work? Was that successful at helping me stay present and reduce behaviors that actually create more problems?" FEEL YOUR FEET ON THE FLOOR Someone says, "I just feel my feet on the floor." Again, these are so basic, but almost everybody's response wasn't like, "I practice these very complex skills." They're just talking about simple, really basic things. "I put my feet on the floor." USE TEMPERATURE Someone says, "I splash cold water on my face." Again, simple. They're just bringing their attention to sensations in the present. CONNECT WITH YOUR SPIRITUALITY Someone said, "I pray." I love that some of you bring your religion into it or your faith. "I pray and I be quiet." Some of you might call that a form of meditation. FEEL YOUR EMOTIONS & CRY This one I really love. Someone said, "I cry. I embrace crying. It's such a good emotional release." This one's really hard for me, you guys. I'm a crier, but when I'm at a high level of anxiety, I feel like there are no tear ducts in my eyes, like I can't get myself to cry. But really when I do allow myself to cry, it is such a cathartic experience, especially if I do it kindly. EXERCISE Someone says they work out. I think that there's some interesting piece to that. Let me just bring a little nuance to that. When we work out, really what I think we're doing is we're putting our attention on something that is very strategic, like 15 bicep curls. Or you get on the treadmill, you listen to some music, and so forth. I love this tool. SOMETHING TO THINK ABOUT (IF YOU ARE PRONE TO EATING DISORDERS) One thing to think about, and the only reason I'm telling you this is just because I myself used to use working out as a skill and it was very helpful. But if you are someone who's prone to an eating disorder or compulsive exercise, just keep an eye out for that because, for me, my healthy practice of working out ended up becoming a compulsive eating disorder compulsion. Now, for most of you, that's probably not the case, but I think with any of these things, like any time we overdo it or we do it to make the fear go away or to avoid the fear, we can get ourselves a little bit into trouble there. So just keep an eye out for that. For me, when I heard that, I was like, "Oh gosh, no, I couldn't do that." But I think for most of you and many of you, that is a really effective tool. We do have research that exercise is a very, very helpful way of managing anxiety. I do still work out for that exact reason, but we have to be careful of becoming compulsive VALIDATE YOURSELF Now, of the last of the tools, P.S. It's actually mine. I did weigh in on the end. My tool and action that I would weigh in, in addition to all of these great ideas, is validate, validate, validate. One of the things I think we miss is when we're at a 10 out of 10, whether that be anxiety, sadness, depression, stress, panic, whatever it may be, we forget to validate ourself by going, "This is really hard." It makes complete sense that you can't think about what tools. You're at A 10 out of 10. It makes complete sense that this is something that is rocking your world. You could say, "Anybody in this position would struggle to find tools." Validate, validate, validate. That's a self-validation, guys. A self-validation. It might be simply as much as you saying, "It's okay that you're struggling, I got you," which moves me to the mindset shifts. There's only four of them, but I thought they were beautiful. The reason I separated them is sometimes when we are in the 10 out of 10, naturally, our brain will send us to get away from here, fight, flight, freeze, and fawn. How can we make the fear go away and get out of this "dangerous" situation? If you can, often you won't be able to. Again, there is some research that when you're at a 10 out of 10, it's very hard to actually have a mindset shift. But on the lower 6s, 7s, and 8s out of 10s, if you practice it, I think it gets a little easier. Here are some of the things that a lot of the folks did weigh in on and say. MINDSET SHIFTS TO CONSIDER Number one mindset shift is, "I remind myself that I don't have to solve the thoughts I'm having." Great mindset shift because in those moments, we're like, "What is the answer? What is the answer? We need to figure it out," and so forth. I love that. The second one is, "I remind myself that I'm resilient and strong." Total shift, away from, "I can't handle this, what do I do" to "I'm resilient and strong." For me—I'll weigh in here—I often say, "Everything is figureoutable. I'll figure this one out." That sentence has changed my life because it takes away the pressure of having to find solutions right now and says, "I'm in a process now. I'll figure it out. We'll get to the end of it. It might take some bounces and bumps." The third one is of course my all-time favorite, which is, "I can do hard things." Today is a beautiful day to do hard things. So good. It can remind you that this is a moment to lean into. I think this last one here is really important. someone weighed in and said, "I remind myself that being uncomfortable doesn't mean dangerous." This is gold, you guys. There are some ideas of the people who weighed in and the most common responses. Let me also say, to be honest, a lot of people wrote, "I totally can't handle it and I just fall apart." A lot of people were making jokes like, "I throw a tantrum on the floor." They were basically saying, "I haven't figured it out yet." I want to just really emphasize again the importance that it's okay if you don't have the 10 out of 10s figured out. We are not here to win all of the challenges. I have been thinking about this a lot lately and I'll actually use this as the final point. In our society and even in the community that I have built here, I have to also acknowledge that we can sometimes overdo the "Face your fears, use the tools, fix yourself, get better." That message can be very, very helpful but also sometimes a little overachieving, a little condescending, a little pressured. I want to just conclude here, if you are early in your recovery and you're working on the 4s, 5s, and 6s out of 10, you're doing enough. If you're in the middle of your recovery or you're accelerating in your recovery and you're doing the 7s, 8s, and 9s, it's okay that you don't yet have the skills to do the 10s. Don't focus too much on that. Just keep the expectations realistic. I don't want you to leave today thinking, "Okay, now I have to go do those tools and I have to handle 10 out of 10s well." That's a lot to ask. I don't handle the 10 out of 10s perfectly. Nobody does. I know so many anxiety specialists who also don't handle the 10 out of 10s perfectly. Let's not fantasize that or let's not make that a thing so that you are constantly feeling like you have to be doing this perfectly. Again, do what you can. Practice. This is trial and error. If it does work, great. If it doesn't work, well good to know. Let's just try again next time. It mightn't work next time, that's fine. Just good to know. We're not here to always win every battle, but the fact that you asked this question, the fact that your inquiring shows me how much you value your recovery and how much you want to overcome this problem. For that, I applaud you. I applaud everyone listening. I hope that today was helpful for you. Again, for those of you who are interested, go to CBTSchool.com . We have a whole vault of different courses you can take. We do have some new ones coming out here this year, which I'm super excited about. We've got courses for depression, all the things. You can go and listen to those. They are on demand. You have unlimited access. You can watch them as many times as you want. Take notes. Just listen, whatever you want to do, and I hope that you find them helpful. Have a wonderful day, everybody, and I will see you next week.

May 5, 2023

Welcome back, everyone. I am so happy to do the final episode of our Sexual Health and Anxiety Series. It has been so rewarding. Not only has it been so rewarding, I actually have learned more in these last five weeks than I have learned in a long time. I have found that this series has opened me up to really understanding the depth of the struggles that happen for people with anxiety and how it does impact our sexual health, our reproductive health, our overall well-being. I just have so much gratitude for everyone who came on as guests and for you guys, how amazing you've been at giving me feedback on what was helpful, how it was helpful, what you learn, and so forth. Today, we are talking about PMS and anxiety, and it is so hopeful to know that there are people out there who are specifically researching PMS and anxiety and depression, and really taking into consideration how it's impacting us, how it's affecting treatment, how it's changing treatment, how we need to consider it in regards to how we look at the whole person. Today, we have the amazing Crystal Edler Schiller on. She is a Psychologist, Assistant Professor, and Associate Director of Behavioral Health for the University of North Carolina Center for Women's Mood Disorders. She provides therapy for women who experience mood and anxiety symptoms across the lifespan. She talks about her specific research and expertise in reproductive-related mood disorders. She was literally the perfect person for the show, so I'm so excited. In today's episode, we talked about PMS , PMDD , the treatments for these two struggles. We also just talked about those who tend to have an increase in symptoms of their own anxiety disorder or mood disorder when at different stages of their menstrual cycle. I found this to be so interesting and I didn't realize there were so many treatment options. We talked about how we can implement them and how we may adjust that depending on where you are in terms of your own recovery already. I'm going to leave it there and get straight over to the show. Thank you again to Crystal Schiller for coming on, and I hope you guys enjoy it just as much as I did. Kimberley: Thank you so much for being here, Crystal. This is a delight. Can you just share quickly anything about you that you want to share and what you do? Crystal: Sure. I'm a clinical psychologist at UNC Chapel Hill. I'm an Associate Director of the UNC Center for Women's Mood Disorders, where we provide treatment to people with reproductive hormones across the lifespan—starting in adolescence, going through pregnancy, postpartum, and all the way up through the transition to menopause. We also do research. My research focuses on how hormones trigger depression and anxiety symptoms in women. I do that by administering hormones, so actually giving women hormones and looking at the impact on their brain using brain imaging and then also studying specific symptoms that they have with that treatment. We've given hormones that mimic pregnancy and postpartum, and we also use hormones to treat symptoms as women transition through menopause and look at, like I said, how that impacts how their brain is responding to certain kinds of things in the environment and also how they report that changes their mood. WHAT IS PMS? AND WHAT IS THE DIFFERENCE BETWEEN PMS AND PMDD? Kimberley: Wow. You couldn't be more perfect for this episode. You've just confirmed it right there. Thank you for being here. Before we get started, mostly we're talking about what we call PMS, but I know that's actually maybe not even a very good clinical term and so forth. Can you share with us what is PMS and What is the difference btween PMS and PMDD? Crystal: Yeah. PMS stands for premenstrual syndrome. It actually is a medical diagnosis and it includes a host or a range of physical symptoms as well as some mild psychological symptoms. It can be things like breast tenderness or swelling, bloating, cramps, menstrual pain, as well as some anxiety, low mood, mood fluctuations. But those tend to be mild in a PMS diagnosis. PMS is really common in the general population. Some studies estimate 30, 40, 50% of women experience these symptoms. Very, very common. On the other hand, premenstrual dysphoric disorder is a condition that is associated with more severe depression and anxiety symptoms. The mood symptoms are more at the forefront, although those physiologic symptoms like the breast tenderness, swelling, pain, cramps can certainly be a part of it. HOW CAN WOMEN DISTINGUISH BETWEEN NORMAL PREMENSTRUAL SYMPTOMS AND THOSE ASSOCIATED WITH PMS OR PMDD? Most women with PMDD do have those physical symptoms as well. Pain is a commonly reported symptom in folks with PMDD, but the mood fluctuations are more severe. People spend about half their menstrual cycle usually with pretty severe symptoms. And then once the period starts, those symptoms go away in PMDD. That's actually part of the criteria for the disorder that the symptoms have to what we call clear out or remit soon after menstrual bleeding starts. So, that's for the formal diagnosis of PMDD. But then all sorts of people with anxiety or depression have what we call a premenstrual exacerbation of symptoms, so it's also possible to have, let's say generalized anxiety disorder or panic disorder, OCD , and have those symptoms get worse during certain periods of the menstrual cycle. We wouldn't say that that person has PMDD; they just have a premenstrual worsening of symptoms. For some women, that occurs during that time, the week or two leading up to a period, but others have symptoms that are more around ovulation. Other women have symptoms that persist through the period. That's the interesting thing. But also, the really complicated thing about this space is that there's so many individual differences where some people have symptoms that sometimes, but not others. And then if you look at symptoms across the menstrual cycle and the next person, it may show a totally different pattern. But then over time, that pattern is maintained. It is clearly a pattern and a function of hormone change, but it can look different between different people. PMS SYMPTOMS VS PMDD SYMPTOMS? Kimberley: Why is it so different for different people? Do we understand that yet, or do we not have enough research? Crystal: We don't have enough research. This is a relatively new area that one of my colleagues, Dr. Tory Eisenlohr, has been working on at the University of Illinois at Chicago. What she has been finding is that there are different subgroups or subtypes of people with this premenstrual worsening where, like I said, some people have it right before their period; others more around ovulation. Some people seem to have worsening symptoms when their hormone levels are going up. Other people have worsening symptoms when their hormone levels are going down. Some people have worsening symptoms anytime there's a fluctuation or change. That's what we see in my research as well. When I start administering hormones in some women, they almost immediately start experiencing anxiety and irritability. And then as soon as I take the hormone away, they feel better. Whereas other women feel terrible until their hormones even out again, and I've stopped messing with them so much. It's really individualized and it probably has something to do with genetic predisposition as well as early environment. It's this combination of factors. DOES ANXIETY INCREASE DURING PMS? Kimberley: Right. I could be so off base here, and please just tell me if I am. While we know it's chemical, hormonal, biological, and genetic, is there also a small percentage of people who have these shifts from a cognitive component to where they've maybe had some depressive symptoms in the past, and so that when it comes on, they're anxious about the symptoms coming on? Does anxiety increase during PMS? Is it as cognitive as well, or are you more looking at just the physiological piece? Crystal: Both, for sure. First of all, you're not way off base. That's totally what I see in the clinic, that as folks have had these experiences with hormonal shifts and they had some anxiety or symptoms of depression during those times, it raises concern as they go through those similar hormonal shifts in the future. It becomes, in some ways, a self-fulfilling prophecy. Like, "Oh my gosh, this time is going to be so horrible, I must prepare for it. Oh no, here it comes." And then it is terrible because you're expecting it to be terrible on some level. TREATMENT OPTIONS FOR PMS AND PMDD Crystal: There are great treatment options for PMS and PMDD . That's what we do in cognitive behavioral therapy for these very symptoms, is working through some of those expectations about how things are going to be and what we can actually do to prepare for it so that it doesn't end up being bad just because we think it's going to be bad. But that's not to say that there isn't also a hormonal driver because for some people, there clearly is. Again, that's what makes this work so interesting and complicated, is that it's both for so many people. And that's what makes treatment somewhat complicated. CBT can go a long way toward helping with these symptoms. Not everybody, of course, can afford to access CBT. There are medication options as well, but the combination of these treatments seems to work the best for that reason. Kimberley: Yeah. CBT is good for so many things, isn't it? Crystal: Yeah. Kimberley: This is a perfect segue into questions I commonly get. I'm not a medical professional, everybody knows that. I'm a therapist. But people will often report to me that their doctor said, "There's nothing you can do. It's your hormones, it's your cycle. You have to ride it out and ride the PMDD or ride out your OCD or ride out your anxiety or your panic and just wait." Would you agree with that? If so, or if not, what treatments would you encourage people to consider? Crystal: Okay, I want people to know that that is absolutely not true. If a medical provider tells you that, go see someone else because it's just not true. I actually hear the same thing all the time from my own patients and from our research participants too. They raised this concern with their physician; it wasn't taken seriously. That's why I do this work because I think it's really important. We do have good treatments that work. There are a whole bunch of different things that people can try. MEDICATIONS FOR PMDD + PMS Crystal: Because I mentioned there are different ways in which hormones influence mood symptoms across individuals, the unfortunate news is that we have certainly different medication for pmdd + pms treatments that work for a lot of people, but you have to work with a physician that you like to find the combination or the exact right treatment for you. It's not like a one-and-done where you would go in and say, "Okay, great, you're going to put me on this low-dose antidepressant and I will feel better and it will completely take care of this." The thing that I would really encourage people to do is find a physician who's willing to work with them and see them regularly in the beginning, once every few weeks, or even more often as they try these different treatments to see what's going to work. I already mentioned cognitive behavioral therapy. That's a first-line treatment option for PMDD as well as for this premenstrual exacerbation or cyclic exacerbation of underlying anxiety or depression. The other thing that works well for PMDD is selective serotonin reuptake inhibitors. SSRIs that are used to treat depression and anxiety work well for PMDD but the mechanism is different, which is really interesting. A lot of people I hear from are reluctant to take SSRIs because they've heard that they're difficult to come off of eventually if they wanted to, that you can become dependent on them. The good news for PMDD, for people who are worried about those studies, is actually, you don't have any dependence on it because you only take it during that period of the menstrual cycle that's problematic for you. You can take it just those two weeks leading up to the beginning of your period and then stop taking it once the period starts. That has been shown to fully prevent PMDD symptoms in some women. And then some other people take it all the time, like around the whole menstrual cycle just because it's hard to remember to start it, or because they're not exactly sure when their period is going to start. If you're not super regular, it's hard to know and you might miss that window of opportunity to start it before the mood symptoms. That's another option. But SSRIs are another first-line treatment option. And then some women have really good success with oral contraceptives. Low-dose combined estrogen-progestin contraceptives are what's recommended. Yaz is the only one that's FDA-approved to treat PMDD, but it's not all that dissimilar from any other low-dose combined oral contraceptive. Sometimes it isn't covered by all insurances. If that one is not covered, I tell people to ask their doctor about what are the other alternatives because you shouldn't be paying tons and tons of money for your oral contraceptive. And then the other thing that often helps, for women who have some symptom relief with Yaz or other oral contraceptives, is to take it continuously because, as I mentioned, it is often that hormone change that seems to provoke symptoms in folks. If you don't have a period, then you don't have any hormone change. It's those placebo pills that cause a period, it's the switching from a low-dose hormone to then having that withdrawal of progestin that causes a period. But you don't medically need one. You can ask your doctor to prescribe the hormone continuously and not have a period at all. And that works well for a lot of folks with PMDD as well. And then you can combine all these different treatments. LIFESTYLE CHANGES TO HELP PMS ANXIETY + PMDD And then, in addition, some other non-pharmacologic lifestyle changes to help PMS anxiety and PMDD. Exercise has been shown to help. Regular exercise I think enhances all of our moods. It has the same effect within PMDD. There's some studies showing that taking calcium seems to reduce symptoms as well. For most of our patients, I just have them start taking a multivitamin and try to boost up that calcium a little bit. But like I said, a lot of people need a combination of treatments. Different SSRIs work in slightly different ways and may be more effective for some people than others. Just because the first SSRI doesn't work doesn't mean that you couldn't try another one. Again, it's just a matter of finding a physician that's willing to work with you to find the right combination and dose of these various treatments. Also possible for some people that none of these things work and those cyclic mood symptoms persist. And then there are other more invasive options for folks who don't have good success with any of these. Kimberley: Right. I have a couple of questions about that. You've just given us an amazing treatment plan, or treatment options for someone who is experiencing PMDD or they're having more onset of anxiety not to maybe that degree. I just want to clarify, for those who also have a chronic anxiety disorder, I'm assuming, but please again correct me, that they wouldn't be one of the people who should be coming off of their SSRIs; they should stay on them if you've got an additional psychiatric or a mental illness on the side. Crystal: Correct. I would never advise someone to come off of their SSRI if they're still having some breakthrough cyclicity in their symptom exacerbation. What I would suggest instead is to try adding on some of these other options. If you're already on an SSRI and not doing CBT, that's maybe where I would start, is to first track your mood symptoms relative to your period. This is a step that many people skip. The only way to diagnose PMDD , but also an important indicator for this cyclic exacerbation of symptoms, is to track every day your mood symptoms. You can just do this really easily on a calendar, even in the Notes app on your phone. I just have my patients make a mood rating of 0 to 10. 0 is feeling terrible, awful, worst I've ever felt; 10 is the best I've ever felt. It can be as simple as that. Or you can even use a smiley face symptom like, okay, feeling happy, feeling terrible. It doesn't have to be anything special. There are apps and things you can use as well to do this. But what we're looking for is a regular pattern of mood change relative to the menstrual cycle. Once you've established there is a regular pattern, then a CBT therapist can help you, like I said, prepare for those times and use some coping skills or strategies to manage those mood symptoms. But I think the treatments are largely the same for people with PMDD versus other anxiety and depressive disorders. But if you have more of a chronic picture that just has some change in symptoms around the menstrual cycle, then you wouldn't come off your SSRI. That's just for people with pure PMDD. CBT FOR PMDD and PMS ANXIETY Kimberley: I'm thinking about questions I'm assuming people will ask, and what comes to mind is, as myself as an OCD Specialist and as an anxiety specialist, we use CBT, but there are different types of CBT. We do a lot of exposure and response prevention for OCD and so forth. When we are talking about CBT, I want us to really be clear about what that looks like compared to all these other forms. What would that look like specific to somebody who has these symptoms, particularly around their menstrual cycle? Would it be more focused on the cognitive component or would it be an equal balance between managing cognitive distortions and behavioral activation? If we did behavioral activations, what would that look like? Crystal: I'm just going to lay my bias out on the table that I tend to lean more on the B side of CBT. I tend to be a behaviorist, and I do a lot of behavioral activation because, in my experience, it tends to work well in this space and for this population of folks. We do some behavioral planning. We track behaviors and mood symptoms. What did you do or not do when you were having that feeling of frustration or irritability and how did that work out for you? We get pretty in the weeds of like, what did you say, and then what happened next, and that sort of thing, and then we figure out like, okay, how do we prevent this kind of exchange from happening in the future when you're feeling really frustrated or irritable, if it caused problems, because sometimes it doesn't. Sometimes anger, frustration, or irritability serves as fuel to make a behavior change that needs to be made. It's a signal that something isn't working well. I don't want to pathologize all negative emotions because they're not always bad. Anyways, we look at what happened and where are the points at which we could have intervened and we rewind back in time to say, "Okay, how did you sleep the night before that thing happened that didn't go so well? Were you eating that day? What was that like? Were you already pretty depleted going into this negative interaction with your boss?" How do we prepare for the next cycle to make sure that you are allotting enough time to sleep and protecting that sleep time, not staying up super late, getting emails done or something, but really taking good care of yourself, eating well, drinking enough water, taking care of yourself the way you would take care of a child? And then from there, we talk about, "Okay, let's say this frustrating thing happens again and you're noticing yourself getting anxious or frustrated in that moment. What are some tools or skills we could use to respond?" Here, we might use something like taking a break, like, "All right, I noticed I'm getting really upset. I need to take a break from this interaction so that I don't say something that I might regret." We might practice a skill like, "Thank you for that feedback. I'm feeling myself just getting flustered. I'm going to take five minutes and then I'd like to come back and have this conversation with you later, or an hour," or "Can we come back and have this conversation next week," depending on what it is and how out of sorts the person is feeling. And then using some skills to calm down. These might be mindfulness skills or any kind of self-care, emotion regulation skill that a person could use. We tend to start with skills that folks have already had good success with. I'm not teaching Buddhist meditation on the first day of treatment, but instead, it might be simple things like, "Oh, I feel better when I get some sunshine and take a walk outside," so that might be a good skill we could just use right off the bat. It's pretty skill-based. And then we create a behavioral plan around that time of the month that tends to be more problematic so that we can keep people feeling well and well supported. A lot of times, that's all it takes. It doesn't require much more than that. Kimberley: I love that. I love that you're bringing in the mindfulness piece and a lot of self-care. This is really more of a question of curiosity, but I remember as a young teen, having a lot of PMS, being told you have to drink a lot of water. Is that like an old wives' tale? Because now I'm telling my daughter. I'm curious, is that an old wives' tale or is that actually a treatment or a part of the work? Crystal: I don't know. I mean, I think Americans probably go a little overboard on water consumption, but I think it's a good part of self-care to stay well-hydrated as well as well-fed and well-rested. You do lose some water through menstruation, and so it's probably good practice in general just to keep yourself well hydrated. That doesn't mean drinking a certain amount of water every day, but just noticing when you're thirsty and drinking something when you are. Kimberley: Okay, I'll be better about that because, like I said, as I tell my daughter, I'm always like, "This is probably an old wives' tale." Maybe we could talk this one through together. Let's say I'm treating somebody. They've got severe OCD, severe panic disorder or severe health anxiety, severe social anxiety. They know and they've tracked using an app or, as you said, the notes on their phone or on paper, they've tracked it. They know around approximately that such and such day of the month, they're going to probably have an onset of treatment. How prepared should they be in terms of what would that preparation time look like? Is there a strategy you would give people? I know for us, on the clinical side, I'm amping up homework skills for them to manage the actual disorder, but is there something they could be doing on the PMS side that we should remember to do? Crystal: I think it's in my mind really specific to the individual and the symptoms that they're having that they find tend to get worse as well as the physical symptoms. If they're having a lot of pain around that time, then we want to also work on some pain management. Because when you're feeling a lot of pain, that can make your anxiety worse. That would be something I would think about in addition to the standardized ramping up of homework that you would ordinarily be doing. Pain management can again look more like mindfulness, some meditative practice, or it can mean talking with one's doctor about how to manage pain because there are non-addictive ways of managing pain as well. Kimberley: Right. You mentioned before talking to your doctor. Are you speaking specifically about just a GP or should they be going more to a reproductive doctor, OB-GYN? What kind of medical professional would you encourage people to reach out to? Crystal: I think if you have a doctor that you trust, whether it's a GP, OB-GYN, or even a psychiatrist, all of those are good options. Any of them can help treat these symptoms. Sometimes if the symptoms are really severe, then going to a specialist in reproductive mental health—that person would be a psychiatrist—can be helpful. There aren't that many of us out there though. I have a number of really wonderful colleagues that I work alongside in our clinic and we treat patients together. I provide the psychotherapy and then they provide the pharmacotherapy and then I also have an OB-GYN on the team who provides the hormonal treatment. Not everyone can access this highly skilled team, however, and I do recognize that. I think starting with a GP or your OB-GYN is a good place to start. Again, if they're not as knowledgeable as they need to be and they're telling you, you just have to suck it up and deal with it, that's not the right person. Kimberley: I appreciate you saying that because I do think—I'll be transparent—even to get somebody as skilled as yourself on the show for this was a really difficult thing. I was surprised how few people really understand it and are knowledgeable about the treatment options. It was harder than I thought and I'm so grateful for you to be here and talk about it with us. Crystal: I'm really sorry to hear that. I think there are a growing number of people interested in this, and I have a number of wonderful colleagues. But like you mentioned, there aren't that many of us out there. The bright spot, I would say, is that we have a training program at UNC Chapel Hill with lots and lots of applicants every year. We're training clinical psychologists and social workers and psychiatrists to do this work. Kimberley: Amazing. Thank you. Last question: Any final advice you would give someone who is experiencing symptoms of PMS and PMDD in regards to getting better or seeking treatment and help? LAST PIECE OF ADVICE FROM CRYSTAL Crystal: You're not alone. It's not all in your head. You deserve access to treatments that work. There are lots of treatments that work. Unfortunately, our medical system is really complex and sometimes you have to really advocate for yourself in this space. But if you are persistent and know what you're looking for in a provider, you, I hope, will be able to find one that can be a good advocate and supporter of you to recovery because you don't have to experience these symptoms by yourself or forever. Kimberley: Thank you so much for saying that. I think a lot of people feel like they're crazy or they've been told they're being crazy, which doesn't help. Crystal: Yeah. I mean, the word "hysteria" came from studying or psychiatrists working with women who they felt were hysterical and their uterus was traveling around their bodies. The roots of all of this are in this really misogynistic place where many of us are working really hard to overcome that unfortunate history, but there's often still a lot of stigma and misinformation out there. Kimberley: I remember in my master's degree, that was the first part of the history of Psychology, that women who were just having PMS were being totally hyper-pathologized. Horrible. Crystal: Yeah. Really horrible. I hope that the work that we do makes a difference. I'm so glad that you're tackling this topic on your podcast. I think this will, I hope, reach a lot of people. Kimberley: Thank you. Can you tell us where people can get ahold of you, where they might learn about you and the work that you're doing? Crystal: Yeah. I have a website, it's CrystalSchiller.com. C-R-Y-S-T-A-L S-C-H-I-L-L-E-R.com. I'm actually starting to write a book on this topic, so I really appreciate you reaching out and to know that people have questions about this because that's what I see where I'm at too. And then the UNC Center for Women's Mood Disorders, if you just Google that, you'll find our website and you can read more about the different research studies that we're doing and about our treatment program as well. Kimberley: Thank you so much and congratulations on writing a book. It's a big challenge and a big accomplishment. Crystal: Thanks. Kimberley: Thank you so much for coming on. It's been an absolute pleasure.Crystal: It was wonderful being with you today. Thank you so much. Take care.

Apr 28, 2023

In this week's podcast episode, we talked with Dr. Katherine Unverferth on Menopause, anxiety, and mental health. We covered the below topics: How do we define peri-menopause and menopause ? What causes menopause? Why do some have more menopausal symptoms than others? Why do some people report rapid rises in anxiety (and even panic disorder) during menopause. Is the increase in anxiety with menopause biological, physiological, or psychological? Why do some people experience mood differences or report the onset of depression during menopause? What treatments are avaialble to help those who are suffering from menopause (or perimenopause) and anxiety and depression? Welcome back, everybody. I am so happy to have you here. We are doing another deep dive into sexual health and anxiety as a part of our Sexual Health and Anxiety Series. We first did an episode on sexual anxiety or sexual performance anxiety . Then we did an episode on arousal and anxiety . That was by me. Then we did an amazing episode on sexual side effects of antidepressants with Dr. Aziz . And then last week, we did another episode by me basically going through all of the sexual intrusive thoughts that often people will have, particularly those who have OCD . This week, we are deep diving into menopause and anxiety. This is an incredibly important episode specifically for those who are going through menopause or want to be trained to understand what it is like to go through menopause and how menopause impacts our mental health in terms of sometimes people will have an increase in anxiety or depression. This week, we have an amazing guest coming on because this is not my specialty. I try not to speak on things that I don't feel confident talking about. This week, we have the amazing Dr. Katherine Unverferth. She is an Assistant Clinical Professor at The David Geffen School of Medicine and she also serves as the Director of the Women's Life Center and Medical Director of the Maternal Mental Health Program. She is an expert in reproductive psychiatry, which is why we got her on the show. She specializes in treating women during periods of hormonal transitions in her private practice in Santa Monica. She lectures and researches and studies areas on postpartum depression, antenatal depression, postpartum psychosis, premenstrual dysphoric disorder—which we will cover next week, I promise; we have an amazing guest talking about that—and perimenopausal mood and anxiety disorders. I am so excited to have Dr. Unverferth on the show to talk about menopause and the collision between menopause and anxiety. You are going to get so much amazing information on this show, so I'm just going to head straight over there. Again, thank you so much to our guest. Let's get over to the show. Kimberley: Welcome. I am so honored to have Dr. Katherine Unverferth with us talking today about menopause and anxiety. Thank you for coming on the show. Dr. Katie: Of course. Thanks for having me. HOW DO WE DEFINE PERI-MENOPAUSE AND MENOPAUSE ? Kimberley: Okay. I have a ton of questions for you. A lot of these questions were asked from the community, from our crew of people who are really wanting more information about this. We've titled it Menopause and Anxiety , but I want to get really clear, first of all, in terms of the terms and whether we're using them correctly. Can you first define what is menopause, and then we can go from there? Dr. Katie: Definitely. I think when you're talking about menopause, you also have to think about perimenopause. Menopause is defined as the time after the final menstrual period. Meaning, the last menstrual period somebody has. It can only be defined retrospectively, so you typically only know you're in menopause a year after you've had your final menstrual period. But that's the technical definition—after the final menstrual period, it's usually defined one year after. Perimenopause is the time leading up to that where people have hormonal changes. Sometimes they have vasomotor symptoms, they can have mood changes, and that period typically lasts about four years but varies. I think that people often know that they're getting close to menopause because of the perimenopausal symptoms they might be experiencing. Kimberley: Okay. How might somebody know they're going into perimenopause? I think that's how you would say you go into it. Is that right? Dr. Katie: Yeah. You start experiencing it there. I don't know if there's a specific term. Kimberley: Sure. How would one know they're moving in that direction? Dr. Katie: Typically, we look for a few different things. One of the earliest signs is menstrual cycle changes. As someone enters perimenopause, their menstrual cycle starts to lengthen, whereas before, it might have been a normal 28-day cycle. Once it lengthens to greater than seven days, over 35 days, we would start to think of someone might be in perimenopause because it's lengthened significantly from their baseline before. Other symptoms that are really consistent with perimenopause are vasomotor symptoms. Most women who go through perimenopause will have these. These are hot flashes or hot flushes—those are synonyms for the same experience—and night sweats. Hot flashes, as the name describes what it is, they last about two to four minutes. It's a feeling of warmth that typically begins in the chest or the head and spreads outward, often associated with flushing, with sweating that's followed by a period of chills and sometimes anxiety. The night sweats are hot flashes but in the middle of the night when someone is sleeping, so it can be very disruptive to sleep. That combination of the menstrual cycle changes plus these vasomotor symptoms is typically how we define perimenopause or how we diagnose perimenopause. Once someone is later in perimenopause, when they're getting closer to their final menstrual period, often they'll skip menstrual cycles altogether, so it might be 60 days in between having bleeding. Whereas before, it was a more regular period of time. I think one of the defining features too is hormonal fluctuations during those times. But interestingly, there's not much clinical utility to getting the blood test to check hormone levels because they can vary wildly from cycle to cycle. Overall, what we do see is that certain hormones increase, others decrease, and that probably contributes to some of the symptoms that we see around that time as well. Kimberley: Right, which is so interesting because I think that's why a lot of people come to me and I try to only answer questions I'm skilled to answer. Those symptoms can very much mimic anxiety. I know we'll get into that very soon, but that's really interesting—this idea of hot flashes. I always remember coming home to my mom from school and she was actually in the freezer, except for her feet. It was one of those door freezers. So, I understand the heat that they're feeling, this hot flash, it's a full body hot flash stimulant like someone may have if they're having a panic attack maybe. Dr. Katie: Exactly. There are lots of interesting studies really looking at the overlap of menopausal panic attacks and hot flashes too. There's a lot of this research that's really trying to suss out what comes first in perimenopause because we know that anxiety predisposes someone to hot flashes and it can predispose someone to panic attacks , which is interesting. It seems like there's this common denominator there. But I think that that's a really interesting thing that hopefully we'll get into this overlap between the two. WHAT AGE DOES SOMEONE GET PERIMENOPAUSE AND MENOPAUSE? Kimberley: I'm guessing this is something I'm moving towards as well. What age groups, what ages does this usually start? What's the demographics for someone going into perimenopause and menopause? Dr. Katie: The average age of menopause is 51, and then people spend about four years in perimenopause. Late 40s would be a typical time to start perimenopause. Basically, any age after 40, when someone's having these symptoms, they're likely in perimenopause. If it happens before the age of 40 where someone's having menstrual cycle abnormalities and they're having these vasomotor symptoms, that might be a sign of primary ovarian insufficiency. It used to be called premature ovarian failure, but that would be a sign that they should probably go see a doctor and get checked out. If it's after 40, it's very likely that they're having perimenopausal symptoms. Kimberley: Okay. What causes this to happen? What are the shifts that happen in people's bodies that lead someone into this period of their life? Dr. Katie: I think there are a lot of things that are going on. I think it's really important to emphasize that menopause is a natural part of aging. That this isn't some abnormal process. Nothing is wrong. It's a natural part of aging. It can still be very uncomfortable, I think. But basically, over time, a woman's eggs decline and the follicles that help these eggs develop also develop less. There's this decline in the functioning of the ovaries. There are a few reasons this might be. There are some studies that show that blood flow to the ovaries is reduced as a result of aging, so maybe that makes them function a little bit less. The follicles that remain in the ovaries are probably aging, and then the follicles, which are still there, also might not be the healthiest of follicles, which is why they weren't used earlier. There's this combination of things that leads to these very significant hormonal changes that start around perimenopause. The first of these is an increase in follicle-stimulating hormone. Follicle-stimulating hormone is released by the pituitary and encourages the ovaries to develop follicles. That increases over time because the follicles aren't developing in the same way. It's like the pituitary is trying harder and harder to get them to work. At the same time as these, as the follicles and ovaries are aging, what we see is that the ovaries produce less estrogen and progesterone overall. But there's still these wild fluctuations that are happening. FSH is going up, but it's fluctuating up; estrogen and progesterone are going down, but they're fluctuating down. It's these really big shifts that seem to cause a lot of the symptoms that we associate with this time. WHY DO SOME HAVE MORE MENOPAUSAL SYMPTOMS THAN OTHERS? Kimberley: Is there a reason why some people have more symptoms than others? Is it your genetic component or is there a hormonal component? What's your experience? Dr. Katie: I think there are lots of different reasons and we probably need more research in this area. There are definitely genetic components that influence it. For example, we know that women who have family members who went through menopause earlier are likely to go through menopause themselves earlier. There's some genetic thing that's influencing the interplay of factors. I think we know that there are certain lifestyles. There are certain behaviors, like certain behaviors in someone's life that can influence, I think, their symptoms. We know that smoking, obesity, having a more sedentary lifestyle can impact vasomotor symptoms. I think some really interesting research looks at the psychological influences here. We know that women who have higher levels of neuroticism, when they go through perimenopause, have more anxiety and mood changes associated with it. People who have higher levels of somatic anxiety, coming into this perimenopausal transition, can also have a tougher time. I think that makes sense when we think about someone with somatic anxiety. They're going to be very, very attuned to these small changes in their body. During perimenopause, there are these huge changes that are happening in your body. That can trigger, I think, a lot of anxiety and a focus on the symptoms. I think with vasomotor symptoms specifically, like hot flashes and hot flashes specifically, night sweats, not quite as much, we know that there are these psychological characteristics that probably perpetuate and worsen hot flashes. When someone has a hot flash, it's certainly uncomfortable for most people. But the level of distress can be very different. They've looked at the cognitions that occur when people have hot flashes and at some point, people believe like, "Oh, this is very embarrassing, this is very shameful." That doesn't help them process it. They might believe, "This is never going to go away. I can't cope with it." That's also not going to help. I think that's really a target for cognitive behavioral therapy to help people during this time. Kimberley: It just makes me think too, as somebody who has friends going through this, and you can please correct me, what I've noticed is there's also a grief process that goes along with it too, like it's another flag in terms of being flown, in terms of I'm aging. I've also heard, but maybe you have more to say about people feeling like it makes them less feminine. Is that your experience too, or is that just my experience of what I've heard? Dr. Katie: No, I agree. I think in my clinical experience, people go through it in a lot of different ways. I think that there is this grief. I think it can bring out a lot of existential anxiety. It is a sign that you are getting older. This can bring up a lot of these questions like, who am I? What's my purpose? Where am I going? But I think it's really important to remind women that we're not defined by our reproductive functioning. I think that that's something that people forget. Were you less of a woman when you were 15 or when you were 10 maybe and you hadn't gone through puberty? You're still the same person. But I do think that there's a lot of cultural stress around this, and I think there are a lot of complexities around the way society sees aging women. I think that those are cultural issues that need to be fixed, but not necessarily a problem within the woman themselves. WHAT CAUSES MENOPAUSE AND ANXIETY SYMPTOMS? Kimberley: That's really helpful to know and understand. Okay, let's talk about if I could get a little more understanding of this relationship with anxiety. Maybe you can be clearer with me so that I understand it. Is it more of what we're saying in terms of like, it's the chicken and the egg? Is that what you mean in terms of people who have anxiety tend to have more symptoms, but then those symptoms can create more anxiety and it's like a snowball? Or is that not true for everybody? Can you explain how that works? Dr. Katie: With regard to the perimenopausal period, what I think researchers are trying to figure out is, do vasomotor symptoms, like hot flashes, lead to anxiety and panic, or do anxiety and panic worsen the vasomotor symptoms? We don't have a lot of information there. Part of it is because it's difficult to study. Because when you're doing symptom checklists, there's a lot of overlap between a hot flash and a panic attack. It's just been difficult, I think, to suss out in research. I think what we do know is there was one study that showed that people who have higher levels of anxiety are five times more likely to report hot flashes than women with anxiety in the normal range. Whether or not the anxiety is necessarily causing it, I do think that there's probably some perpetuation of like, I think that the anxiety is perpetuating the hot flashes, which perpetuates the anxiety. We just don't know exactly where it starts. MENOPAUSE & PANIC ATTACKS But I mean, if we just think about it for a second, if we think about what's common between them, I think that both panic attacks and hot flashes have a quick onset. They have a spontaneous onset, a rapid peak, they can be provoked by anxiety, they can include changes in temperature, like feelings of heat and sweating. They can have these palpitations, they can have this shortness of breath, nausea. And then it's very common that panic is reported during hot flashes, and hot flashes can be reported during panic. I think there's this interplay that we're trying to figure out. I think what's interesting too is that common antidepressants can treat both panic and hot flashes, which is not something that probably everybody knows. There are probably different reasons that they're treating each of them, but it is still just this other place where there is this overlap. Kimberley: Okay. That's really interesting. One thing that really strikes me is I actually have a medical condition called postural orthostatic tachycardic syndrome (POTS), and you get really dizzy. I'm an Anxiety Specialist , so I can be good at pulling apart what is what, but it is very hard. You have to really be mindful to know the difference in the moment because let's say I have this whoosh of dizziness. My mind immediately first says I'm having a panic attack, which makes you panic. I'm assuming someone with that whoosh of maybe a hot flash has that same thing where your amygdala, I'm guessing, is immediately going to be like, "Yeah, we're having a panic attack. This is where we're going." That makes a lot of sense to me. Now, some people also have reported to me that their anxiety has made them-- and again we have to understand what causes what, and we don't understand it, but how does that spread into their daily life? What I've heard is people say, "I don't feel like I can leave the house because what if I have a hot flash, which creates then a panic attack," or "It's embarrassing to have a hot flash. You sweat and your clothes are all wet and so forth." Do you have a common example of how that also shows up for people? Dr. Katie: Yeah. I think that what you were alluding to is this behavioral avoidance that can happen. We can see that with panic attacks where people sometimes develop agoraphobia, fear of being in certain places. Sometimes they don't want to leave their home. I think with hot flashes, we do also see this behavioral avoidance when people especially tend to find them very distressing. They catastrophize it when they happen. They worry about social shaming. That avoidance, I think, the way that we understand anxiety is that if you have an anxiety and then you change your behaviors as a result of that anxiety, that tends to perpetuate the anxiety. That's one of the targets of cognitive behavioral therapy for hot flashes , is really trying to unwind some of this behavioral avoidance. Also, we know that temperature changes can trigger hot flashes. Unfortunately, it looks like strong positive and strong negative emotion can trigger hot flashes, just feeling any end of the spectrum. There are certain other triggers that can trigger hot flashes. I think that it's just this discomfort and this fear of having a hot flash that I think really generalizes the anxiety during this time. HORMONES, ANXIETY, & MENOPAUSE There's also this interesting hormonal component too that's being studied as well. We've talked a little bit about progesterone. But in reproductive psychiatry, we really focus on this metabolite of progesterone called allopregnanolone. I think this is interesting because allopregnanolone is a metabolite of progesterone. We know that progesterone is going like this, up and up and down during this time. Allopregnanolone works on this receptor that tends to have very calming effects. Other things that work at this receptor are benzodiazepines like Xanax and Ativan or alcohol. It has this calming effect. But when it's going like this, it's calming and then it's not, and then it's calming and then it's not, up and down rollercoaster. There's some thought that that specifically might contribute to anxiety during this time. It can be more generalized. It's not always just related to hot flashes, even though we've been more specific on that. It can be the same as anxiety at any point in anyone else's life, like ruminative thoughts, worry, intrusive thoughts, just this general discomfort. I think this is a really exciting area of research where we're looking at ways to modulate this pathway to help women cope better. There are studies looking at progesterone metabolites to see if they can be helpful with mood changes during this time. Kimberley: Interesting. Let's work through it. As a clinician, if someone presents with anxiety, what I would usually do is do an inventory of the behaviors that they do in effort to reduce or remove that anxiety or uncertainty that they feel. And then we practice purposely returning to those behaviors. Exposure and so forth. From what you understand, would you be doing the same with the hot flashes or is there a balance between, there will be sometimes where you will go in purposely or go out and live your life whether you have a hot flash or not? How do we balance that from a clinical standpoint? Even as a clinician, I'm curious to know. As a clinician, what would I encourage my client to do? Would it be like our normal response of, "Come on, let's just do it, let's face all of our fears," or is there a bit of a balance here that we move towards? Dr. Katie: It's more of a balance. I think one of the important things is that what you want to do-- I think the focus is on the cognition here a little bit. I'm not familiar and I don't think that exposure to hot flashes is intentionally triggering hot flashes repeatedly, like sometimes we do in panic disorders is part of this. What I understand from the protocol is that it's really looking at the unhelpful cognitions that relate to menopause, aging, and vasomotor symptoms. This idea of like, everybody is looking at me when I'm having a hot flash, this is so shameful. Or maybe it goes further, like no one will like me anymore. Who knows exactly where it can go? We know that when people have cognitive distortions, it's not really based on rational thinking. I think other part is you work on monitoring and modifying hot flash triggers, so it feels more in your control like temperature changes and doing those things. I think other things that you do is there's some evidence for diaphragmatic breathing to help with the management of hot flashes. You teach someone those skills. I think your idea is you want to get them back out there and living their life despite the hot flashes, and also just education. This isn't going to last forever. Yes, this is uncomfortable, but everybody goes through this. This is a normal part of aging. Also encouraging them to seek treatment if they need it. In addition to therapy, we know that there are medications that can help with this. If the hot flashes are impacting their life in a significant way or very distressing to them, go see a reproductive psychiatrist or go see an OB-GYN who can talk to you about the different options to really treat what's coming up. Kimberley: Right. That's helpful. I want to quickly just add on to that with your advice. I think what you're saying is when we come from an anxiety treatment model, we are looking at exposure, but when it comes to someone who's going through this real life, like their actual symptoms aren't imagined, they're there, it's okay for them to modify to not be going to hot saunas and so forth that we know that they're going to be triggered, but just to do the things that get them back to their daily functioning, but it is still okay for them. I think what I'm trying to say is it's still okay for them to be doing some accommodation of the symptoms of perimenopause, but not accommodation of the anxiety. Is that where we draw the line? Dr. Katie: I think that's a really good way of explaining it. DEPRESSION AND MENOPAUSE Kimberley: All right. The other piece of this is as important, which is how depression impacted here. Can you share a little bit how mood changes can be impacted by perimenopause ? Dr. Katie: Definitely. We know that there's a significant increase in not only the onset of a new depression, but also recurrence of prior depressive episodes during perimenopause. It's probably related to the changing levels of hormones, but also, I think what we've alluded to and what we have to acknowledge is there are big life changes that are happening around this time as well. I think cultural views of aging, I think a lot of times people have changes in their relationships, their partners. Their libido can change. There's so many moving parts that they think that also contributes to it. But specifically with regard to perimenopausal depression, we categorize this in the reproductive subtype of depression. At these different periods of hormonal transition, certain women are prone to have a depressive episode. We know that that's true during normal cycling. For example, premenstrual dysphoric disorder or PMDD is a reproductive subtype of depression . People sometimes get depressed in those two weeks before their period and then feel fine during the week of their period or the week after. During the luteal phase, they experience depression. We know that that group of women also is at increased risk for perinatal depression, so depression during pregnancy and postpartum. And then that same group is also at risk for perimenopausal depression. What we know is that a subset of women is probably sensitive to normal levels of changing hormones, and that for them, it triggers a depressive episode. One of the biggest risk factors for depression during perimenopause is a prior history of depression. Unfortunately, the way depression works is that once you have it, you're more likely to have it in the future. For people who have had depression in their life or have specifically had depression around these times of hormonal transition, it's probably just important to keep an eye on how they're doing, make sure they have appropriate support, whether that's from a therapist or a psychiatrist, and monitor themselves closely. Kimberley: Okay. This is really helpful to know. We know that people with anxiety tend to have depression as well. Have you found those who've had previous depression or previous anxiety also have coexisting in terms of having those panic attacks and depression at the same time? Dr. Katie: That's interesting. I haven't read any research on that. It wouldn't surprise me. But I think at least for research purposes, they're separating it. I think clinically, of course, we can see it being all mixed together. But for research, it's depression or panic and they keep those separate. Kimberley: Right. One thing that just came to me in terms of just clarifying too is, I'm assuming a lot of people who have health anxiety are incredibly triggered during perimenopause as well, these symptoms that are unexplained but explained. But I'm wondering, is that also something that you commonly see in terms of they're having these symptoms and questioning whether it means something serious is happening? Has that been something that you see a lot of? Dr. Katie: Definitely. I think the first time someone has a hot flash, it can be extremely distressing. It's a very uncomfortable sensation. I think there are other changes that happen during perimenopause that, of course, I think, raise concern. We know that in addition to night sweats, people can just have general aches and pains. They can have headaches. Cognitive complaints can be very common during this time. Just this feeling of brain fog, not feeling as sharp as one used to be. They can have sleep disturbances, which can of course worsen the anxiety and the cognitive complaints, and the depression. I think there can be a myriad of symptoms. Other distressing symptoms, I'm not sure if they necessarily-- I think if you know what's going on, it's not quite as distressing, but there can be these urogenital symptoms, like vaginal dryness, vaginal burning. There can be recurrent UTIs, there can be difficulty with urination. There are this constellation of symptoms that I'm sure could trigger health anxiety in people, especially if they have preexisting health anxiety. WHAT TREATMENTS ARE AVAIALBLE TO HELP THOSE WHO ARE SUFFERING FROM MENOPAUSE (OR PERIMENOPAUSE) AND ANXIETY AND DEPRESSION? Kimberley: Yeah, absolutely. Someone's listened to this episode so they're at least informed, which is wonderful. They start to see enough evidence that this may be what is going on for them. What would be the steps following that? Is it something that you just go through and like a fever, you just ride it out kind of thing? Or are there medications or treatments? What would you suggest someone do in the order as they go through it? Dr. Katie: I think it depends on what's going on and how they're experiencing it. If this is distressing, life interfering, if they're having trouble functioning, they should absolutely seek treatment. I think there are a few different things they can do depending on what's going on. For depression and anxiety, medications are the first line. Antidepressants would still be the first-line therapy there. There's some evidence for menopausal hormone therapy, but there's not really enough. There is evidence for menopausal hormone therapy, but it's not currently first line for depression or anxiety. If someone had treatment-resistant depression that came up in the perimenopausal transition, I think it's reasonable to consider menopausal hormone therapy. But currently, menopausal hormone therapy isn't really recommended for that. If someone is having distressing vasomotor symptoms with night sweats and recurrent hot flashes or hot flushes during the day, menopausal hormone therapy is a very good option. That is something to consider. They could go talk to their OB-GYN about it. Certain people will be candidates for it and other people might not. If you think it might be something you're interested in, I recommend going and speaking to your OB-GYN sooner rather than later. Antidepressants themselves can also help with vasomotor symptoms as well. They can specifically help with hot flashes and night sweats. If someone has depression and anxiety and hot flashes and night sweats, antidepressant can be a really good choice because it can help with both of those. There was a really interesting study that compared Lexapro to menopausal hormone therapy for hot flashes, for quality of life, for sleep, and for depression. Essentially, both of them helped sleep quality of life in vasomotor symptoms, but only the Lexapro helped the depression. It really just depends on what's going on. I think another thing that we've also talked about is therapy. This can be a big life transition. I think really no woman going through menopause is the same. Some people have toddlers. Some people have grown children who have just left their home. Some people are just starting their career. Some people are about to retire. Relationships can change. I think that it's really important to take what's going on in the context of a woman's life. I think therapy can be really helpful to help them process and understand what they're going through. Kimberley: Right. You had mentioned before, and I just wanted to touch on this, vaginal drying and stuff like that, which I'm sure, again, a reason for this series is just how much sexual intimacy and so forth can impact somebody's satisfaction in life or functioning or in relationships. Is that something that is also treatable with these different treatment models or is there a different treatment for that? Dr. Katie: With menopausal hormone therapy, when someone has hot flashes or these other symptoms that we were talking about, not the urogenital ones, they need to take systemic menopausal hormone therapy. They basically need estrogen and progesterone to go throughout their body. When someone is just having these urogenital symptoms, they can often use topical vaginal estrogen. It's applied vaginally. That can be really helpful for those symptoms as well. I think if that's something that someone is struggling with that they want treatment for, it's very reasonable to go talk to their OB-GYN about it because there are therapies that can be-- Kimberley: Right, that's like a cream or lotion kind of thing. Dr. Katie: Exactly. Kimberley: Interesting. Oh wow. All right. That is so helpful. We've talked about the medical piece, the medication piece. A lot of people also I see on social media mostly talk about these more-- I don't want to use the word "natural" because I don't like that word "natural." I don't even know what word I would use, but non-medical-- Dr. Katie: Like supplements or-- Kimberley: Yeah. I know it's different for everyone and everyone listening should please seek a doctor for medical advice, but is that something that you talk about with patients or do you stick more just to the things that have been researched? What are your thoughts? Dr. Katie: I think that supplements can be helpful for some people. I don't always find that they're as effective as medications. If someone is really struggling on a day-to-day basis, I do think that using treatments that have more evidence behind them is better. I think that there are some supplements that have a little bit of evidence, but I do think that they come with their own risks. Because supplements aren't regulated by the FDA and things like that, I don't typically recommend them. I think if someone is interested in finding a more naturopathic doctor who might be able to talk to them about those things is reasonable. Kimberley: Super helpful. Is there anything that you feel like we haven't covered or that would be important for us to really drill home and make sure we point out here at the end before we finish up? Dr. Katie: I think we've covered a lot. I think that the most important thing that I really want to stress is this is a normal part of aging. This is not a disease; this is not a disease state. Also, there are treatments that can be so effective. You don't have to struggle in silence. It is not something shameful. There are clinicians who are trained, who are able to help if these symptoms are coming up. Just not being afraid to go and talk about it and go reach out for help. I think that that can be so helpful and really life-changing for some people when they get the right treatment. Kimberley: Right. Thank you. Where can we hear about you, get in touch with you, maybe seek out your services? Dr. Katie: You can find me online. I have a website. It's just www.drkatiemd.com. It's D-R-K-A-T-I-E-M-D.com. You can follow me on Instagram on the same. If you're interested to see more of my talks and lectures, I often post those on my LinkedIn page. You can follow me on LinkedIn. I think if you are personally interested in learning more about menopause, there's a really great book by an OB-GYN, her name is Dr. Jen Gunter, and it's called The Menopause Manifesto. For anybody who really wants to educate themselves about menopause and understand more about what's going on in their body and their treatments, I really recommend that book. Kimberley: Amazing. That's so good to have that resource as well. Thank you. I'm really, really honored. I know you're doing so many amazing things and running so many amazing programs. I'm so grateful for your time and your expertise on this. Dr. Katie: Of course. I'm so glad that you're doing a podcast on this. I think this is a topic that we really need more information and education out there. Kimberley: Yeah. Thank you.

Apr 21, 2023

Welcome. This is Week 4 of the Sexual Health and Anxiety Series. I have loved your feedback about this so far. I have loved hearing what is right for you, what is not right for you, getting your perspective on what can be so helpful. A lot of people are saying that they really are grateful that we are covering sexual health and anxiety because it's a topic that we really don't talk enough about. I think there's so much shame in it, and I think that that's something we hopefully can break through today by bringing it into the sunlight and bringing it out into the open and just talking about it as it is, which is just all good and all neutral, and we don't need to judge. Let's go through the series so far. In Episode 1 of the series, we did sexual anxiety or sexual performance anxiety with Lauren Fogel Mersy. Number two, we did understanding arousal and anxiety. A lot of you loved that episode, talking a lot about understanding arousal and anxiety . Then last week, we talked about the sexual side effects of anxiety and depression medication or antidepressants with Dr. Sepehr Aziz. That was such a great episode. This week, we're talking about sexual intrusive thoughts. The way that I structured this is I wanted to first address the common concerns people have about sexual health and intimacy and so forth. Now I want to talk about some of the medical pieces and the human pieces that can really complicate things. In this case, it's your thoughts. The thoughts we have can make a huge impact on how we see ourselves, how we judge ourselves, the meaning we make of it, the identity we give it, and it can be incredibly distressing. My hope today is just to go through and normalize all of these experiences and thoughts and presentations and give you some direction on where you can go from there. Because we do know that your thoughts, as we discussed in the second episode, can impact arousal and your thoughts can impact your sexual anxiety. SEXUAL OCD OBSESSIONS Let's talk a little bit today about specific sexual intrusive thoughts . Now, sexual intrusive thoughts is also known as sexual obsessions. A sexual obsession is like any other obsession, which is, it is a repetitive, UNWANTED—and let's emphasize the unwanted piece—sexual thought. There are all different kinds of sexual intrusive thoughts that you can have. For many of you listening, you may have sexual intrusive thoughts and OCD that get together and make a really big mess in your mind and confuse you and bring on doubt and uncertainty, and like I said before, make you question your identity and all of those things. In addition to these intrusive thoughts, they often can feel very real. Often when people have these sexual intrusive thoughts, again, we all have intrusive thoughts, but if they're sexual in nature, when they're accompanied by anxiety, they can sometimes feel incredibly real, so much so that you start to question everything. SEXUAL SENSATIONS Now, in addition to having sexual intrusive thoughts, some of you have sexual sensations, and we talked a little bit about this in previous episodes. But what I'm really speaking about there is sensations that you would often feel upon arousal. The most common is what we call in the OCD field a groinal response . Some people call it the groinal in and of itself, which is, we know again from previous episodes that when we have sexual thoughts or thoughts that are sexual in nature, we often will feel certain sensations of arousal, whether that be lubrication, swelling, tingling, throbbing. You might simply call it arousal or being turned on. And that is where a lot of people, again, get really confused because they're having these thoughts that they hate, they're unwanted, they're repetitive, they're impacting their life, they're associated with a lot of anxiety and uncertainty, and doubt. And then, now you're having this reaction in your body too, and that groinal response can create a heightened need to engage in compulsions. As we know—we talk about this in ERP School , our online course for OCD; we go through this extensively—when someone has an obsession, a thought, an intrusive thought, it creates uncertainty and anxiety. And then naturally what we do is we engage in a compulsion to reduce or remove that discomfort to give them a short-term sense of relief. But then what ends up happening is that short-term relief ends up reinforcing the original obsession, which means you have it more, and then you go back through the cycle. You cycle on that cycle over and over again. It gets so big. It ends up impacting your life so, so much. INTRUSIVE SEXUAL URGES Now, let's also address while we're here that a lot of you may have intrusive sexual urges. These are also obsessions that we have when you have OCD or OCD-related disorders where you feel like your body is pulling you towards an action to harm someone, to do a sexual act, to some fantasy. You're having this urge that feels like your body is pulling you like a magnet towards that behavior. Even if you don't want to do that behavior, or even if that behavior disgusts you and it doesn't line up with your values, you may still experience these sexual OCD urges that really make you feel like you're on the cusp of losing control, that you may snap and do that behavior. This is how impactful these sexual intrusive thoughts can be. This is how powerful they can be in that they can create these layers upon layers. You have the thoughts, then you have the feelings, then you have the sensations, you also have the urges. Often there's a lot of sexual intrusive images as well, like you see in front of you, like a projector, the image happening or the movie scene playing out that really scares you, concerns you, and so forth. And then all of those layers together make you feel absolutely horrible, terrified, so afraid, so unsure of what's happening in and of yourself. TYPES OF SEXUAL OCD OBSESSIONS Let's talk about some specific OCD obsessions and ways in which this plays out. Now, in the OCD field, we call them subtypes. Subtypes are different categories we have of obsessions. They don't collect all of them. There are people who have a lot of obsessions that don't fall under these categories, but these subtypes usually include groups of people who experience these subtypes. The reason we do that is, number one, it can be very validating to know that other people are in that subgroup. Number two, it can also really help inform treatment when we have a specific subtype that we know what's happening, and that can be very helpful and reduce the shame of the person experiencing them. 1. SEXUAL ORIENTATION OBSESSIONS OR SEXUAL ORIENTATION OCD It used to be called homosexual OCD. That was because predominantly people who were heterosexual were reporting having thoughts or sexual intrusive thoughts about their sexual orientation—am I gay, am I straight—and really struggling with having certainty about this. Again, now that we're more inclusive and that I think a lot more people are talking about sexuality, that we have a lot less shame, a lot more education, we scrapped the homosexual OCD or homosexual obsessions or subtype category. Now we have a more inclusive category, which is called sexual orientation OCD . That can include any body of any sexual orientation who has doubt and uncertainty about that. Now remember when we started, we talked about the fact that sexual intrusive thoughts are usually unwanted, they're repetitive and they don't line up with our values. What we are not talking about here is someone who is actually questioning their sexual orientation. I know a lot of people are. They're really exploring and being curious about different orientations that appeal to them. That's way different to the people who have sexual orientation OCD or sexual orientation obsessions. People with OCD are absolutely terrified of this unknown answer, and they feel an incredible sense of urgency to solve it. If you experience this, you may actually want to listen back. We've got a couple of episodes on this in the past. But it's really important to understand and we have to understand the nuance here that as you're doing treatment, we are very careful not to just sweep people under the rug and say, "This is your OCD," because we want to be informed in knowing that, okay, you also do get to question your sexual orientation. But if it is a presentation of sexual orientation OCD, we will treat it like that and we will be very specific in reducing the compulsions that you're engaging in so that you can get some relief. That is the first one. 2. SEXUAL INTRUSIVE THOUGHTS ABOUT FAMILY OR SEXUAL INTRUSIVE THOUGHTS ABOUT INCEST Incest sexual OCD or that type of subtype is another very common one. But often, again, one that is not talked about enough in fear of being judged, in fear of having too much shame, in fear of being reported. When people have these types of obsessions, they often will have a thought like, "What if I'm attracted to my dad?" Or maybe they're with their sibling and they experience some arousal for reasons they don't know. Again, we talked about this in the arousal and anxiety episode, so go back and listen to that if you didn't. They may experience that, and that is where they will often say, "My brain broke. I feel like I had to solve that answer. I had to figure it out. I need to get complete certainty that that is not the case, and I need to know for sure." The important thing to remember here is a lot of my patients, I will see and they may have some of these sexual intrusive thoughts, but their partners will say, "Yeah, I've had the same thoughts." It's just that for the person without OCD, they don't experience that same degree of distress. They blow it off. It doesn't really land in their brain. It's just like a fleeting thought. Whereas people with OCD, it's like the record got stuck and it's just repeating, repeating, repeating. The distress gets higher. The doubt and uncertainty get higher. Therefore, because of all of this bubbling kettle happening, there's this really strong urgency to relieve it with compulsions. 3. SEXUAL INTRUSIVE THOUGHTS ABOUT GOD OR ABOUT A RELIGIOUS LEADER This is one that's less common, or should I say less commonly reported. We actually don't have evidence of how common it is. I think a lot of people have so much shame and are so afraid of sinning and what that means that they may even not report it. But again, this is no different to having thoughts of incest, but this one is particularly focused on having sexual thoughts about God and needing to know what that means and trying to cleanse themselves of their perceived sin, of having that intrusive thought. It can make them question their religion. It can make them feel like they have to stop going to church. They may do a ton of compulsive prayer. They may do a ton of reassurance with certain religious leaders to make sure that they're not sinning or to relieve them of that uncertainty and that distaste and distress. These are all very common symptoms of people who have sexual intrusive thoughts about God. 4. BESTIALITY OBSESSIONS These are thoughts about pets and animals, and it's very common. It's funny, as we speak, I am recording this with a three-pound puppy sitting on my lap. We just got a three-pound puppy. It is a Malti-Poo puppy dog, and he's the cutest thing you've ever seen. But it's true that when you have a dog, you're having to take care of its genitals and wipe it up and its feces and its urine and clean and all the things, and it's common to have sexual intrusive thoughts about your pet or about your dog or your cat. Some people, again, with bestiality obsessions or bestiality OCD , have a tremendous repetitive degree of these thoughts. They're very distressing because they love their dog. They would never do anything to hurt their dog, but they can't stop having these thoughts or these feelings or these sensations, or even these urges. Again, all these presentations are the same, it's just that the content is different. We treat them the same when we're discussing it, but we're very careful with addressing the high level of shame and embarrassment, humiliation, guilt that they have for these thoughts. Guilt is a huge one with these sexual obsessions. People often feel incredibly guilty as if they've done something wrong for having these obsessions. These are a few. 5. PEDOPHILIA OBSESSIONS Now, for someone who has intrusive sexual thoughts and feelings and sensations and urges about children ( POCD ), they tend to be, in my experience, the most distressed. They tend to be, when I see them, the ones who come in absolutely completely taken over with guilt and shame. A lot of the time, they will have completely removed themselves from their child. They feel they're not responsible. They won't go near the parks. They won't go to family's birthday parties. They're so insistent on trying to never have these thoughts. Again, I understand. I don't blame them. But as we know, the more you try not to have a thought, what happens? The more you have it. The more you try and suppress a thought, the more you have it. That can get people in a very stuck cycle. SEXUAL OCD COMPULSIONS Let's move on now to really address different sexual OCD compulsions. Now, for all sexual obsessions, or what I should say is, for all obsessions in general, there are specific categories of compulsions and these are things again that we do to reduce or remove the discomfort and certainty, dread, doubt, and so forth. 1. Trigger Avoidance This is where you avoid the thing that may trigger your obsession or thought. Avoiding your dog, avoiding your child, avoiding your family member, avoiding people of the sexual orientation that you're having uncertainty about. 2. Actual Sex Avoidance We talked about that in the first episode. We talked a lot about how people avoid sex because of the anxiety that being intimate and sexual causes. 3. Mental Rumination This is a really common one for sexual intrusive thoughts because you just want to solve like why am I having it? What does it mean? You might be ruminating, what could that mean? And going over and over and over that a many, many time. 4. Mental Checking What you can also be doing here is checking for arousal. Next time you're around, let's say, a dog and you have bestiality obsessions, you might check to see if you're aroused. But just checking to see if you're aroused means that you get aroused. Now that you're aroused, you're now checking to see what that means and trying to figure that out and you're very distressed. We can see how often the compulsion that the person does actually triggers more and more and more distress. It may provide you a moment or a fleeting moment of relief, but then you actually have more distress. It usually brings on more uncertainty. We know that the more we try and control life, the more out of control we feel. That's a general rule. That's very much the case for these types of obsessive thoughts. 5. Pornography Use A lot of people who have sexual orientation OCD in particular, but any of these, they may actually use pornography as a way to get reassurance that they are of a certain sexual orientation, that they are not attracted to the orientation that they're having uncertainty about, or they're not attracted to animals or God or a family member because they were aroused watching pornography. That becomes a form of self-reassurance. There's two types of reassurance. One is reassurance where we go to somebody else and say, "Are you sure I wouldn't do that thing? Are you sure that thing isn't true? Are you sure I don't have that? I'm not that bad a person?" The other one is really giving reassurance to yourself, and that's a very common one with pornography use. SEXUAL INTRUSIVE THOUGHTS PTSD There are some sexual intrusive thought examples, including specific obsessions and subtypes, and also compulsions. But one sexual intrusive thought example I also wanted to address is not OCD-related; it's actually related to a different diagnosis, which is called PTSD (post-traumatic stress disorder). Often for people who have been sexually assaulted or molested, they too may experience sexual intrusive thoughts in the form of memories or images of what happened to them or what could have happened to them. Maybe it's often some version of what happened to them, and that is a common presentation for PTSD. If you are experiencing PTSD, usually, there is a traumatic event that is related to the obsession or the thoughts. They usually are in association or accompanied by flashbacks. There are many other symptoms. I'm not a PTSD specialist, but there's a high level of distress, many nightmares. You may have flashbacks, as I've said. Panic is a huge part of PTSD as well. That is common. If you have had a traumatic event, I would go and see a specialist and help them to make sure that they've diagnosed you correctly so that you can get the correct care. SEXUAL INTRUSIVE THOUGHTS TREATMENT If you have OCD and you're having some of these sexual intrusive thoughts, the best treatment for you to go and get immediately is Exposure and Response Prevention. This is a particular type of cognitive behavioral therapy where you can learn to change your reaction, break yourself out of that cycle of obsessions, anxiety, compulsions, and then feed yourself back into the loop around and around. You can break that cycle and return back to doing the things you want and have a different reaction to the thoughts that you have. PEOPLE ASK HOW TO STOP SEXUAL INTRUSIVE THOUGHTS? Often people will come to me and say, "How do I stop these sexual intrusive thoughts?" I will quickly say to them, "You don't. The more you try and stop them, the more you're going to have. But what we can do is we can act very skillfully in intervening, not by preventing the thoughts, but by changing how we relate and respond to those thoughts." For those of you who don't know, I have a whole course on this called ERP School. ERP is for Exposure and Response Prevention . I'll show you how you can do this on your own, or you can reach out to me and we can talk about whether if you're in the states where we're licensed, one of my associates can help you one-on-one. If you're not in a state where I belong, reach out to the IOCDF and see if you can find someone who treats OCD using ERP in your area. Because the truth is, you don't have to suffer having these thoughts. There is a treatment to help you manage these thoughts and help you be much more comfortable in response to those thoughts. Of course, the truth here is you're never going to like them. Nobody likes these thoughts. The goal isn't to like them. The goal isn't to make them go away. The goal isn't to prove them wrong even; it's just to change your reaction to one that doesn't keep that cycle going. That is the key component when it comes to sexual intrusive thoughts treatment or OCD treatment . That's true for any subtype of OCD because there are many other subtypes as well. That's it, guys. I could go on and on and on and on about this, but I want to be respectful of your time. The main goal again is just to normalize that these thoughts happen. For some people, it happens more than others. The goal, if you can take one thing away from today, it would be, try not to assign meaning to the duration and frequency of which you have these thoughts. Often people will say, "I have them all day. That has to mean something." I'm here to say, "Let's not assign meaning to these thoughts at all. Thoughts are thoughts. They come and they go. They don't have meaning and we want to practice not assigning meaning to them so we don't strengthen that cycle." I hope that was helpful for you guys. I know it was a ton of information. I hope it was super, super helpful. I am so excited to continue with this. Next week, we are talking about menopause and anxiety, which we have an amazing doctor again. I want to talk about things with people who are really skilled in this area. We have a medical doctor coming on talking about menopause and the impact of anxiety. And then we're going to talk about PMS and anxiety, and that will hopefully conclude our sexual health and anxiety series. Thank you so much for being here. I love you guys so much. Thank you from me and from Theo, our beautiful little baby puppy. I will see you next week.

Apr 14, 2023

Hello and welcome back everybody. We are on Week 3 of the Sexual Health and Anxiety Series. At first, we talked with the amazing Lauren Fogel Mersy about sexual anxiety or sexual performance anxiety. And then last week, I went into depth about really understanding arousal and anxiety , how certain things will increase arousal, certain things will decrease it, and teaching you how to get to know what is what so that you can have a rich, intimate, fulfilling life. We are now on Week 3. I have to admit, this is an episode that I so have wanted to do for quite a while, mainly because I get asked these questions so often and I actually don't know the answers. It's actually out of my scope. In clinical terms, we call it "out of my scope of practice," meaning the topic we're talking about today is out of my skill set. It's out of my pay grade. It's out of my level of training. What we're talking about this week is the sexual side effects of antidepressants or anxiety medications, the common ones that people have when they are anxious or depressed. Now, as I said to you, this is a medical topic, one in which I am not trained to talk about, so I invited Dr. Sepehr Aziz onto the episode, and he does such a beautiful job, a respectful, kind, compassionate approach to addressing sexual side effects of anxiety medication, sexual side effects of depression medication. It's just beautiful. It's just so beautiful. I feel like I want to almost hand this episode off to every patient when I first start treating them, because I think so often when we're either on medication or we're considering medication, this is a really common concern, one in which people often aren't game to discuss. So, here we are. I'm actually going to leave it right to the doctor, leave it to the pro to talk all about sexual side effects and what you can do, and how you may discuss this with your medical provider. Let's do it. Kimberley: Welcome. I have been wanting to do this interview for so long. I am so excited to have with us Dr. Sepehr Aziz. Thank you so much for being here with us today. Dr. Aziz: Thanks for having me. Kimberley: Okay. I have so many questions we're going to get through as much as we can. Before we get started, just tell us a little about you and your background, and tell us what you want to tell us. Dr. Aziz: Sure. Again, I'm Dr. Sepehr Aziz. I go by "Shepherd," so you can go ahead and call me Shep if you'd like. I'm a psychiatrist. I'm board certified in general adult psychiatry as well as child and adolescent psychiatry by the American Board of Psychiatry and Neurology. I completed medical school and did my residency in UMass where they originally developed mindfulness-based CBT and MBSR. And then I completed my Child and Adolescent training at UCSF. I've been working since then at USC as a Clinical Assistant Professor of Psychiatry there. I see a lot of OCD patients. I do specialize in anxiety disorders and ADHD as well. Kimberley: Which is why you're the perfect person for this job today. Dr. Aziz: Thank you. WHAT ARE THE BEST MEDICATIONS FOR PEOPLE WITH ANXIETY & OCD (IN GENERAL)? Kimberley: I thank you so much for being here. I want to get straight into the big questions that I get asked so regularly and I don't feel qualified to answer myself. What are the best medications for people with anxiety and OCD? Is there a general go-to? Can you give me some explanation on that? Dr. Aziz: As part of my practice, I first and foremost always try to let patients know that the best treatment is always a combination of therapy as well as medications. It's really important to pursue therapy because medications can treat things and they can make it easier to tolerate your anxiety, but ultimately, in order to have sustained change, you really want to have therapy as well. Now, the first-line medications for anxiety and OCD are the same, and that's SSRIs or selective serotonin reuptake inhibitors. SNRIs, which are selective norepinephrine reuptake inhibitors, also work generally, but the best research that we have in the literature is on SSRIs, and that's why they're usually preferred first. There are other medications that also might work, but these are usually first-line, as we call it. There are no specific SSRIs that might work better. We've tried some head-to-head trials sometimes, but there's no one medication that works better than others. It's just tailored depending on the patient and the different side effects of the medication. SSRI'S VS ANTIDEPRESSANTS DEFINITION Kimberley: Right. Just so people are clear in SSRI, a lot of people, and I notice, use the term antidepressant. Are they synonymous or are they different? Dr. Aziz: Originally, they were called antidepressants when they first were released because that was the indication. There was an epidemic of depression and we were really badly looking for medications that would work. Started out with tricyclic antidepressants and then we had MAOIs, and then eventually, we developed SSRIs. These all fall under antidepressant treatments. However, later on, we realized that they work very well for anxiety in addition to depression. Actually, in my opinion, they work better for anxiety than they do for depression. I generally shy away from referring to them as antidepressants just to reduce the stigma around them a little bit and also to be more accurate in the way that I talk about them. But yes, they're synonymous, you could say. BEST MEDICATION FOR DEPRESSION Kimberley: Sure. Thank you for clearing that up because that's a question I often get. I know I led you in a direction away but you answered. What is the best medication for people with depression then? Is it those SSRIs or would you go-- Dr. Aziz: Again, these are first-line medications, which means it's the first medication we would try if we're starting medication, which is SSRIs. Other medications might also work like SNRIs again. For depression specifically, there are medications called serotonin modulators that are also effective such as vortioxetine or nefazodone, or vilazodone. But SSRIs are generally what people reach for first just because they've been around for a long time, they're available generic, they work, and there's no evidence that the newer medications or modulators work better. They're usually first line. Kimberley: Fantastic. Now you brought up the term "generic" and I think that that's an important topic because the cost of therapy is high. A lot of people may be wondering, is the generic as good as the non-generic options? Dr. Aziz: It really depends on the medication and it also depends on which country you're in. In the US, we have pretty strict laws as to how closely a generic has to be to a regular medication, a brand name medication, and there's a margin of error that they allow. The margin of error for generics is, I believe, a little bit higher than for the brand name. However, most of the time, it's pretty close. For something like Lexapro, I usually don't have any pressure on myself to prescribe the brand name over the generic. For something like other medications we use in psychiatry that might have a specific way that the brand name is released, a non-anxiety example is Concerta, which is for ADHD. This medication uses an osmotic release mechanism and that's proprietary. They license it out to one generic company, but that license is expiring. All those patients who are on that generic in the next month or two are going to notice a difference in the way that the medication is released. Unless you're a physician privy to that information, you might not even know that that's going to happen. That's where you see a big change. Otherwise, for most of the antidepressants, I haven't noticed a big difference between generic and brand names. Kimberley: Right. Super helpful. Now you mentioned it depends on the person. How might one decide or who does decide what medication they would go on? Dr. Aziz: It's really something that needs to be discussed between the person and their psychiatrist. There are a number of variables that go into that, such as what's worked in a family member in the past, because there are genetic factors in hepatic metabolism and things like that that give us some clue as to what might work. Or sometimes if I have a patient with co-occurring ADHD and I know they're going to be missing their medications a lot, I'm more likely to prescribe them Prozac because it has a longer half-life, so it'll last longer. If they miss a dose or two, it's not as big of a deal. If I have a patient who's very nervous about getting off of the medication when they get pregnant, I would avoid Prozac because it has a long half-life and it would take longer to come off of the medication. Some medications like Prozac and Zoloft are more likely to cause insomnia or agitation in younger people, so I'll take that into consideration. Some medications have a higher likelihood of causing weight loss versus weight gain. These are all things that would take into consideration in order to tailor it to the specific patient. Kimberley: Right. I think that's been my experience too. They will usually ask, do you have a sibling or a parent that tried a certain medication, and was that helpful? I love that question. I think it informs a lot of decisions. We're here really. The main goal of today is really to talk about one particular set of side effects, which is the sexual side effects of medication. In fact, I think most commonly with clients of mine, that tends to be the first thing they're afraid of having to happen. How common are sexual side effects? Is it in fact all hype or is it something that is actually a concern? How would you explain the prevalence of the side effects? Dr. Aziz: This is a really important topic, I just want to say, because it is something that I feel is neglected when patients are talking to physicians, and that's just because it can be uncomfortable to talk about these things sometimes, both for physicians and for patients. Oftentimes, it's avoided almost. But because of that, we don't know for sure exactly what the incidence rate is. The literature on this and the research on this is not very accurate for a number of reasons. There are limitations. The range is somewhere between 15 to 80% and the best estimate is about 50%. But I don't even like saying that because it really depends on age, gender, what other co-occurring disorders they have such as depression. Unipolar depression can also cause sexual dysfunction. They don't always take that into account in these studies. A lot of the studies don't ask baseline sexual function before asking if there's dysfunction after starting a medication, so it's hard to tell. What I can say for sure, and this is what I tell my patients, is that this sexual dysfunction is the number one reason why people stop taking the medication, because of adverse effects. WHAT MEDICATIONS ARE MORE PRONE TO SEXUAL SIDE EFFECTS? Kimberley: Right. It's interesting you say that we actually don't know, and it is true. I've had clients say having anxiety has sexual side effects too, having depression has sexual side effects too, and they're weighing the pros and cons of going on medication comparative to when you're depressed, you may not have any sexual drive as well. Are some medications more prone to these sexual side effects? Does that help inform your decision on what you prescribe because of certain meds? Dr. Aziz: Yeah. I mean, the SSRIs specifically are the ones that are most likely to cause sexual side effects. Technically, it's the tricyclics, but no one really prescribes those in high doses anymore. It's very rare. They're the number one. But in terms of the more commonly prescribed antidepressants and anti-anxiety medications among the SSRIs and the SNRIs and the things like bupropion and the serotonin modulators we talked about, the SSRIs are most likely to cause sexual dysfunction. Kimberley: Right. Forgive me for my lack of knowledge here, I just want to make sure I'm understanding this. What about the medications like Xanax and the more panic-related medications? Is that underneath this category? Can you just explain that to me? Dr. Aziz: I don't usually include those in this category. Those medications work for anxiety technically, but in current standard practice, we don't start them as an initial medication for anxiety disorders because there's a physical dependency that can occur and then it becomes hard to come off of the medication. They're used more for panic as an episodic abortive medication when someone is in the middle of a panic attack, or in certain cases of anxiety that's not responding well to more conventional treatment, we'll start it. We'll start it on top of or instead of those medications. They can cause sexual side effects, but it's not the same and it's much less likely. SEXUAL SIDE EFFECTS OF MEDICATION FOR MEN VS WOMEN Kimberley: Okay. Very helpful. Is it the same? I know you said we don't have a lot of data, and I think that's true because of the stigma around reporting sexual side effects, or even just talking about sex in general. Do we have any data on whether it impacts men more than women? Dr. Aziz: The data shows that women report more sexual side effects, but we believe that's because women are more likely to be treated with SSRIs. When we're looking at the per capita, we don't have good numbers in terms of that. In my own practice, I'd say it's pretty equal. I feel like men might complain about it more, but again, I'm a man and so it might just be a comfort thing of reporting it to me versus not reporting. Although I try to be good about asking before and after I start medication, which is very important to do. But again, it doesn't happen all the time. Kimberley: Yeah, it's interesting, isn't it? Because from my experience as a clinician, not a psychiatrist, and this is very anecdotal, I've heard men because of not the stigma, but the pressure to have a full erection and to be very hard, that there's a certain masculinity that's very much vulnerable when they have sexual side effects—I've heard that to be very distressing. In my experience. I've had women be really disappointed in the sexual side effects, but I didn't feel that... I mean, that's not really entirely true because I think there's shame on both ends. Do you notice that the expectations on gender impacts how much people report or the distress that they have about the sexual side effects? Dr. Aziz: Definitely. I think, like you said, men feel more shame when it comes to sexual side effects. For women, it's more annoyance. We haven't really talked about what the sexual side effects are, but that also differs between the sexes. Something that's the same between sexes, it takes longer to achieve orgasm or climax. In some cases, you can't. For men, it can cause erectile dysfunction or low libido. For women, it can also cause low libido or lack of lubrication, which can also lead to pain on penetration or pain when you're having sex. These are differences between the sexes that can cause different reporting and different feelings, really. Kimberley: Right. That's interesting that it's showing up in that. It really sounds like it impacts all the areas of sexual playfulness and sexual activity, the arousal, the lubrication. That's true for men too, by the sounds of it. Is that correct? Dr. Aziz: Yeah. Kimberley: We've already done one episode about the sexual performance anxiety, and I'm sure it probably adds to performance anxiety when that's not going well as well, correct? Dr. Aziz: It's interesting because in my practice, when I identify that someone is having sexual performance anxiety or I feel like somebody, especially people with anxiety disorders, if I feel like they have vulvodynia, which means pain on penetration—if I see they have vulvodynia and I feel that this is because of the anxiety, oftentimes the SSRI might improve that and cause greater satisfaction from sex. It's a double-edged sword here. COMMON SEXUAL SIDE EFFECTS OF ANTIDEPRESSANTS Kimberley: Yeah. Can you tell me a little more about What symptoms are they having? The pain? What was it called again? Dr. Aziz: Vulvodynia. Kimberley: Is that for men and women? Just for women, I'm assuming. Dr. Aziz: Just from vulva, it is referring to the outside of the female genitalia. Especially when you have a lack of lubrication or sometimes the muscles, everyone with anxiety knows sometimes you have muscle tension and there are a lot of complex muscles in the pelvic floor. Sometimes this can cause pain when you're having sex. There are different ways to address that, but SSRIs sometimes can improve that. Kimberley: Wow. It can improve it, and sometimes it can create a side effect as well, and it's just a matter of trial and error, would you say? Dr. Aziz: It's a delicate balance because these side effects are also dose-dependent. It's not like black or white. I start someone on 5 milligrams, which is a child's dose of Lexapro. Either they have sexual side effects or don't. They might not have it on 5, and then they might have it a little bit on 10, and then they get to 20 and they're like, "Doctor, I can't have orgasms anymore." We try to find the balance between improving the anxiety and avoiding side effects. SEXUAL SIDE EFFECTS TREATMENT Kimberley: You're going right into the big question, which is, when someone does have side effects, is it the first line of response to look at the dose? Or how would you handle a case if someone came to you first and said, "I'm having sexual side effects, what can we do?" Dr. Aziz: Again, I'm really thorough personally. Before I even seem to start a medication, I'll ask about libido and erectile dysfunction and ability to climax and things like that, so I have a baseline. That's important when you are thinking about making a change to someone's medications. The other thing that's important is, is the medication working for them? If they haven't seen a big difference since they started the medication, I might change the medication. If they've seen an improvement, now there's a pressure on me to keep the medication on because it's working and helping. I might augment it with a second medication that'll help reverse the sexual side effects or I might think about reducing the dose a little bit while maintaining somewhere in the therapeutic zone of doses or I might recommend, and I always recommend non-pharmacological ways of addressing sexual side effects. You always do that at baseline. Kimberley: What would that be? Dr. Aziz: There's watchful waiting. Sometimes if you just wait and give it some time, these symptoms can get better. I'm a little more active than that. I'll say it's not just waiting, but it's waiting and practicing, whether that's solo practice or with your partner. Sometimes planning sex helps, especially if you have low libido. There's something about the anticipation that can make someone more excited. The use of different aids for sex such as toys, vibrators, or pornography, whether that's pornographic novels or imagery, can sometimes help with the libido issues and also improve satisfaction for both partners. The other thing which doesn't have great research, but there is a small research study on this, and not a lot of people know about this, but if you exercise about an hour before sex, you're more likely to achieve climax. This was specifically studied in people with SSRI-related anorgasmia. Kimberley: Interesting. I'm assuming too, like lubricants, oils, and things like that as well, or? Dr. Aziz: For lubrication issues, yes. Lubricants, oils, and again, you really have to give people psychoeducation on which ones they have to use, which ones they have to avoid, which ones interact with condoms, and which ones don't. But you would recommend those as well. Kimberley: Is it a normal practice to also refer for sex therapy? If the medication is helping their symptoms, depression, anxiety, OCD, would you ever refer to sex therapy to help with that? Is that a standard practice or is that for specific diagnoses, like you said, with the pain around the vulva and so forth? Dr. Aziz: Absolutely. A lot of the things I just talked about are part of sex therapy and they're part of the sexual education that you would receive when you go to a sex therapist. I happen to be comfortable talking about these things, and I've experienced talking about it. When I write my notes, that would fall under me doing therapy. But a lot of psychiatrists would refer to a sex therapist. Hopefully, there are some in the town nearby where someone is. It's sometimes hard to find someone that specializes in that. Kimberley: Is there some pushback with that? I mean, I know when I've had patients and they're having some sexual dysfunction and they do have some pushback that they feel a lot of shame around using vibrators or toys. Do you notice a more willingness to try that because they want to stay on the meds? Or is it still very difficult for them to consider trying these additional things? Are they more likely to just say, "No, the meds are the problem, I want to go off the medication"? Dr. Aziz: It really depends on the patient. In my population that I see, I work at USC on campus, so I only see university students in my USC practice. My age group is like 18 to 40. Generally, people are pretty receptive. Obviously, it's very delicate to speak to some people who have undergone sexual trauma in the past. Again, since I'm a man, sometimes speaking to a woman who's had sexual trauma can be triggering. It's a very delicate way that you have to speak and sometimes there's some pushback or resistance. It can really be bad for the patient because they're having a problem and they're uncomfortable talking about it. There might be a shortage of female psychiatrists for me to refer to. We see that. There's also a portion of the population that's just generally uncomfortable with this, especially people who are more religious might be uncomfortable talking about this and you have to approach that from a certain angle. I happen to also be specialized in cultural psychiatry, so I deal with these things a lot, approaching things from a very specific cultural approach, culturally informative approach. Definitely, you see resistance in many populations. Kimberley: I think that that's so true. One thing I want to ask you, which I probably should have asked you before, is what would you say to the person who wants to try meds but is afraid of the potential of side effects? Is there a certain spiel or way in which you educate them to help them understand the risks or the benefits? How do you go about that for those who there's no sexual side effects, they're just afraid of the possibility? Dr. Aziz: As part of my practice, I give as much informed consent to my patients as I can. I let them know what might happen and how that's going to look afterwards. Once it happens, what would we do about it if it happened? A lot of times, especially patients with anxiety, you catastrophize and you feel this fear of some potential bad thing happening, and you never go past that. You never ask yourself, okay, well now let's imagine that happens. What happens next? I tell my patients, "Yeah, you might have sexual dysfunction, but if that happens, we can reduce the medications or stop them and they'll go away." I also have to tell my patients that if they search the internet, there are many people who have sexual side effects, which didn't go away, and who are very upset about it. This is something that is talked about on Reddit, on Twitter. When my patients go to Dr. Google and do their research, they often get really scared. "Doctor, what if this happens and it doesn't go away?" I always try to explain to them, I have hundreds of patients that I've treated with these medications. In my practice, that's never happened. As far as I know from the literature, there are no studies that show that there are permanent dysfunctions sexually because of SSRIs. Now, like I said, the research is not complete, but everything that I've read has been anecdotal. My feeling is that if you address these things in the beginning and you're diligent in asking about the side effects of baseline sexual function beforehand and you are comfortable talking with your patients about it, you can avoid this completely. That's been my experience. When I explain that to my patients, they feel like I have their back, like they're protected, like I'm not just going to let them fall through the cracks. That has worked for me very well. Kimberley: Right. It sounds like you give them some hope too, that this can be a positive experience, that this could be a great next step. Dr. Aziz: Yeah, absolutely. Kimberley: Thank you for bringing up Dr. Google, because referring to Reddit for anything psychologically related is not a great idea, I will say. Definitely, when it comes to medications, I think another thing that I see a lot that's interesting on social media is I often will get dozens of questions saying, "I heard such and such works. Have your clients taken this medication? I heard this medication doesn't work. What's your experience?" Or if I've told them about my own personal experience, they want to know all about it because that will help inform their decision. Would you agree, do not get your information from social media or online at all? Dr. Aziz: I have patients who come to me and they're like, "My friend took Lexapro and said it was the worst thing in the world, and it may or not feel any emotions." I'm explaining to them, I literally have hundreds of patients, hundreds that I prescribe this to, and I go up and down on the dose. I talk to them about their intimate lives all day. But for some reason, and it makes sense, the word of their friend or someone close to them, really, carries a lot of weight. Also, I don't want to discount Reddit either, because I feel like it's as a support system and as a support group. I find other people who have gone through what you've gone through. It's very strong. Even pages like-- I don't want to say the page, but there's a page that's against psychiatry, and I peruse this page a lot because I have my own qualms about psychiatry sometimes. I know the pharmaceutical companies have a certain pressure on themselves financially, and I know hospitals have a certain pressure on themselves. I get it. I go on the page and there's a lot of people who have been hurt in the past, and it's useful for patients to see other people who share that feeling and to get support. But at the same time, it's important to find providers that you can trust and to have strong critical thinking skills, and be able to advocate for yourself while still listening to somebody who might have more information than you. Kimberley: I'm so grateful you mentioned that. I do think that that is true. I think it's also what I try to remember when I am online. The people who haven't had a bad experience aren't posting on Reddit. They're out having a great time because it helped, the medication helped them, and they just want to move on. I really respect those who have a bad experience. They feel the need to educate. But I don't think it's that 50% who gave a great experience are on Reddit either. Would you agree? Dr. Aziz: Right. Yeah. The people who are having great outcomes are not creating a Reddit page to go talk about it, right? Kimberley: Yeah. Thank you so much for answering all my questions. Is there a general message that you want to give? Maybe it's even saying it once over on something you've said before. What would be your final message for people who are listening? WHEN SSRIs IMPACTS YOUR SEX LIFE: ADVICE FROM DR AZIZ Dr. Aziz: I just want to say that when SSRI's impact your sex life , it's really important for psychiatry, and especially in therapy, that you feel comfortable sharing your experiences in that room. It should be a safe space where you feel comfortable talking about your feelings at home and what's going on in your intimate life and how things are affecting you. Your feelings, positive or negative towards your therapist or your psychiatrist, whether things they said made you uncomfortable, whether you feel they're avoiding something, that room should be a safe space for you to be as open as possible. When you are as open as possible, that's when you're going to get the best care because your provider, especially in mental health, needs to know the whole picture of what's going on in your life. Oftentimes, we are just as uncomfortable as you. And so, again, a lot of providers might avoid it because they're afraid of offending you by asking about your orgasms. As a patient, you take the initiative and you bring it up. It's going to improve your care. Try not to be afraid of bringing these things up. If you do feel uncomfortable for any reason, always let your provider know. I always tell my patients, I have a therapist. I pay a lot of money to see my therapist, and sometimes I tell him things I hate about him. He's a great therapist. He's psychoanalytic. Every time I bring something up, he brings it back to something about my dad. He's way older than me. But he's a great therapist. Every time I've brought something like that up, it's been a breakthrough for me because that feeling means something. That would be my main message to everyone listening. Kimberley: Thank you. I'm so grateful for your time and your expertise. Really, thank you. Can you tell us where people can get in touch with you, seek out your services, read more about you? Dr. Aziz: Sure. I work for OCD SoCal. I'm on the executive board, and that's the main way I like to communicate with people who see me on programs like this. You can always email me at S, like my first name, Aziz, that's A-Z-I-Z, @OCDSoCal.org. If you're a USC student, you can call Student Health and request to see me at the PBHS clinic. That's the Psychiatry and Behavioral Health Services clinic on campus at USC. Kimberley: They're lucky to have you. Dr. Aziz: Thank you. Kimberley: Yes. I love that you're there. Thank you so much for all of your expertise. I am so grateful. This has been so helpful.

Apr 7, 2023

Welcome back, everybody. We are on Episode 2 of the Sexual Health and Anxiety Series. Today, I will be the main host and main speaker for the episode, talking about arousal and anxiety . This is a topic that goes widely misunderstood, particularly in the OCD and anxiety field where people are having arousal that they can't make sense of. It's also very true of people with PTSD. They're having arousal that makes no sense to them, that confuses them, that increases anxiety, increases shame, increases guilt, and from there, it all becomes like a huge mess to them. It becomes incredibly painful, and it's just so messy they can't make sense of it. My hope with this episode is to help you understand the science behind arousal and the science behind arousal and anxiety so that you can move forward and manage your anxiety around arousal and manage your shame and guilt and sadness and grief around arousal, and have a better relationship with your body and with yourself and your soul. Now, these are more difficult conversations. I have talked about them in the past, and so I want you just to go into this really, really gentle, really open with con compassion and kindness, and curiosity. Your curiosity is going to help you immensely as you move through this series, as you move through some of the difficult conversations we're going to have, maybe a little bit embarrassing, humiliating, and so forth. Even me telling my kids that I'm so excited, I'm doing a series on sexual health, they're like, "Mom, you can't talk about that to other people." I'm like, "Yes, I can. We're going to talk about it. Hopefully, when you're old enough, you'll be able to listen to this and you'll be so glad that we're having conversations around this and taking the shame and stigma, and misinformation out of it." I'm going to go straight into the episode. This is our episode on understanding arousal and anxiety. We are going to come on next week talking about an entirely different subject about sexual health and intimacy, sex and anxiety , and arousal and anxiety. I am so excited. Stick around. Enjoy every bit of it. Take as many notes as you can, but please, please be kind to yourself. Let's get to the show. ANXIETY AND AROUSAL Let's get into the episode. Let me preface the episode by, we're talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she's off doing amazing things—Netflix specials, podcasts, vet documentaries. She's doing amazing things. Hopefully one day. But until then, I want to really highlight her as the genius behind a lot of these concepts. Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She's written two amazing books. Well, actually three or four, but the ones I'm referring to today is Come As You Are . It's an amazing book, but I'm actually in my hand holding The Come As You Are Workbook . I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It's got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it's so filled with amazing information and I'm going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come As You Are Workbook: A Practical Guide to The Science of Sex . The reason I love it is because it's so helpful for those who have anxiety. It's like she's speaking directly to us. She's like, "It's so helpful to have this context." Here's the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We're going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you're having arousal at particular times that concern you and confuse you, and alarm you. You could be one or both of those camps. Let's first talk about those who are struggling with arousal in terms of getting aroused. The thing I want you to think about is, commonly, this is true for any mental health issue too. It's true for depression, anxiety disorders, eating disorders, dissociative disorders—all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you're feeling fine about it, we all have what's called inhibitors and exciters. Here is an example: An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now, you're probably already feeling a ton of judgment here like, "I shouldn't be aroused by this, and I should be aroused by this. What if I'm aroused by this and I shouldn't be," and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I'll talk about this more, it's for reasons that don't make a lot of sense, and that's okay. SEXUAL INHIBITORS AND SEXUAL EXCITERS Let's talk about a sexual inhibitor —something that pumps the brakes on arousal or pleasure. It could be either. There's exciters, which are the things that are really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth. We have the content. The content may be, first, mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You're just so wiped out and you're so exhausted and your brain is foggy, and it's just like nothing. That would be, in my case, an inhibitor. I'm not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one. It could also be other physical health like headaches or tummy aches or, as we said before, depression. It could be hormone imbalances, things like that. It's all as important. Go and speak with your doctor. That's super important. Make sure medically everything checks out if you're noticing a dip or change in arousal, that's concerning you. The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don't like, that may pump the brakes. But if they smell a certain way that you do really like, and really is arousing to you, that may excite your arousal. It could also be the vibe of the relationship. A lot of people said, at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do, and there was all this spare time. All of a sudden, the vibe is like, that's what's happening. Now, this could be true for people who are in any partnership, or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you're not in a relationship as well, and that's totally fine. This is for all relationships. There's no specific kind. Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don't actually have a lot of research on that. But I'm sure there are some hormonal impacts for men as well. There's also ludic factors, which are like fantasy, whether you have a really strong imagination that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you're being touched. Sometimes there's certain areas of your body that will set off either the gas pedal or the brakes. It could be a certain foreplay. Again, really what I'm trying to get at here isn't breaking it down according to the workbook, but there's so many factors that may influence your arousal. SHAME AND SEXUAL AROUSAL Another one is environmental and cultural and shame. If arousal and the whole concept of sex was shamed or booked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. I want you to explore this not from a place of pulling it apart really aggressively and critically, but really curiously, and check in for yourself. What arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there's tons of worksheets for this, but you could also just consider this on your own. Write it down on your own. Be aware over the next several days or weeks, just jot down in a journal what you're noticing. Now, before we move on, we've talked about a lot of people who are struggling with arousal and they've got a lot of inhibitors and brake pushing. There are the other camps who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions, because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don't understand, that don't make sense to you or maybe go against your values. I've got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I'm quoting her and citing her throughout this whole podcast. She says: "Bodies do not say yes or no; they say sex-related or not sex-related." Let me say it again. "Bodies do not say yes or no; they say sex-related or not sex-related." This is where I want you to consider, and I've experienced this myself. Just because something arouses you doesn't mean it brings you pleasure—main point. We've got to pull them apart. SEXUAL OBSESSIONS & AROUSAL Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it. An example of this is, for people with sexual obsessions , maybe they have OCD or some other anxiety disorder and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD, or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes, because the context of it is that it's sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means, is not to try and resolve like, does that mean I like it? Does that mean I'm a terrible person? What does that mean? I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. THE GROINAL RESPONSE Let's talk about the groial resopsne. Again, the body doesn't say yes or no; they say either sex-related or not sex-related. Here's the funny thing, and I've done this experiment with my patients before, if you look at a lamp post or it could be anything. You could look at the pencil you're holding, and you think about, and then you bring to mind a sexual experience, you may notice arousal (or the groinal response ). Again, it doesn't mean that you're now aroused by pencils or pens; it's that it was labeled as sex-related. Often your brain will naturally press the accelerator. That's often how I educate people, particularly those who are having arousal that concern it. It's the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something, and then that concerns them, what does that mean about me? The thing to remember too is it's not your body saying yes or no; it's your body saying sex-related or not sex-related. It's important to just help remind yourself of that so that you're not responding to the content so much and getting caught up in compulsive behaviors. A lot of my patients in the past have reported, particularly during times when they're stressed, their anxiety is really high, life is difficult, any of this content we went through, they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don't understand. I think here, we want to practice, again, non-judgment. Instead, move to curiosity. There's probably some content that impacted that, which is, again, very, very normal. BETTER SEX THROUGH MINDFULNESS I'm talking with patients. I've done episodes on this in the past and we've in fact had sex therapists on the podcast in the past. They've said, if you've lost arousal, it doesn't mean you give up. It doesn't mean you say, "Oh, well, that's that." What you do is you move your attention to the content that pumps the gas. When I mean content, it's like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you're doing, whether it's with a partner or by yourself or whatever means that works for you. You can bring that back. Another amazing book is called Better Sex Through Mindfulness . It talks a lot about bringing your attention to one or two sensations. Touch and smell being two really, really great ones. Again, if your goal is to be aroused, you might find it's very hard to be aroused because the context of that is pressure. I don't know about you, but I don't really find pressure arousing. Some may, and again, this is where I want this to be completely judgment free. There is literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it's forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well, it's probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you're likely to spin out with anxiety. It's really no different. Here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought, actually in the context of that, does that actually pump the brakes? Because I know you're trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what's going on for you. Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, they're more like goal, like I have to do it this way. That often pumps the brakes. Keep an eye out for that. Engage in the exciters and get really mindful and present. A couple of things here. We've talked about erections. That's for people who struggle with that. It's also true for women and men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we've been misled to believe that if you're not lubricated, you mustn't be aroused or that you mustn't want this thing, or that there must be something wrong with you, and that is entirely not true. A lot of women, when we study them, may be really engaged and their gas pedal is going for it, but there may be no lubrication. It doesn't mean something is wrong in those cases. Often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant. I've talked to clients and they're so ashamed of that. But I think it's important to recognize that that's just because somebody taught us that, and sadly, it's a lot to do with patriarchy and that it was pushed on women in particular, that that meant they're like a good woman if they're really lubricated. That's not true. That's just fake, false, no science, has no basis in reality. Now we've talked about lubrication, we've talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can't reach orgasm. If for any reason you're struggling with this, please, I urge you, go and see a sex therapist. They are like the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often. What I want you to do, and this is your homework, is don't focus on arousal; focus on pleasure. Again, it's really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can and in the moment being aware of, ooh. Move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn't mean thought suppress, that doesn't mean judge your thoughts because that in and of itself is an inhibitor often. I want to leave you with that. I'm going to, in the future, do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I used: "The bodies don't say yes or no; they say sex-related or not sex-related." I'll do more of that in the future, but for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both. I'm not a sex therapist. Again, I'm getting all of this directly from the workbook, but most of the clients I've talked to about this, and we've used some worksheets and so forth, they've said, "When I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good, use it as a north star. You just keep following, that feels good. Okay, that feels good. That doesn't feel so great. I'll move towards what feels good"—moving in that direction non-judgmentally and curiously, they've had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus non-judgmentally and curiously, being aware of what's current and present in your senses. That's all I got for you for today. I think it's enough. Do we agree? I think it's enough. I could talk about this all day. To be honest, and I've said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I'll probably do it when I'm like 70. That will be awesome. I'll be down for that for sure. I just love this content. Again, I want to be really clear, I'm not a sex therapist and so I still have tons to learn. I still have. Even with what we've covered today, there's probably nuanced things that I could probably explain better, which is why I'm going to stress to you, go and check out the book. I was thinking about this. Remember I just recently did the episode on the three-day silent retreat and I was sitting in meditation. I remember this so clearly. I'm just going to tell you this quick story. For some reason, my mind was a little scattered this day and something came over with me where I was like, "Wouldn't it be wonderful if I didn't just treat anxiety disorders but I treated the person and the many problems that are associated with the anxiety disorder? Isn't that a beautiful goal? Isn't that so? Because it's not just the anxiety; it's the little tiny areas in our lives that it impacts." As soon as I finished the meditation, I went on to my organization board that I use online and it was like, "Arousal. Let's talk about pee and poop," which is one episode we recently did. "Let's talk about all the things because anxiety affects it all." We can make little changes in all these areas, and slowly, you get your life back. So, I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure. I love you. Thank you for staying with me for this. This was brave work you're doing. You probably had cringey moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff. So, finish up. Again, go check out the book. Her name is Emily Nagoski. I'll leave a link in the show notes. One day we'll get her on. But in the meantime, I'll hopefully just give you the science that she's so beautifully given us.

Mar 31, 2023

You guys, I am literally giggling with excitement over what we are about to do together. Last year, we did a series, the first series on Your Anxiety Toolkit where we talked about mental compulsions. It was a six-part series. We had some of the best therapists and best doctors in the world talking about mental compulsions. It was such a hit. So many people got so much benefit out of it. I loved it so much, and I thought that was fun, let's get back to regular programming. But for the entire of last year after that series, it kept bugging me that I needed to do a series on sexual health and anxiety. It seems like we're not talking about it enough. It seems like everyone has questions, even people on social media. The algorithm actually works against those who are trying to educate people around sex and sexual side effects and arousal and how anxiety impacts it. And so here I am. No one can stop us. Let's do it. This is going to be a six-part sexual health and anxiety series, and today we have a return guest, the amazing Lauren Fogel Mersy. She is the best. She is a sex therapist. She talks all about amazing stuff around sexual desire, sexual arousal, sexual anxiety. She's going to share with you, she has a book coming out, but she is going to kick this series off talking about sexual anxiety, or we actually also compare and contrast sexual performance anxiety because that tends to better explain what some of the people's symptoms are. Once we go through this episode, we're then going to meet me next week where I'm going to go back over. I've done an episode on it before, but we're going to go back over understanding arousal and anxiety. And then we're going to have some amazing doctors talking about medications and sexual side effects. We have an episode on sexual intrusive thoughts. We have an episode on premenstrual anxiety. We also have an episode on menopause and anxiety. My hope is that we can drop down into the topics that aren't being covered enough so that you feel like you've got one series, a place to go that will help you with the many ways in which anxiety can impact us when it comes to our sexual health, our sexual arousal, our sexual intimacy. I am so, so, so excited. Let's get straight to it. This is Episode 1 of the Sexual Health and Anxiety Series with Dr. Lauren Fogel Mersy. Lauren is a licensed psychologist. She's a certified sex therapist, she's an author, and she is going to share with us and we're going to talk in-depth about sexual anxiety. I hope you enjoy the show. I hope you enjoy all of the episodes in this series. I cannot wait to listen to these amazing speakers—Lauren, being the first one. Thank you, Lauren. What Is Sexual Anxiety Or Sexual Performance Anxiety? Are They The Same Thing? Kimberley: Welcome. I am so happy to have you back, Dr. Lauren Fogel Mersy . Welcome. Dr. Lauren: Thank you so much for having me back. I'm glad to be here. Kimberley: I really wanted to deep dive with you. We've already done an episode together. I'm such a joy to have you on. For those of you who want to go back, it's Episode 140 and we really talked there about how anxiety impacts sex. I think that that is really the big conversation. Today, I wanted to deep dive a little deeper into talking specifically about sexual anxiety , or as I did a little bit of research, what some people call sexual performance anxiety. My first question for you is, what is sexual anxiety or what is sexual performance anxiety? Are they the same thing or are they a little different? Dr. Lauren: I think people will use those words interchangeably. It's funny, as you say that, I think that performance anxiety, that word 'performance' in particular, I hear that more among men than I do among women. I think that that might be attributed to so many people's definition of sex is penetration. In order for penetration to be possible, if there's a partner who has a penis involved that that requires an erection. I often hear that word 'performance' attributed to essentially erection anxiety or something to do with, will the erection stay? Will it last? Basically, will penetration be possible and work out? I think I often hear it attributed to that. And then sexual anxiety is a maybe broader term for a whole host of things, I would say, beyond just erection anxiety, which can involve anxiety about being penetrated. It could be anxiety about certain sexual acts like oral sex giving, receiving. It could be about whether your body will respond in the way that you want and hope it to. I think that word, sexual anxiety, that phrasing can encompass a lot of different things. WHAT ARE SOME SEXUAL ANXIETY SYMPTOMS? Kimberley: Yeah. I always think of it as, for me, when I talk with my patients about the anticipatory anxiety of sex as well. Like you said, what's going to happen? Will I orgasm? Will I not? Will they like my body? Will they not? I think that it can be so broad. I love how you define that, how they can be different. That performance piece I think is really important. You spoke to it just a little, but I'd like to go a little deeper. What are some symptoms of sexual anxiety that a man or a woman may experience? Dr. Lauren: I think this can be many different things. For some people, it's the inability to get aroused, which sifting through the many things that can contribute to that, knowing maybe that I'm getting into my head and that's what's maybe tripping me up and making it difficult to get aroused. It could be a racing heartbeat as you're starting to get close to your partner, knowing that sex may be on the table. I've had some people describe it can get as severe as getting nauseated, feeling like you might be sick because you're so worked up over the experience. Some of that maybe comes from trauma or negative experiences from the past, or some of it could be around a first experience with a partner really hoping and wanting it to go well. Sometimes we can get really nervous and those nerves can come out in our bodies, and then they can also manifest in all of the thoughts that we have in the moment, really getting distracted and not being able to focus and just be present. It can look like a lot of different things. SEXUAL AVOIDANCE Kimberley: That's so interesting to hear in terms of how it impacts and shows up. What about people who avoid sex entirely because of that? I'm guessing for me, I'm often hearing about people who are avoiding. I'm guessing for you, people are coming for the same reason. You're a sex therapist. How does that show up in your practice? Dr. Lauren: One of the things that can cause avoidance-- there's actually an avoidance cycle that people can experience either on their own or within a partnership, and that avoidance is a way of managing anxiety or managing the distress that can come with challenging sexual experiences and trying to either protect ourselves or protect our relationships from having those outcomes as a possibility. There used to be a diagnosis called sexual aversion. It was called a sexual aversion disorder. We don't have that in our language anymore. We don't use that disorder because I think it's a really protective, sensible thing that we might do at times when we get overwhelmed or when we're outside of what we call a window of tolerance. It can show up as complete avoidance of sexual activity. It could show up as recoiling from physical touch as a way to not indicate a desire for that to progress any further. It could be avoidance of dating because you don't want the inevitable conversation about sexuality or the eventuality that maybe will come up. Depending on whether you're partnered or single and how that manifests in the relationship, it can come out in different ways through the avoidance of maybe different parts of the sexual experience, everything from dampening desire to avoiding touch altogether. Kimberley: That's really interesting. They used to have it be a diagnosis and then now, did they give it a different name or did they just wipe it off of the DSM completely? What would you do diagnostically now? Dr. Lauren: It's a great question. I think it was wiped out completely. I haven't looked at a DSM in a long time. I think it was swiped out completely. Just personally as a sex therapist and the clinician I am today, I don't use many of the sexual health diagnoses from the DSM because I think that they are pathologizing to the variation in the human sexual experience. I'm not so fond of them myself. What I usually do is I would frame that as an anxiety-related concern or just more of a sexual therapy or sex counseling concern. Because I think as we have a growing understanding of our nervous system and the ways in which our system steps in to protect us when something feels overwhelming or frightening or uncertain, I think it starts to make a lot of sense as to why we might avoid something or respond in the ways that we do. Once we have some understanding of maybe there's some good sense behind this move that you're making, whether that's to avoid or protect or to hesitate or to get in your head, then we can have some power over adjusting how we're experiencing the event once we understand that there's usually a good reason why something's there. Kimberley: That is so beautiful. I love that you frame it that way. It's actually a good lesson for me because I am always in the mindset of like, we've got to get rid of avoidance. That's the anxiety work that I do. I think that you bring up a beautiful point that I hadn't even considered, which is, we always look at avoidance as something we have to fix as soon as possible. I think what you're saying is you don't conceptualize it that way at all and we can talk more about what you could do to help if someone is having avoidance and they want to fix that. But what I think you're saying is we're not here to pathologize that as a problem here. Dr. Lauren: Yeah. I see it, I'm trained less in the specifics. I think that makes a lot of sense when you're working with specific anxiety disorders and OCD and the like. I've, as of late, been training in more and more emotionally focused therapy. I'm coming at it from an attachment perspective, and I'm coming at it from somewhat of a systemic perspective and saying, what is the avoidance doing? What is it trying to tell us? There's usually some good reason somewhere along the way that we got where we are. Can I validate that that makes sense? That when something is scary or uncertain or you were never given good information or you really want something to go well and you're not sure about it, and it means a lot to you, there's all kinds of good reasons why that might hit as overwhelming. When we're talking about performance anxiety or sexual anxiety, really the number one strategy I'm looking for is, how can we work with what we call your window of tolerance? If your current comfort zone encompasses a certain amount of things, whatever that might be, certain sexual acts with maybe a certain person, maybe by yourself, I want to help you break down where you want to get to and break that into the smallest, manageable, tolerable steps so that what we're doing is we've got one foot in your current window of what you can tolerate and maybe just a toe at a time out, and breaking that up into manageable pieces so that we don't keep overwhelming your system. That is essentially what my job is with a lot of folks, is helping them take those steps and often what our nervous system needs to register, that it's okay, that it's safe, that we can move towards our goals. Cognitively, we think it's too slow or it's too small. It's not. We have to really break that down. If there's something about the sexual experience that you're avoiding, that is overwhelming, that you're afraid of, what I do is validate that, makes sense that that maybe is just too much and too big all at once. And then let's figure out a way to work ourselves up to that goal over time. Usually, slower is faster. WHY DO PEOPLE HAVE SEXUAL ANXIETY? Kimberley: I love that. I really do. Why do people have sexual anxiety? Is that even an important question? Do you explore that with your patients? I think a lot of people, when I see them in my office or online, we know there's a concern that they want to fix, but they're really quite distressed by the feeling that something is wrong with them and they want to figure out what's wrong with them. Do you have some feedback on why people have sexual anxiety? Dr. Lauren: I do. I think it can stem from a number of experiences or lack thereof in our lives. There are some trends and themes that come up again and again that I've seen over the years in sex therapy. Even though we're taping here in the US, we're in a culture that has a lot of sexuality embedded within the media, there is still a lot of taboo and a lot of misinformation about sex or a lack of information that people are given. I mean, we still have to fight for comprehensive sex education. Some people have gotten explicitly negative messages about sex growing up. Some people have been given very little to know information about sex growing up. Both of those environments can create anxiety about sex. We also live in a world where we're talking openly about sex with friends, parents teaching their children more than just abstinence, and going into a little bit more depth about what healthy sexuality looks like between adults. A lot of that is still not happening. What you get is a very little frame of reference for what's 'normal' and what's considered concerning versus what is par for the course with a lifetime of being a sexual person. So, a lot of people are just left in the dark, and that can create anxiety for a good portion of those folks, whether it's having misinformation or just no information about what to expect. And then the best thing that most of us have to draw on is the Hollywood version of a very brief sex scene. Kimberley: Yes. I was just thinking about that. Dr. Lauren: And it's just so wildly different than your actual reality. Kimberley: Yeah. That's exactly what I was thinking about, is the expectation is getting higher and higher, especially as we're more accessible to pornography online, for the young folks as well, just what they expect themselves to do. Dr. Lauren: That's right. We have young people being exposed to that on the internet. We've got adults viewing that. With proper porn literacy and ethical porn consumption, that can be a really healthy way to enjoy erotic content and to engage in sexuality. The troubling thing is when we're not media literate, when we don't have some of the critical thinking to really remember and retain the idea that this entertainment, this is for arousal purposes, that it's really not giving an accurate or even close depiction of what really goes on between partners. I think it's easier for us to maintain that level of awareness when we're consuming general movies and television. But there's something about that sexuality when you see it depicted in the media that so many people are still grappling with trying to mimic what they see. I think that's because there's such an absence of a frame of reference other than those media depictions. SEXUAL ANXIETY IN MALES VS SEXUAL ANXIETY IN FEMALES Kimberley: Right. So good. Is there a difference between sexual anxiety in males and sexual anxiety in females? Dr. Lauren: I think it can show up differently, certainly depending on what role you play in the sexual dynamic, what positions you're looking to or what sexual acts you're looking to explore. There's a different level or a different flavor of anxiety, managing erection anxiety, managing anxiety around premature ejaculation. They're all similar, but there's some unique pieces to each one. All of the types of anxiety that I've seen related to sex have some common threads, which is getting up into our heads and dampening the experience of pleasure not being as present in the moment, not being as embodied in the moment, because we get too focused on what will or won't happen just moments from now. While that makes so much sense, you're trying to foretell whether it's going to be a positive experience, there is a-- I hate to say like a self-fulfilling prophecy, but there's a reaction in our bodies to some of those anxious thoughts. If I get into my head and I start thinking to myself, "This may not go well. This might hurt. I might lose my arousal. I might not be able to orgasm. My partner may not think I'm good in bed," whatever those anxious thoughts are, the thoughts themselves can become a trigger for a physical reaction. That physical reaction is that it can turn on our sympathetic nervous system, and that is the part of our body that says, "Hey, something in the environment might be dangerous here, and it's time to mobilize and get ready to run." What happens in those moments once our sympathetic system is online, a lot of that blood flow goes out of our genital region, out of our chest and into our extremities, to your arms, to your legs. Your body is acting as if there was a bear right there in front of you and your heart rate goes up and all of these things. Now, some of those can also be signs of arousal. That's where it can get really tricky because panting or increased heart rate or sweating can also be arousal. It's really confusing for some people because there can be a parallel process in your physiology. Is this arousal or is this anxiety? CAN ANXIETY IMPACT AROUSAL? CAN ANXIETY IMPACT SEX DRIVE? Kimberley: It's funny that you mentioned that because as I was researching and doing a little bit of Googling about these topics, one of the questions which I don't get asked very often is, can anxiety cause arousal? Because I know last time, we talked about how anxiety can reduce arousal. Is that something that people will often report to you that having anxiety causes them to have sexual arousal, not fight and flight arousal? Dr. Lauren: Yeah. I mean, what I see more than anything is that it links to desire, and here's how that tends to work for some people because then the desire links to the arousal and it becomes a chain. For many people out in the world, they engage in sexual activity to impart self-soothe and manage stress. It becomes a strategy or an activity that you might lean on when you're feeling increased stress or distress. That could be several different emotions that include anxiety. If over my lifetime or throughout the years as I've grown, maybe I turn to masturbation, maybe I turn to partnered sex when I'm feeling anxious, stressed, or distressed, over time, that's going to create a wiring of some of that emotion, and then my go-to strategy for decreasing that emotion or working through that emotion. That pairing over time can definitely work out so that as soon as I start feeling anxious, I might quickly come to feelings of arousal or a desire to be sexual. Kimberley: Very interesting. Thank you. That was not a question I had, but it was interesting that it came up when I was researching. Very, very cool. This is like a wild card question. Again, when I was researching here, one of the things that I got went down a little rabbit hole, a Google rabbit hole, how you go down those... Dr. Lauren: That's never happened to me. WHAT IS POST-SEX ANXIETY? Kimberley: ...is, what about post-sex anxiety? A lot of what we are talking about today, what I would assume is anticipatory anxiety or during-sex anxiety. What about post-sex anxiety? What is post-sex anxiety? Dr. Lauren: I've come across more-- I don't know if it's research or articles that have been written about something called postcoital dysphoria, which is like after-sex blues. Some people get tearful, some get sad, some feel like they want to pull away from their partner and they need a little bit of space. That's certainly a thing that people report. I think either coexisting with that or sometimes in its place can be maybe feelings of anxiety that ramp up. I think that can be for a variety of things. Some of it could be, again, getting into your head and then doing a replay like, was that good? Are they satisfied? We get into this thinking that it's like a good or bad experience and which one was it. Also, there's many people who look to sex, especially when we have more anxiety, and particularly if we have a more predominantly anxious attachment where we look to sex as a way to validate the relationship, to feel comforted, to feel secure, to feel steady. There's a process that happens where it's like seeking out sex for comfort and steadiness, having sex in the moment, feeling more grounded. And then some of that anxiety may just return right on the other end once sex is over, and then you're back to maybe feeling some insecurity or unsteadiness again. When that happens, that's usually a sign that it's not just about sex. It's not just a sexual thing. It's actually more of an attachment and an insecurity element that needs and warrants may be a greater conversation. The other thing is your hormones and chemicals change throughout the experience. You get this increase of bonding maybe with a partner, oxytocin, and feel-good chemicals, and then they can sometimes drop off after an orgasm, after the experience. For some people, they might just experience that as depressed mood anxiety, or just a feeling of being unsettled. Kimberley: That's so interesting. It makes total sense about the attachment piece and the relational piece, and that rumination, that more self-criticism that people may do once they've reviewed their performance per se. That's really helpful to hear. Actually, several people have mentioned to me when I do lives on Instagram the postcoital dysphoria. Maybe you could help me with the way to word it, but is that because of a hormone shift, or is that, again, because of a psychological shift that happens after orgasm? Dr. Lauren: My understanding is that we're still learning about it, that we've noticed that it's a phenomenon. We're aware of it, we have a name for it, but I don't know that we have enough research to fully understand it just yet. Right now, if I'm not misquoting the research, I believe our understanding is more anecdotal at this point. I would say, many different things could be possible, anything from chemical changes to attachment insecurities, and there's probably things that are beyond that I'm also missing in that equation. I think it's something we're still studying. HOW TO OVERCOME SEX ANXIETY, AND HOW CAN WE COPE WITH SEX ANXIETY? Kimberley: Very interesting. Let's talk now about solutions. When should someone reach out to either a medical professional, a mental health professional? What would you advise them to do if they're experiencing sexual anxiety or performance anxiety when it comes to sex? Dr. Lauren: That makes a lot of sense. That's a great question. What I like to tell people is I want you to think of your sexual experiences like a bell curve. For those who were not very science or math-minded like myself, just a quick refresher, a bell curve basically says that the majority of your experiences in sex are going to be good, or that's what we're hoping for and aiming for. And then there's going to be a few on one tail, there's going to be some of those, not the majority, that are amazing, that are excellent, that really stand out. Yes, mind-blowing, fabulous. And then there's the other side of that curve, that pole. The other end is going to be, something didn't work out, disappointing, frustrating. There is no 100% sexual function across a lifetime with zero hiccups. That's not going to be a realistic goal or expectation for us. I always like to start off by reminding people that you're going to have some variation and experience. What we'd like is for at least a good chunk of them to be what Barry McCarthy calls good enough sex. It doesn't have to be mind-blowing every time, but we want it to be satisfying, of good quality. If you find that once or twice you can't get aroused, you don't orgasm, you're not as into it, one of the liabilities for us anxious folks, and I consider myself one of them having generalized anxiety disorder my whole life—one of the things that we can do sometimes is get catastrophic with one or two events where it doesn't go well and start to jump to the conclusion that this is a really bad thing that's happening and it's going to happen again, and it's life-altering sort of thing. One thing is just keeping this in mind that sometimes that's going to happen, and that doesn't necessarily mean that the next time you go to be sexual that it'll happen again. But if you start to notice a pattern, a trend over several encounters, then you might consider reaching out to someone like a general therapist, a sex therapist to help you figure out what's going on. Sometimes there's a medical component to some of these concerns, like a pattern of difficulty with arousal. That's not a bad idea to get that checked out by a medical provider because sometimes there could be blood flow concerns or hormone concerns. Again, I think we're looking for patterns. If there's a pattern, if it's something that's happening more than a handful of times, and certainly if it's distressing to you, that might be a reason to reach out and see a professional. Kimberley: I think you're right. I love the bell curve idea and actually, that sounds very true because often I'll have clients who have never mentioned sex to me. We're working on their anxiety disorder, and then they have one time where they were unable to become aroused or have an erection or have an orgasm. And then like you said, that catastrophic thought of like, "What happens if this happens again? What if it keeps happening?" And then as you said, they start to ruminate and then they start to avoid and they seek reassurance and all those things. And then we're in that kind of, as you said, self-fulfilling, now we're in that pattern. That rings very, very true. What about, is there any piece of this? I know I'm disclosing and maybe from my listeners, you're probably thinking it's TMI, but I remember after having children that everything was different and it did require me to go and speak to a doctor and check that out. So, my concerns were valid in that point. Would it be go to the therapist first, go to the doctor first? What would you recommend? Dr. Lauren: Yeah. I mean, you're not alone in that. The concerns are always valid, whether they're medical, whether they're psychological, wherever it's stemming from. If after once or twice you get freaked out and you want to just go get checked out, I don't want to discourage anybody from doing that either. We're more than happy to see you, even if it's happened once or twice, just to help walk you through that so you're not alone. But the patterns are what we're looking for overall. I think it depends. Here's some of the signs that I look for. If sex is painful, particularly for people with vaginas, if it's painful and it's consistently painful, that's something that I would recommend seeing a sexual medicine specialist for. There are some websites you can go to to look up a sexual medicine specialist, someone in particular who has received specialized training to treat painful sex and pelvic pain. That would be an indicator. If your body is doing a lot of bracing and tensing with sex so your pelvic floor muscles are getting really tight, your thighs are clenching up, those might be some moments where maybe you want to see a medical provider because from there, they may or may not recommend, depending on whether it's a fit for you, something called pelvic floor therapy. That's something that people can do at various stages of life for various reasons but is doing some work specifically with the body. Other things would be for folks with penises. If you're waking up consistently over time where you're having difficulty getting erections for sexual activity and you're not waking up with erections anymore, that morning wood—if that's consistent over time, that could be an indicator to go get something checked out, maybe get some blood work, talk to your primary care just to make sure that there's nothing in addition to maybe if we think anxiety is a part of it, make sure there's nothing else that could be going on as well. HOW TO COPE WITH SEX ANXIETY Kimberley: Right. I love this. This is so good. Thank you again. Let's quickly just round it out with, how may we overcome this sex anxiety, or how could we cope with sex anxiety? Dr. Lauren: It's the million-dollar question, and I've got a pretty, I'll say, simple but not easy answer. It's a very basic answer. Kimberley: The good answers are always simple but hard to apply. Dr. Lauren: Simple, it's a simple theory or idea. It's very hard in practice. One of, I'd say, the main things I do as a sex therapist is help people really diversify what sex is. The more rigid of a definition we have for sex and the more rigidly we adhere to a very particular set of things that have to happen in a particular order, in a very specific way, the more trouble we're going to have throughout our lifetime making that specific thing happen. The work is really in broadening and expanding our definition of sex and having maybe a handful of different pathways to be sexual or to be intimate with a partner so that, hey, if today I have a little bit more anxiety and I'm not so sure that I get aroused that we can do path A or B. If penetration is not possible today because of whatever reason that we can take path C. When we have more energy or less energy, more time, less time, that the more flexibility we have and expansiveness we have to being intimate and sexual, the more sexual you'll be. Kimberley: Just because I want to make sure I can get what you're saying, when you say this inflexible idea of what this narrow you're talking about, I'm assuming, I'm putting words in your mouth and maybe what you're thinking because I'm sure everybody's different, but would I be right in assuming that the general population think that sex is just intercourse and what you're saying is that it's broader in terms of oral sex and other? Is that the A, B, and C you're talking about? Dr. Lauren: Yeah. There's this standard sexual script that most people follow. It's the one that we see in Hollywood, in erotic videos. It centers mostly heterosexual vaginal penetration, so penis and vagina sex. It centers sex as culminating in orgasm mainly for the man, and then nice if it happens for the woman as well in these heterosexual scenarios. It follows a very linear progression from start to finish. It looks something like—tell me if this doesn't sound familiar—a little bit of kissing and some light touching and then some heavier touching, groping, caressing, and then maybe oral sex and then penetration as the main event, orgasm as the finish line. That would be an example of when I say path A or B or C. I'm thinking like that in particular what I just described. Let's call that path A for not that it's the gold standard, but it's the one we draw on. Let's say that's one option for having a sexual encounter. But I also want people to think about there's going to be times where that is not on the table for a variety of reasons, because if you think about it, that requires a certain energy, time. There might be certain conditions that you feel need to be present in order for that to be possible. For some people, it automatically goes to the wayside the moment something happens like, "Well, I don't feel like I have enough time," or "I'm tired," or "I'm menstruating," or whatever it is. Something comes up as a barrier and then that goes out the door. That can include things like anxiety and feeling like we have to adhere to this progression in this particular way. Let's call that path A. Path B might be, we select a couple of things from that that we like. Let's say we do a little kissing and we do oral sex and we say goodnight. Let's say path C is we take a shower together and we kiss and we soap each other's backs and we hug. That's path C. Path D is massaging each other, full body. You've got all these different pathways to being erotic or sensual or intimate or sexual. The more that you have different pathways to being intimate, the more intimate you'll be. Kimberley: That is so relieving is the word I feel. I feel a sense of relief in terms of like, you're right. I think that that is a huge answer, as you said. Actually, I think it's a good answer. I don't think that's a hard answer. I like that. For me, it feels like this wonderful relief of pressure or change of story and narrative. I love that. I know in the last episode you did, you talked a lot about mindfulness and stuff like that, which I will have in this series. People can go and listen to it as well. I'm sure that's a piece of the pie. I want to be respectful of your time. Where can people hear more about you and the work that you're doing? I know that you have an exciting book coming out, so tell us a little bit about all that. Dr. Lauren: Thank you. I do. I co-authored a book called Desire . It's an inclusive guide to managing libido differences in relationships. I co-authored that with my colleague Dr. Jennifer Vencill. That comes out August 22nd, 2023 of this year. We'll be talking in that book mainly about desire. There are some chapters or some sections in the book that do intersect with things like anxiety. There's some particular instructions and exercises that help walk people through some things that they can do with a partner or on their own to work through anxiety. We've got an anxiety hierarchy in there where whatever your goal might be, how to break that up into smaller pieces. We're really excited about that. I think that might be helpful for some people in your audience. And then in general, I am most active on Instagram. My handle is my full name. It's @drlaurenfogelmersy . I'm also on Facebook and TikTok. My website is drlaurenfogel.com . Kimberley: Thank you. Once again, so much pleasure having you on the show. Thank you for your beautiful expertise. You bring a gentle, respectful warmth to these more difficult conversations, so thank you. Dr. Lauren: Oh, I appreciate it. Thanks for having me back.

Mar 24, 2023

Welcome back, everybody. I had a whole other topic planned to talk with you about today and I've had to basically bench it because I feel so compelled to talk to you about this topic, which is the topic of having fun. Now, you might be having a strong reaction to this and maybe there's a bunch of people who didn't listen because the idea of having fun feels so silly when you are anxious and depressed. It feels like a stupid idea, a ridiculous idea. But the last few weeks have taught me such valuable lessons about mental health. I talk about mental health all the time. That's what I live and breathe pretty much. Sometimes when you have an experience—I keep saying it changes your DNA—I feel to a degree my DNA has been changed these last few weeks and let me share with you why. For those of you who follow me on social media, you will know that in the last couple of weeks, I made a very last-minute trip to the United Kingdom. What happened was pre-COVID, I had booked tickets to visit London for a work event, and COVID happened. I had a certain amount of time to use these tickets, and I actually had thought that those tickets had expired on December 30th of last year. And then one Friday morning, I woke up and checked my email and it said, "You have 18 days until you depart." I'm thinking, 18 days to depart, where? I haven't booked any tickets. Only to find out that my tickets were put on what's called an "open hold," which meant they had just put a date to a trip knowing that I would log in and reschedule it when I was ready. It turned out to be three years later. And then I logged on and saw I have 19 days to use my ticket. I went upstairs, I talked to my husband, and I said, "I have this ticket to the United Kingdom I've never been to. I would really love to go." He said, "You should go. I think it would be really good for you. I'll stay home with the kids. You go." That was the plan. I was going to go, I was going to keep working, I was going to see my clients, but when I wasn't working, I would go out and have British food and maybe go walk around London and maybe visit a castle or two. That was the plan. I was so excited. I happened to mention it to my sister-in-law who I love, and I said, "Ha-ha, you should come." She said, "Oh! No, there's no way I could come and I didn't think anything of it." And then the next morning I woke up, she had messaged me and said, "I've changed my mind. I'm coming." Now, there is a point to this story, which is, my first thought was, "Oh my gosh, that's so exciting." My second thought was, "Oh my gosh, that is scary," because my sister-in-law is the most wonderful human being and she loves to have fun. What was shocking to me is I started to notice I was going to pump the brakes on fun. No, no, no, no, no, no. Oh my gosh. Now quickly, of course, I said, "Come, I'm so excited." We went, but that response was so interesting to me. What it was, was my anxiety did not like the idea that we were going to go and let loose. My anxiety did not like that inhibitory piece, that amygdala deep in my brain was like, "Whoa, whoa, whoa, whoa, pump the brakes. This is going way too fast for me." The reason I'm doing today's episode is I bet you that's what your brain does too. It wants to pump the brakes on fun and pleasure because it creates uncertainty and it creates vulnerability and it creates where things aren't in control anymore. Letting go and having fun is hard when you have anxiety. Letting go and having fun is hard when you have depression. "Yes" Week We went and we called the week "YES week." Actually, I called it "YES week" because I knew this was an exposure I needed to do. We made an agreement that if one person wanted to do something, both of us had to say yes. If someone wanted to try a food, and my sister-in-law loves to try all the different foods, we both had to say yes. It was such a deep exposure experience for me. A deep, oh my gosh, pleasurable. I don't want you to think it was all hard because the truth is, it was all pleasurable and I was so surprised at how my brain kept making problems out of having fun. I'll give you another example. We're sitting at this Indian restaurant. We kept saying to the maitre d' or the people at the front desk, "Tell us the best Indian restaurant. Tell us the best high tea. Tell us the best place to go and have drinks. Tell us the best place to get scotch eggs. Tell us the best place to have Scottish pie. Tell us the best." We kept saying that. We were sitting at this Indian restaurant and my sister-in-law was like, "We'll have one of those and one of those and one of those and one of those." She's a foodie. I could even feel my body going like, "No, no, no, no, that's too much fun." It's so interesting to me how my brain was pumping the breaks on fun and how when you have fun, again, after doing this for one week, I felt like my DNA was changed. I realized how-- I don't want to use the word controlling because I don't consider myself a controlling person, but how much my brain wants to monitor the amount of fun that happens and how much my brain's anxiety wants to raise alerts about the simplest things. We went to a million abbeys and I realized that I have this deep love for visiting churches and abbeys. Oh my gosh, I feel like my whole heart just shines bright. I'm not particularly a religious person at all, but just visiting these abbeys in these gorgeous places. And then she'll come up and she'll pull on my sleeve and she'll say, "Let's go do this extra tour." My mind wants to be like, "No, no, no, no. We've done enough fun for one day." She's like, "Let's go." I'd be like, "Yes," because we have to say yes. There's this place called Duck & Waffle, which is a '70s nightclub restaurant. It was fabulous. She's like, "We should try that." My brain kept going, "No, no. We just had some food before." It was all these things and it was just keep saying yes to fun. Keep saying yes, keep saying yes. Yes week, that's what it was. I realized after a week of doing this how little power my anxiety had. I'm thinking about it. I'm just dropping down into it. You can see I'm slowing down. Now, number one, I want to acknowledge, you can't live like that forever. That was a vacation. I would never do that on a day-to-day basis because it's not realistic, it's not reasonable. We have to live a reasonable life. But I made a deal with myself as I was going back over Greenland. I was flying over Greenland looking at this huge snowy country and I was thinking, wow, I wish I lived in a country this beautiful. And then I was like, "Wait, I do." You could start to practice being in the beauty of your country more. And then I started thinking, what would happen if I went home and I deeply enjoyed the food? Like I slowed down to actually take in the pleasure of the food. I mean, I think I do an okay job at this, but on vacation, like I said, we were practicing going, "Ooh, I love the flavor of this. Ooh, that's so soft and that's so sweet and that's so tender," and all the things. What if I actually really allowed pleasure and fun to tickle my senses here in my daily life? What if instead of making dinner like a serious mom, which I often do because I don't want to embarrass my children—what if instead I let myself dance more? What if I goofed off more? What if I enjoyed laughing more? What if I practiced and made a habit of implementing fun into my life on the daily? This is what I was thinking about, what's the ratio of work to fun in your life? I mean, I'm guessing you have either school or work or family or a mental health issue that you're managing or a medical health issue that you're managing. That's work. What's the ratio of work to fun? It made me really think like I have a wonderful life and I'm so grateful for my wonderful life, but the ratio of work to fun is not ideal. It's not where I want it to be. Once I had spent a week of just saying yes, yes, yes, and not letting fear ever say no, it was so cool because I had this accountability buddy right next to me. I realized like once I'd done that for a week, I wanted to keep it going. I didn't want to go back to pumping the brakes anymore. It's been such a beautiful gift that I had. The Fun Habit Now, I'm going to encourage you to create a yes week or a yes day, or a yes hour. I just finished a book called The Fun Habit: How the Pursuit of Joy and Wonder Can Change Your Life. It's by Mike Rucker . A friend of mine encouraged me to read it after I had told her like I literally just had this date with fun. I had this exposure of fun. I had a yes week where we said yes to. If we wanted to sleep in, we slept in. If we wanted to read, we read. It was really beautiful. Again, I understand the privilege of having that experience, but I worked my butt off too. I needed that. I really, really needed that. My mental health really needed it and so forth. But the book is talking about how we have talked about and trained ourselves to be afraid of fun. We've demonized fun as if it's irresponsible or unnecessary or ridiculous or lazy. I want to leave you today with the idea to plant a seed where you go and have more fun. I was thinking about it. For those of you who have anxiety disorders or depressive disorder, this is the biggest FU to anxiety. It's the biggest FU to depression. It's the biggest "Don't tell me what to do" when it comes to recovering from anxiety and depression. Is it going to fix it completely? No. I don't want to oversell it here. But is it a major game changer? Does it change the way we see the world? Does it increase the dopamine that gets released into your body? Does it make the hard work worth it? Yes. I was thinking like, I was so excited to go back to work because I had a week of fun. If I had have done my original plan, which is where I worked while I was in London, and I just visited a little on the side, I wouldn't have been that excited to come back to work. But I was so excited to come back to work and I was so excited to sit down and talk to you on this podcast. I don't think that would've been the case if I had have pumped the brakes like I was planning to for that week. Have More Fun! There you have it. I'm going to ask you, please give you permission. Go and have more fun. Increase the percentage a few percent or 100% or 50% or 10%, whatever you can do. But do your best to implement pieces of fun into your daily life. It will literally change your DNA. Not literally, that's scientifically not true. Don't take that as literal. But for me, I felt like my DNA had been changed. I kept saying it. I'm like, "I feel like my DNA has something shifted in me." It's because I realized even though I have so much joy in my life, I do still pump the brakes on fun and I want there to be more and I'm dedicating more time to fun and savoring pleasure. So that's all I want to say. Go and have some fun, please. I'd love to hear about the fun that you're having. When fear shows up, try to confuse it by saying, "You know what, fear? You can be here and I'm going to go choose fun anyway." Fun can be whatever it is for you. There's no right way of having fun and it doesn't have to be expensive here either. Like I said, a lot of the things that my sister-in-law and I did cost no money. It's just that we were saying yes to silly things. Some of it was even like cartwheeling in the underground train station or giggling at stupid things that are so silly and so immature, but having fun with it. Just have some fun. I love you. I hope you're having a wonderful day. It is a beautiful day to have fun is all I'm going to say to you today. I will see you next week. We have a very cool series coming up, which you are going to love, so stick around. I'll see you next week.

Mar 17, 2023

Today, we're going to talk about the 15 depression symptoms you may not know about. My hope is that it will help you, number one, understand your symptoms, and number two, get help faster. Let's do this. Let's get started. I hope you are well. I hope you are kind and gentle to yourself today. I hope you are taking moments to notice that the trees are changing, the leaves are changing, and spring is here. If you're in the Northern Hemisphere, maybe the weather is changing. Also, if you're in the southern hemisphere, my lovely friends in Australia, I just want to remind you to stop and take note of the weather. It can be one of the most mindful activities we engage in, and it can help us be grounded in the present instead of thinking forward, thinking backward, and ruminating on the past and the future. I hope you can take a minute. We can take a breath right here... and you can actually take in this present moment before we get started. Today, we're talking about 15 depression symptoms you may not know about. As I said in the intro, my hope is that these symptoms help you understand what's going on for you if you're depressed or help you get help faster. Mnemonic For Depression Symptoms Now, some of you may really have a good understanding of depression symptoms. Some of you may know the common ways that it shows up, so I will first address those just to make sure you've got a basic understanding of common depression symptoms. I'm going to actually give you a mnemonic for depression symptoms. I find it's very helpful to have this on hand when I'm assessing my clients and my patients. It's a really good check-in even for myself like, what's going on? Could this be depression? Let's go through this mnemonic for depression . D is for depressed mood. I think we all know about that one. That's a very common Hollywood way of understanding people who are sad, feeling very down, and so forth. We mostly all know the D for depression. E is for energy loss and fatigue. In fact, I did a poll on Instagram. For those of you who don't follow me, go ahead and follow me @youranxietytoolkit . I did a poll and I asked, what are the most painful parts of depression, and the most common response was complete fatigue, complete exhaustion, just overwhelming tiredness and energy loss. I think that that's a really common one. It can be confusing because you're like, "What's going on?" It makes you feel like maybe there's a medical condition going on, but often it is depression. The P is for pleasure loss. Now, this is an important one that we look for in clinical work as we're looking for. Is the person with depression completely at a loss and they're not enjoying the things they used to? Are they struggling to get joy out of even the most joyful things that they used to find joyful? That's a very common one. The R is for retardation or excitation. What we're talking about there is moving very slowly, like a sloth pace or even just sitting there and staring and unable to move your body completely, inability to get motivated to move. Excitation is the other one, which is like you feel very jittery and you feel very on edge and so forth. The E is for eating changes such as appetite increase or decrease, or weight increase or decrease. Again, common symptoms for depression. The S is for sleep changes. It is very common for people with depression to either want to sleep or need to sleep all day, again, because of that energy loss. Or they lay awake for hours at night staring at the roof, unable to sleep, experiencing sleep anxiety , which can often then impact their sleep rhythm. They're sleeping all day, staying awake all night, or vice versa, but in a very lethargic way. The next S is for suicidal thoughts or what we call suicidal ideation. These are thoughts of death, thoughts of dying, and sometimes plans to die. If that is you, please do go and see a mental health professional immediately or go to your ER or call the emergency in whatever country you are. For America, it's 911. Suicidal thoughts are very, very common with depression. We have two types of suicidal thoughts in depression, and that's usually passive suicidal thoughts and then active suicidal thoughts. Passive is thoughts of death, but you just want to crawl under a rock and just go to sleep and never wake up. Active suicidal thoughts is where you're actually wishing to die. It's important to differentiate, and clinically, we do make some changes depending on which is which. The I for depression is "I am a failure." This has a lot to do with shame or loss of confidence and self-esteem issues. "I am a failure" is a big one that often doesn't get disclosed until the person is in therapy. We even did an episode a couple of weeks ago. Depression Is A Liar was the title. Depression tells you all these lies. It tells you you're a failure and you start to believe it. It tells you there's something wrong with you and you start to believe it. That is a very common part of having depression. The O is "only me to blame," and this is what we call guilt. With depression, often people will feel guilty for everything, feel guilt & regret all day, every day. "I'm not a good mom," "I'm not a good friend," "I'm not a good talk daughter," "I'm not a good employee," "I'm not a good boss," whatever it may be. And then they blame themselves, punish themselves, and a lot. The N is for no concentration. Again, when I did the poll on Instagram, so many people posted that they just cannot think, they can't plan, they can't concentrate, they can't learn if they're in school, they can't stay focused on a conversation. These are all very common symptoms of depression that may be impacting you either a little bit or, in many cases, an immense amount. They're the most common. That's a mnemonic for depression symptoms. They're the most common that we assess for. But now I want to go into the 15 depression symptoms you may not know about. The way that I'm structuring this podcast episode is I've broken it down into different categories of people. But what I want you to recognize before we go down is these are not specific to only these categories of people because it depends on the person. We have to be very person-centered when it comes to looking at depression and diagnosing depression and treating depression because there's no one way to have depression. I don't want to miscategorize any of this. I'm just talking very generally, so I want to give a disclaimer as I go through these different categories or groups of people. Please note that it's probably true for everybody. It's just more common in these groups. Before we get started, I want to remind you. I know I did an announcement. I want to remind you, the Overcoming Depression Course is going live on March 11th. This is very exciting. This is a live online course that I am teaching live on Zoom. I will be teaching you over the course of three different weekends on Saturday mornings from 9:00 to 10:30 on March 11th, March 18th, and March 25th, 2023. If you want to sign up and come and learn from me, I'll be going through five major areas in which you can make changes related to depression. I will be giving you all of this psychoeducation upfront. There will be a workbook that you can use on your own to really put the skills and tools and strategies into place. If you're interested in joining us, may I say again live, head on over to CBTSchool.com/Depression. It'll take you to the page. You can sign up there and then I will send you via email all of the information you need to be there for our live conversations. You can ask questions in the chat box. My hope is to double down with motivating you, inspiring you, educating you, and getting you feeling a little more confident on what to do if you're struggling with these symptoms. My hope is to help you see that depression is a liar and you can break free! Here we go. Depression Symptoms In Men Again, I'm speaking generally here, and I really want to be careful here because it's definitely not just men who experienced this, but I did a lot of research for this episode and these were the statistics that I found to be most common in these areas. Anger, irritability, or aggressiveness That's not in the mnemonic for depression that we went over. A lot of times people miss this core symptom, which is anger, irritability, or aggressiveness. Now, is it only men? Absolutely not. I want to be really clear here, that is absolutely not the case, but I think because of the stigma for men around showing sadness or showing depression, they have shown that men tend to express it in a different way, because sometimes men don't feel comfortable crying in public with their friends or loved ones. Not always true. Again, I'm going to keep saying not always, but I think that's a cultural expectation put on men and therefore it does come out when in the form of anger, irritability, or aggressiveness. Irritability is a huge one when it comes to depression that I have seen clinically. Problems with sexual desire and performance This is, again, not just for men, but common in the research for men is common problems with sexual desire and performance. A lot of men and women, but again, I don't want to be excluding anyone here, have found that they either have a massive lack of sexual desire or struggle to reach arousal, struggle to reach orgasm. We are going to be addressing this in-depth here in the next couple of months and I'm going to put a lot of energy into making sure we address how much it impacts people and sex. Stick around for that. I'm super excited. But there is another common depression symptom you may not know about. Sometimes we think it's anxiety that causes that, but it's not just anxiety; it can be depression too. Engaging in high-risk activities Again, not just for men, but it has been shown to be more prevalent in men. High-risk activities, spending a lot of money, driving fast in cars, gambling, drug use, and so forth. Again, not just in men, but this is another common depression symptom you may not know about and maybe diagnosed and put in a different category when really the person is deeply depressed and trying to feel pleasure. Remember we talked about the mnemonic P is for pleasure loss. Often we engage in these high-risk activities because we're just desperate to feel that sense of pleasure and exhilaration again. A need for alcohol or drugs Again, not just men and I will discuss this in other categories as well, but it is common that an increased use of alcohol and drugs could be a sign that you are getting an increased level of depression. Then what happens is when you're using a lot of alcohol and drugs, you usually have a hangover or some kind of side effect to that which makes you feel more depressed, which then makes you feel more like you need to have more alcohol and drugs. Again, it's a cycle that can really cause a lot of chaos in people's life and could be simply the first symptom or way to cope with depression. Depression Symptoms In Women Women are twice as likely to develop depression than men. That's a statistic I didn't know. Up to 1 in 4 women are likely to have major depressive disorder or major depression at some point in their life. 1 in 4, that is so high. We have to make sure we're catching people and helping people with this massive issue. Premenstrual Dysphoric Disorder Prementstrual Dysphoric Disorder involves a massive influx of depressive symptoms right before your period or at specific stages of your menstrual cycle. Very common. In fact, again, we're going to be addressing this very soon on the podcast as well. These are some areas I feel like I have completely missed as your podcast host, so I want to really make sure we're targeting and addressing these issues as we move forward. Perinatal Depression Perinatal depression occurs around pregnancy before or after pregnancy starts. Perimenopausal Depression Perimenopausal depression is around the menopausal period for people going into menopause. These are common symptoms of depression that get missed all the time or get misdiagnosed or underdiagnosed when the person is really suffering. A lot of people who follow me have said they've gone to their doctor to share how they get this massive influx of depression before their period or in their cycle, and the doctor has blown them off and said, "Eat more celery juice," or "Exercise more." While, yes, exercising can be helpful for depression, we are missing a major depression symptom, and I want you to be informed about those. Depression Symptoms In Kids Oh, the kiddos. It's so hard on the kiddos. In fact, one of the reasons I have been so hyped on talking about depression was, in August of last year, my daughter went in for her yearly checkup with her pediatrician and the pediatrician insisted on doing all of these mental checklists with her. I was saying to her, "Is this really necessary? She's doing fine. To what degree are you scaring her?" She said, "Oh, you have no idea the degree of depression in children since COVID." "I had no idea and I'm a mental health professional. How did I not know this?" She said, "Yeah, it's everywhere in kids, and kids are really good at hiding it." I literally sank in my chair like, "How did I miss this? How did I not know this?" We talked about it a lot and I think it's really important that we understand that depression symptoms in kids often look like what we call in some societies like naughty kids. Again, let's go through them. Big emotional outbursts When we see kids on the playground having big outbursts, big anger responses, again, we talked about that before, sometimes they get labeled as the naughty kids. Well, guess what? We've got to make sure we check to make sure they're not depressed. Because that is a symptom of depression. Difficulty initiating and maintaining social relationships Again, after COVID, a lot of parents I've heard have said, "Oh, I think they just lost their ability to make friends during COVID," which I totally get. We had to train my son after COVID to follow basic social cues because he hadn't seen people in so long. But again, we have to keep an eye on whether this is a symptom of depression in children . Extreme sensitivity to rejection or failure This one is so important not just for kids, but for teens, adults, everyone. With depression, we all have sensitivity to rejection of failure. No one wants that. But often a symptom of depression is extreme sensitivity and absolute devastation about getting rejected for, let's say, a school play or to be picked in soccer or they had a big issue with a test or so forth. They have a strong, strong reaction to that. Frequent absences from school and/or a sudden decline in grades If kids got a massive decline in grades or they started refusing to go to school, my instinct is to always say, "Oh, there's some anxiety going on. They're anxious. They don't want to go to school, they must be 'avoiding school' because of anxiety as a compulsion." Well, guess what? It could be depression, and let's make sure we assess these kiddos correctly. This is true for adults as well. If we're depressed, we don't want to go out, we don't want to go to the show on Friday night, we don't want to hang out with friends. That makes sense as well. Depression With Somatic Symptoms This is probably the most important one. Very common symptoms of depression include headaches, stomach ache, muscle pain, sore back. These are very common physical symptoms of depression and ones that we have to make sure that we aren't ignoring to make sure that they get the care. A lot of people go into the medical system complaining of physical symptoms only to find out that nothing is wrong and they can't understand it, and it could be depression. Not always—please always go and get a medical checkup—but it could be. Depression Symptoms In Teens All of the symptoms I've shared above could be present in teens as well. Like I said, these are not categories that are only just for these categorical lots of people. General overwhelming sense of apathy Commonly with teens is this general overwhelming sense of apathy like, "I don't care. I don't care about you, I don't care about me, I don't care about school." Often parents can interpret this as like, "Oh my god, my kid is horrible." But again, we have to make sure we're assessing for depression first. Excessive guilt I did have that as the mnemonic under O (only me to blame), but this shows up a lot in kids and teens—excessive saying I'm sorry, excessive apologizing, feeling hyper-responsible for everything that happens, feeling hyper-responsible for the social issues and drama that's happening at school, ruminating a lot about that. Again, this is common for anybody, very common for anybody with depression as well, but with teens, it really does start to spike. Preoccupation with death or on death Again, this could be true for other categories or any human being, but we do see it show up a lot in teens—a preoccupation on death regarding movies, music, shows, or books they're reading. Just really a heavy focus on things related to death or very dark, dark topics, aggressive topics. This can play out in many ways. Again, it could also be very normal behavior and that could be something that brings them great pleasure. But again, I'm only bringing it up because these are common unknown depression symptoms that you don't possibly know could be a symptom of depression. I think it's better to be educated than to ignore it and not know. That's the 15 depression symptoms you may not know about. One thing to consider, and I did touch on this during the episode, is commonly we have to look at depression symptoms versus anxiety symptoms. The truth is, many of these are also symptoms of anxiety. Let's go through some of them. Anger, irritability, aggressiveness—true for anxiety. Sexual desire—true for anxiety, engaging in high-risk activities—true for anxiety. A need for alcohol and drugs—true for anxiety. We do notice some perinatal symptoms and perimenopausal symptoms impact anxiety as well, but we're specifically weren't speaking to those today. But if we move into the kids category: outbursts, difficulty maintaining relationships, sensitivity to failure, frequent absences, somatic symptoms, guilt, apathy, preoccupation—these are also very common in anxiety. What I want you to leave with today is this: Take everything you learnt today. I hope that this didn't create more anxiety for you. Just take it as knowledge. Take it as something you now know so that you can be an informed consumer, an informed patient, an informed client with your therapist so that you can know. I will say, if I'm speaking completely vulnerably, reading all the research I did made me very anxious because I have a close to teen child and I was thinking, oh my gosh, what happens if this starts to go down this track and looking at the statistics of suicide and so forth. It is anxiety provoking. But what I did in that moment—and if this helps you, I hope it does—is I said to myself, "Kimberley, you're better to be informed and practice not ruminating and doing mental compulsions about this and catastrophizing than you are to not know at all." Here I have an opportunity to practice all of the response prevention skills, the mindfulness skills, the self-compassion skills that I have in my tool belt and that you hopefully have in your tool belt if you've been a long-term listener here on Your Anxiety Toolkit. We're going to use those tools to help us manage this, but we're going to practice being an informed consumer here. I hope this has been helpful. They are the 15 depression symptoms you may not know about and now you know. Thank you, guys. I'm so happy to be here with you today. Stick around because some pretty exciting things are coming up. A lot of you know we had the mental compulsion series last year. This year, we are having a full sexual health related to mental health series that is just around the corner. It is going to be so incredible. I have some amazing doctors, psychiatrists, sex therapists, educators coming on to talk specifically with you around specific issues, around sexual health related to anxiety and depression. I'm so, so excited, so proud, and so honored to get to do this work with you. All right, I'm going to hit the road. Have a wonderful day. It is a beautiful day to do hard things, and I'll see you next week.

Mar 10, 2023

In this episode, we are talking about the emotional toll of OCD. Kim: Welcome back, everybody. This week is going to include three of some of my most favorite people on this entire planet. We have the amazing Chris Trondsen, Alegra Kastens, and Jessica Serber—all dear friends of mine—on the podcast. This is the first time I've done an episode with more than one guest. Now, this was actually a presentation that the four of us did at multiple IOCDF conferences. It was a highly requested topic. We were talking a lot about trauma and OCD, shame and OCD, the stigma of OCD, guilt and OCD, and the depression and grief that goes with OCD. After we presented it, it actually got accepted to multiple different conferences, so we all agreed, after doing it multiple times and having such an amazing turnout, that we should re-record the entire conversation and have it on the podcast. I'm so grateful for the three of them. They all actually join me on Super Bowl Sunday—I might add—to record this episode. I am going to really encourage you to drop down into your vulnerable self and listen to what they have to say, and note the validation and acknowledgment that they give throughout the episode. It is a deep breath. That's what this episode is. Before we get into this show, let me just remind you again that we are recording live the Overcoming Depression course this weekend. On March 11th, March 18th, and March 25th, at 9:00 AM Pacific Standard Time, I will be recording the Overcoming Depression course. I am doing it live this time. If you're interested in coming on live as I record it, you can ask your questions, you can work along with me. There'll be workbooks. I'll be giving you a lot of strategies and a lot of tools to help you overcome depression. If you're interested, go to CBTSchool.com/depression. We will be meeting again, three dates in March, starting tomorrow, the 11th of March, at 9:00 AM Pacific Time. You will need to sign up ahead of time. But if for any reason you miss one of them, you can watch the replay. The replays will be uploaded. You'll have unlimited on-demand access to any of them. You'll get to hear me answering people's questions. This is the first time I've ever recorded a course live. I really felt it was so important to do it live because I knew people would have questions and I wanted to address them step by step in a manageable, bite-sized way. Again, CBTSchool.com/depression, and I will see you there. Let's get over to this incredible episode. Again, thank you, Chris Trondsen. Thank you, Alegra Kastens. Thank you, Jessica Serber. It is an honor to call you my friend and my colleague. Enjoy everybody. Kim: Welcome. This has been long, long. I've been waiting so long to do this and I'm so thrilled. This is my first time having multiple guests at once. I have three amazing guests. I'm going to let them introduce themselves. Jessica, would you like to go first? Jessica: I'm Jessica Serber. I'm a licensed marriage and family therapist, and I have a practice specializing in the treatment of OCD and related anxiety and obsessive-compulsive spectrum disorders in Los Angeles. I'm super passionate about working with OCD because my sister has OCD and I saw her get her life back through treatment. So, I have so much hope for everyone in this treatment process. Kim: Fantastic. So happy to have you. Chris? Chris: Hi everyone. My name is Chris Trondsen. I am also a licensed marriage family therapist here in Orange County, California at a private group practice. Besides being a therapist, I also have OCD myself and body dysmorphic disorder, both of which I specialize in treatment. Because of that, I'm passionate about advocacy. I am one of the lead advocates for the International OCD Foundation, as well as on their board and the board of OCD Southern California, as well as some leadership on some of their special interest groups. Kind of full circle for me, have OCD and now treat it. Kim: Amazing. Alegra? Alegra: My name is Alegra Kastens and I am a licensed therapist in the states of California and New York. I'm the founder of the Center for OCD, Anxiety and Eating Disorders. Like Chris, I have lived experience with OCD, anxiety, eating disorders, and basically everything, so I'm very passionate. We got a lot going on up here. I'm really passionate about treating OCD, educating, advocating for the disorder, and that is what propelled me to pursue a career as a therapist and then also to build my online platform, @obsessivelyeverafter on Instagram. GRIEF AND OCD Kim: Amazing. We have done this presentation before, actually, multiple times over the years. I feel like an area that I want to drop into as deeply as we can today to really look at the emotional toll of having and experiencing and recovering from OCD. We're going to have a real conversation style here. But first, we'll follow the format that we've used in the past. Let's first talk about grief and OCD because I think that that seems to be a lot of the reason we all came together to present on this. Alegra, would you talk specifically about some of the losses that result from having OCD? I know this actually was inspired by an Instagram post that you had put out on Instagram, so do you want to share a little bit about what those emotional losses are? Alegra: For sure. I think that number one, what a lot of people with OCD experience is what feels like a loss of identity. When OCD really attacks your values, attacks your core as a human being, whether it's pedophile obsession, sexual orientation obsessions, harm obsessions, you really start to grieve the person that you once thought you were. Of course, nothing has actually changed about you, but because of OCD, it really feels like it has. In addition to identity, there's lost relationships, there's lost time, lost experiences. For me, I dropped out of my bachelor's degree and I didn't get the four years of undergrad that a lot of people experienced. I mean, living with OCD is one of the most debilitating, difficult things to do. And that means, if you're fighting this battle and trying to survive, you probably are missing out on life and developmental milestones. Kim: Right. Was that the case for you too, Chris? Chris: Yeah. I actually host a free support group for families and one of the persons with OCD was speaking yesterday talking about how having OCD was single-handedly the most negatively impactful experience in his life. He is dealt with a lot of loss. I feel the same way. It's just not something you could shake off and recover from in the sense of just pretending nothing happened. I know for me, the grief was hard. I mean, I had mapped out what I thought my life was going to look like. I think my first stage of grief, because I think it became two stages, my first, like Alegra said, was about the loss. I always wanted to go to college and be around people in my senior year, like make friends and things like that. It's just my life became smaller and smaller. I became housebound. I missed out on normal activities, and six years of my life were pretty much spent alone. I think what Alegra also alluded to, which was the second layer of grief, was less about the things that I lost, but who I became. I didn't recognize myself in those years with OCD. I think it's hard to explain to somebody else what it's like to literally not live as yourself. I let things happen to me or I did things that I would never do in the mind state that I am in now. I was always such a brave and go-for-it kind of person and confident and I just became a shell of myself. I grieve a lot of the years lost, a lot of the things I always wanted to do, and places I wanted to go. And then I grieve the person I became because it was nothing I ever thought I could become. Kim: Jessica, will you speak also to just the events that people miss out on? I don't know if you want to speak about what you see with your clients or even with your sibling, like just the milestones that they missed and the events they missed. Jessica: Yeah, absolutely. My sister was really struggling the most with her OCD during middle school and high school. Those are such formative years, to begin with. I would say, she was on the fortunate end of the spectrum of being diagnosed relatively early on in her life. I mean, she definitely had symptoms from a very, very young age, but still, getting that diagnosis in middle school is so much before a lot of people get that. I mean, I work with people who aren't diagnosed until their twenties, thirties, and sometimes even later. Different things that most adolescents would go through she didn't. Speaking to the identity piece that Alegra brought up, a big part of her identity was being a sports fan. She was a diehard Clippers fan, and that's how everyone knew her. It was like her claim to fame. She didn't even want to go to Clippers games. My dad was trying to get tickets to try to get her excited about something to get out of the house. She missed certain events in high school because it was too anxiety-provoking to go and it was more comforting to know she could stay in the safety of the home. Their experiences all throughout the lifespan, I think that can be impacted. Even if you're not missing out on them entirely, a lot of people talk about remembering those experiences as tainted by the memories of OCD, even if they got to go experience them. Kim: Right. For me, as a clinician, I often hear two things. One is the client will say something to the likes of, "I've lost my way. I was going in this direction and I've completely lost the path I was supposed to go on." I think that is a full grief process. I think we've associated grief with the death of people, but it's not. It's deeper than that and it's about like you're talking about, identity and events and occasions. The other thing that I hear is—actually, we can go totally off script here in terms of we've talked about this in the past separately—people think that once they're recovered, they will live a really happy life and that they'll feel happy now. Like, "Oh, the relief is here, I've recovered." But I think there is a whole stage of grief that follows during recovery and then after recovery. Do you have any thoughts on that, anybody? Alegra: Well, yeah. I think it reminds me a lot of even my own experience, but my client's experiences of when you recover, there tends to be grief about life before OCD. If I'm being perfectly honest, my life will just never be what it was before OCD, and it's different and wonderful in so many ways that maybe it wouldn't be if I didn't have OCD. But I'm laughing because when you were like, "I'm going to mark my calendar in July because you're probably going to have a relapse," then I have to deal with it every six months. My brain just goes off for like two weeks. I don't know why it happens. It's just my OCD brain, and there's grief associated with that. I can go for six months and I have some intrusive thoughts, but it doesn't really do anything to me to write back in it for two weeks. That's something I have to deal with and I have to get to that acceptance place in the grieving process. I'm not going to have the brain that I did before OCD when I didn't have a single unwanted sexual thought. That just isn't happening. I think we think that we're going to get to this place after recovery, and it's like game over, I forget everything that happened in the past, but we have to remember that OCD can be traumatizing for people. Trauma is stored in the body. The brain is impacted and I think that we can carry that with us afterwards. Kim: Right. Chris: Yeah. I mean, everything that Alegra was saying—I'll never forget. I always joke, but I thought when treatment was done, rainbows were going to shoot out and butterflies. I was going to jump on my very own unicorn and ride off to the sunset. But it was like a bomb had gone off and I had survived the blast, but everything around me was completely pulverized. I just remember thinking, what do I do now? I remember going on social media to look up some of my friends from high school because my OCD got really, really bad after high school. I just remember everybody was starting to date or marry or travel and move on and I'm like, "Great, I live in my grandma's basement. I don't have anything on my calendar. I'm not dating, I don't have any friends. What do I do?" I was just completely like, "Okay, I don't even know where to begin." I felt so lost. Anything I did just didn't feel right. Like Alegra said, there was so much aftermath that I had to deal with. I had to deal with the fact that I was lost and confused and I was angry and I had all these emotions. I had these memories of just driving around. As part of my OCD, I had multiple subtypes—sexual intrusive thoughts, harm thoughts. I remember contamination, stores around me would get dirty, so I'd be driving hours to buy products from non-dirty stores at 4:00 or 5:00 in the morning, crying outside of a store because they were closed or didn't have the product I need, getting home and then my checking would kick in. You left something at the store, driving back. You just put yourself through all these different things that are just not what you would ever experience. I see it with my clients. One client sticks in mind who was in his eighties and after treatment, getting better. He wasn't happy and he is like, "I'm so happy, Chris. You helped me put OCD in remission. But I now realize that I never got married because I was scared of change. I never left the house that I hated in the city I didn't really like because I was afraid of what would happen if I moved." He's like, "I basically lived my OCD according to OCD'S rules and I'm just really depressed about that." I know we're going to talk about the positive sides and how to heal in the second half, but this is just really what OCD can ravish on our lives. Kim: Right. Jessica: If I can add one thing too really quickly, something I really think is a common experience too is that once healing happens, even if people do get certain parts of their lives back and feel like they can function again in the ways that they want to, there's always this sense of foreboding joy, that it feels good and I'm happy, but I'm just waiting for the other shoe to drop all the time. Or what if I go back to how I was and I lose all my progress? Even when there are those periods of joy and happiness and fulfillment, they might also be accompanied with some anxiety and some what-ifs. Of course, we can work on that and should work on that in treatment too because we want to maximize those periods of joy as much as we can. But that's something that I commonly see, that the anxiety sticks around just in different ways. OCD, SHAME, & GUILT Kim: Yeah, for sure. I see that very commonly too. Let's talk now about OCD, shame, and guilt. I'll actually go straight to you, Jessica, because I remember you speaking about this beautifully. Can you explain the difference between shame and guilt specifically related to how it may show up with OCD? Jessica: Yeah. I mean, they're definitely related feelings but they are different. I think the simplest way to define the difference is guilt says, "I did something bad," whereas shame says, "I am bad." Shame is really an identity-based emotion and we see a lot of shame with any theme of OCD. It can show up in lots of different ways, but definitely with some of the themes that are typically classified as Pure O—the sexual intrusive thoughts or unwanted harm thoughts, scrupulosity, blasphemous thoughts. There can be a lot of shame around a person really identifying with their thoughts and what it means about them. Attaching that, meaning about what it means about them. And then of course, there can also be guilt, which I think feels terrible as well, but it's like a shame light where it's like, "I did something wrong by having this thought," or just guilt for maybe something that they've thought or a compulsion that they've done because of their OCD. Kim: Yeah. I've actually also experienced a lot of clients saying they feel guilty because of the impact their OCD has had on their loved ones too. They're suffering to the biggest degree, but they're also carrying the guilt of like, "I've caused suffering to my family," or "I'm a financial burden to my parents with the therapy and the psychiatrist." I think that there's that secondary guilt that shows up for a lot of people as well, which we can clump in as an outcome or a consequence or an experience of having OCD. Chris: Yeah. I mean, right before you said this, Kim, I was thinking for me personally, that was literally what I was going to say. I have a younger sister. She's a couple of years younger than me and I just put her through hell. She was one of the first people that just felt the OCD's wrath because I was so stressed out. She and I shared a lot of the same spaces in the home, so we'd have a lot of fights. Also, when I was younger, because she looks nothing like me—she actually looks more like you, Kim, blonde hair, blue eyes—people didn't know we were related. People would always say things like, "Oh, is that your girlfriend?" So then I'd have a lot of ancestral intrusive thoughts that caused a lot of harm to me, so I'd get mad at her. Because I was young, I didn't know better. And then just the hell I put my mom through. I always think about just like, wow, once again, that's not who Chris is. I would jump in front of eight bullets for both my mom and my sister. I remember one time I needed something because I felt dirty, and my mom hit our spending money so that if there was an emergency. My sister knew where it was and she wouldn't give it to me. I remember taking a lighter and lighting it and being like, "I'll burn your hair if you don't give me the money," because I was so desperate to buy it because that's how intense the OCD was. I remember she and I talking about that and it just feels like a different human. Once again, it's more than just guilt. It's shame of who I had become because of it and not even recognizing the boy I was now compared to the man I am now, way than man now. OCD AND ANGER Kim: One thing we haven't talked a lot about, but Chris, you just spoke to it, and I've actually been thinking about this a lot. Let's talk about OCD and anger because I think that is another emotional toll of OCD. A lot of clients I've had—even just recently, I've been thinking about this a lot—sometimes instead of doing compulsions, they have an anger outburst or maybe as well as compulsions. Does anyone want to speak to those waves of frustration and anger that go around these thoughts that we have or intrusive whatever obsessions in any way, but in addition, the compulsions you feel you have to do when you have OCD? Alegra: I feel like sometimes there can be maybe a deeper, more painful emotion that's underneath that anger, which can be shame or it can be guilt, but it feels like anger is maybe easier to express. But also, there just is inherent anger that comes up with having to live with this. I remember one time in my own personal therapy, my therapist was trying to relate and she pulled out this picture that she had like an, I don't know, eight-year-old client with OCD and was like, "She taps herself a lot." I screamed at her at that moment. I was like, "Put that fucking picture away, and don't ever show that to me again. I do not want to be compared to an eight-year-old who taps himself, like I will tap myself all day fucking long, so long as I don't have these sexually unwanted thoughts about children." I was so angry at that moment because it just felt like what I was dealing with was so much more taboo and shameful. I was angry a lot of the time. I don't think we can answer the question of, why? Why did I have to experience this? Why did someone else not have to experience this? And that anger is valid. The other thing that I want to add is that anger does not necessarily mean that we are now going to act on our obsessions because I think clients get very afraid of that. I remember one time I was so fucking pissed at my coworker. He was obnoxious when I worked in PR, and I was so mad at him, I had to walk outside and regulate. And then instantly, of course, my brain went, "You want his kid to die?" or whatever it was. I felt like, oh my God, I must really want this to happen because I'm mad at him. In terms of anger, we can both feel angry and not align with unwanted thoughts that arise. CAN OCD CAUSE ANGER ISSUES? Kim: Right. OCD can attack the emotions that you experience, like turn it back on you. It's funny, I was doing a little bit of research for this and I typed in 'OCD in anger.' I was looking to see what was out there. What was so fascinating to me is, you know when you type something in on Google, it shows all of the other things that are commonly typed in. At the very top was 'Can OCD cause anger issues?' I was like, that is so interesting, that obviously, loved ones or people with OCD are searching for this because it's so normal, I think, to have a large degree of just absolute rage over what you've been through, how much you've suffered, just the torment and what's been lost, as we've already talked about. I just thought that was really fascinating to see, that that's obviously something that people are struggling with. Chris: When you think about it, when we're struggling with OCD, the parts of our brain that are trying to protect us are on fire or on high alert. If you always think about that, I always think of a feral dog. If you're trying to get him help, then he starts to bite. That's how I honestly felt. My anger was mostly before I was diagnosed, and once again, like I said, breaking things at home, screaming, yelling at my family, intimidating them, and stuff. I know that once again, that wasn't who I am at the course. When I finally got a diagnosis, I know for me, the anger dissipated. I was still angry, but the outbursts and the rage, and I think the saddest thing I hear from a lot of my clients is they tell me, I think people think I'm this selfish and spoiled and bratty and angry person. I'm not. I just cannot get a break. I always remind parents that as your loved one or spouses, et cetera—as your loved one gets better, that anger will subside. It won't vanish, it won't disappear, it may change into different emotions, like Alegra was saying, to guilt and to shame and loss of identity. But that rage a lot of times is because we just don't know what to do and we feel attacked constantly with OCD. Kim: Yeah. Jessica: I also want to validate the piece that anger is a really natural and normal stage of grief. I like that you're differentiating, Chris, between the rage that a lot of people experience in it versus maybe just a different type of anger that can show up after when you recognize how—I think, Alegra, you brought up—we can't answer the question of, why did this happen to me? Or "I missed out on all these times or years of my life that I can't get back." Anger is not a problem. It's not an issue when it shows up like that. It's actually a very healthy natural part of grief. We want to obviously process it in ways that really honor that feeling and tend to that feeling in a helpful way. I just wanted to point out that part as well. DO YOU CONSIDER HAVING OCD A TRAUMATIC EVENT? Kim: Yeah, very, very helpful. This is for everybody and you can chime in, but I wanted to just get a poll even. Alegra spoke on this a little bit already. Do you consider having OCD a traumatic event? Alegra: A hundred thousand percent. I'm obviously not going to trauma dump on all of you all, but boy, would I love to. I have had quite a few of what's classified as big T traumas, which I even hate the differentiation of big T, sexual assault, abuse, whatever. I have had quite a bit of big T traumas and I have to say that OCD has been the most traumatizing thing I have been through and I think we'll ever go through. It bothers me how much I think gatekeeping can happen in our community. Like, no, it's only trauma if you've been assaulted, it's only trauma if X, Y, and Z. I have a lot of big T trauma and I'm here to say that OCD hands down, like I would go through all of that big T trauma 15 times over to not have OCD, 100%. I think Chris can just add cherries to the cake, whatever that phrase is. Chris: Yeah. This is actually how the title, the Emotional Toll of OCD, came about. We had really talked about this. I was really inspired mainly by Alegra talking about the trauma of OCD and I was like, finally, someone put the right word because I always felt that other words didn't really speak to my personal experience and the experience I see with clients. We had submitted it for a talk and it got denied. I remember they liked it so much that they literally had a meeting with you and I, Kim, and we're like, "We actually really love this. We just got to figure out a way to change it." Like Alegra was saying, a lot of the people that were part of a trauma special interest group just said, "Look, we can't be using the word 'trauma' like this." But we had a good talk about it. It's like, I do believe it's trauma. I always feel weird talking about him because sometimes he listens to my stuff, but still, I'll say it anyways. But my dad will hopefully be the first to admit it. But there were a lot of physical altercations between he and I that were inappropriate—physical abuse, emotional abuse, yelling, screaming. Like Alegra said, I would relive that tenfold than go through the depths of my OCD again where I attempted suicide, where I isolated, where I didn't even recognize myself. If 'trauma' isn't the correct word, we only watered it down to emotional toll just to make DSM-5 folks happy. But if 'trauma' isn't the word, I don't know what is, because like I said, trauma was okay to describe the pain I went through childhood, but in my personal experience, it failed in comparison to the trauma that I went through with OCD. Alegra: I also want to add something. Maybe I'm wrong, but if I'm thinking about the DSM definition, I think it's defining post-traumatic stress disorder. I don't think it's describing trauma specifically. Maybe I'm wrong, but it's criteria for PTSD. I will be the first to say and none of you have to agree. I think that you can have PTSD from living with OCD. DSM-wise diagnostically, you can't. But I think when people are like, "Well, that's not the definition of trauma in the DSM," no, they're defining PTSD. It's like, yeah, some people have anxiety and don't have an anxiety disorder. You can experience trauma and not have full-blown PTSD. That's my understanding of it. Kim: Yeah. It's funny because I don't have OCD, so I am an observer to it. What I think is really interesting is I can be an observer to someone who's been through, like you've talked about, a physical assault or a sexual assault and so forth, and they may report I'm having memories of the event and wake up with the physiology of my heart beating and thoughts racing. But then I'll have clients with OCD who will have these vivid memories of having to wash their hands and the absolute chaos of, "I can't touch this. Oh my God, please don't splash the water on me," Memories of that and nightmares of that and those physiological experiences. They're remembering the events that they felt so controlled and so stuck in. That's where for me, I was, with Chris, really advocating for. These moments imprint our brain right in such a deep way. Alegra: Yeah. I'm reading this book, not to tell everyone to buy this book, but it's by Dr. Bruce Perry and he does a bunch of research on trauma and the brain. Basically, the way that he describes it is like when we experience something and it gets associated. Let's say, for instance, there are stores that I could go to and I could still feel that very visceral feeling that I did when I was suffering. Part of that is how trauma is stored in the brain. Even if you logically know I'm not in that experience now, I'm not in the war zone or I'm not in the depths of my OCD suffering, just the store, let's say, being processed through the lower part of your brain can bring up all of those associations. So, it does do something to the brain. Kim: Right. Chris: Absolutely. I was part of a documentary and it was the first time I went back to the home that I had attempted suicide, and the police got called the hospital and all that. It was a bad choice. They didn't push me into it. It was my idea because I haven't gone back there, had no clue how I'd react and I broke down. I mean, broke down in a dry heaving way that I never knew I could and we had to stop filming and we left. Where I was at my worst of OCD was there and also at my grandma's house because that's where I moved right after the suicide attempt. I'd have people around me, and still going down to the basement area that I lived in. It is very hard. I rarely do it. So, I have a reaction. To me, it was like, if that isn't once again trauma, I don't know what is. Alegra: It is. Chris: Exactly. I'll never forget there was a woman that was part of a support group I ran. She was in her seventies and she had gone through cancer twice. I remember her telling the group that she's like, "I'll go through cancer a third time before I'll ever go back to my worst of OCD." Obviously, we're not downplaying these other experiences—PTSD, trauma, cancer, horrible things, abuse, et cetera. What we're saying is that OCD takes a lasting imprint and it's something that I have not been able to shake. I've done so much advocacy, so much therapy, so much as a therapist and I don't still struggle, but the havoc it has on my life, that's something I think is going to be imprinted for life. Alegra: Forever. Jessica: Also, part of the definition of trauma is having a life-threatening experience. What you're speaking to, Chris, you had a suicide attempt during that time. Suicidality is common with OCD. Suicidal ideation, it's changing your life. I think Alegra, you said, "I'll never have the life or the brain that I had before OCD." These things that maybe it's not, well, some of them are actually about real confrontation with death, but these real life-changing, life-altering experiences that potentially also drive some people to have thoughts or feelings about wanting to not be alive anymore. I just think that element is there. Alegra: That's so brilliant, Jessica, because that is so true. If we're thinking about it being life-threatening and life-altering, it was life-threatening for me. I got to the point where I was like, "If something doesn't change, I will kill myself. I will." That is life-threatening to a person. I would be driving on the freeway like, "Do I just turn the car? Do I just turn it now? Because I was so just fucking done with what was happening in my brain." Kim: It feels crisis. Alegra: Yeah. Kim: It's like you're experiencing a crisis in that moment, and I think that that's absolutely valid. Alegra: It's an extended crisis. For me, it was a crisis of three to four years. I never had a break. Not when I was sleeping. I mean, never. Chris: I was just going to add that I hear in session almost daily, people are like, "If I just don't wake up tomorrow, I'm fine. I'd never do anything, but if I just don't wake up tomorrow, I'm fine." We know this is the norm. The DSM talks about 50% of individuals with OCD have suicidal ideation, 25% will attempt. This is what people are going through as they enter treatment or before treatment. They just feel like, "If I just don't wake up or if something were to happen to me, I'd actually be at peace with it." It's a really alarming number. THE EMOTIONAL TOLL OF OCD TREATMENT Kim: Right. Let's move. I love everything that you guys are saying and I feel like we've really acknowledged the emotional toll really, the many ways that it universally impacts a person emotionally and in all areas of their lives. I'm wondering if you guys could each, one at a time or bounce it off each other, share what you believe are some core ways in which we can manage these emotional tolls, bruises left, or scars left from having OCD? Jessica, do you want to go first? Jessica: Sure. I guess the first thing that comes to mind is—I'll speak from the therapist perspective—if you're a therapist specializing in treating OCD, make sure you leave room to talk about these feelings that we're bringing up. Of course, doing ERP and doing all of the things to treat OCD is paramount and we want to do that first and foremost if possible. But if you're not also leaving room for your client to process this grief, process through and challenge their shame, just hold space for the anger and maybe talk about it. Let your client have that anger experience in a safe space. We're missing a huge, huge part of that person's healing if we're leaving that out. Maybe I'll piggyback on what you two say, but that's just the baseline that I wanted to put out there. Chris: I could go next. I would say the first thing is what Jess said. We have to treat the whole person. I think it's great when a client's Y-BOCS score has gone down and symptomology is not a daily impact. However, all the things that we talked about, we aren't unicorns. This is what many of our clients are going through and there has to be space for the therapist to validate, to address, and to help heal. I would say the biggest thing that I believe moves you past where we've been talking about is re-identity formation. We just don't recognize until you get better how nearly every single decision we make is based off of our OCD fears, that some way or another, what we listen to, how we speak, what direction we drive, what we buy. I mean, everything we do is, will the OCD be okay with this? Will this harm me, et cetera? One of the things I do with all my clients before I complete treatment is I start to help them figure out who they are. I say, "Let's knock everything we know. What are the parts of yourself that you organically feel are you and you love? Let's flourish those. Let's water those. Let's help those grow. What are some other things that you would be doing if OCD hadn't completely ransacked your life? Do you spend time with family? Are you somebody that wants to give back to communities? What things do you like to do when you're alone?" I help clients and it was something I did after my own treatment, like re-fall in love and be impressed with yourself and start to rebuild. I tell clients, one of the things that helped me flip it and I try to do it with them is instead of looking at it like, "This is hard, this is tough," look at it as an opportunity. We get to take that pause, reconnect with ourselves and start to go in a direction that is absolutely going to move as far away from the OCD selves as possible, but also to go to the direction of who we are. Obviously, for me, becoming a therapist and advocate is what's helped me heal, and not everybody will go that route. But when they're five months, six months, a year after the hard part of their treatment and they're doing the things they always picture they could do and reconnecting with the people that they love, I start to see their light grow again and the OCD starts to fade. That's really the goal. Alegra: I think something that I'll add—again, I don't want to be the controversial one, but maybe I will be—is there might be, yes. Can I get canceled after this in the community? There might be some kind of trauma work that somebody might need to do after OCD treatment, after symptoms are managed, and this is where we need to find nuance. Obviously, treatments like EMDR are not evidence-based for OCD, but if somebody has been really traumatized by OCD, maybe there is some kind of somatic experience, some kind of EMDR, or some kind of whatever it might be to really help work on that emotional impact that might still be affecting the person. It's important of course to find a therapist who understands OCD, who isn't reassuring you and you're falling back into your symptoms. But I have had clients successfully go through trauma therapy for the emotional impact OCD had and said it was tremendously helpful. That might be something to consider as well. If you do all the behavioral work and you still feel like, "I am really in the trenches emotionally," we might need to add something else in. Chris: I actually don't think that's controversial, Alegra. I think that what you're speaking-- Alegra: I don't either, but a lot of clinicians do. Jessica: No, I agree. I think a lot of people will, and it's been a part of my recovery. I don't talk about a lot for that very reason. But after I was done with treatment, I didn't feel like I needed an OCD therapist anymore. I was doing extremely well, but all the emotions we'd been talking about, I was still experiencing. I found a clinician nearby because I was going on a four-hour round trip for treatment. I just couldn't go back to my therapist because of that. She actually worked with a lot of people that lost their lifestyle because of gambling. I went to her and I said, "What really spoke to me is how you help people rebuild their lives. I don't need to talk about OCD. If I need to, I'll go back to my old therapist. I need to figure out how to rebuild my life." That's really what she did. She helped me work through a lot of the trauma with my dad and even got my dad to come to a session and work through that. We worked through living in the closet for my sexual orientation for so long and how hard coming out was because I came out while I was in the midst of OCD. It was a pretty horrible coming out experience. She helped me really work through that, work through the time lost and feeling behind my peers and I felt like a whole person leaving. I decided, as a clinician, I have to do that for my clients. I can't let my clients leave like I felt I left. It was no foul to my therapist. We just didn't talk about these other things. Now what I'll say as a clinician is, if I'm working with a client and I feel like I could be the one to help them, I'll keep them with me. I also know my limitations. Like Alegra was saying, if they had the OCD went down so other traumas came to surface and they've dealt with molestation or something like that, I know my limitations, but what I will make sure to do is refer to a clinician that I think can help them because once again, I think treating the whole client is so important. Kim: Yeah. There's two things I'll bring up in addition because I agree with everything you're saying. I don't think it's controversial. In fact, I often will say to my staff who see a lot of my clients, we want to either be doing, like Jessica said, some of the processing as we go or really offer after ERPs. "Do you need more support in this process of going back to the person you want?" That's a second level of treatment that I think can be super beautiful. As you're going too with exposures and so forth, you're asking yourself those questions like, what do I value? Take away OCD, what would I do? A lot of times, people are like, "I have no idea. I have really no idea," like Chris then. I think that you can do it during treatment. You can also do it after, whichever feels best for you and your clinician. The other thing that I find shows up for my patients the most is they'll bring up the shame and the guilt, or they'll bring up the anger, they'll bring up the grief. And then there's this heavy layer of some judgment for having it. There's this heavy layer as if they don't deserve to have these emotions. Probably, the thing I say the most is, "It makes complete sense that you feel that way." I think that we have to remember that. That every emotion that is so strong and almost dysregulating, it makes complete sense that you feel that way given what you're going through. I would just additionally say, be super compassionate and non-judgmental for these emotional waves that you're going to have to ride. I mean, think about the grief. This is the other thing. We don't go in and then process the grief and then often you're running. It's a wave. It's a process. It's a journey. It's going to keep coming and going. I think it's this readjustment on our thinking, like this is the life goal, the long-term practice now. It's not a one-and-done. Do you guys have thoughts? Jessica: I think as clinicians, validating that these are absolutely normal experiences and you deserve to be feeling this way is important because I think that sometimes, I don't think there's ill intent, but clinicians might gaslight their clients in a certain way by saying, "This isn't traumatic. This is not trauma. You can feel sad, but it is absolutely not a trauma," and not validating that for a person can be really painful. I think as clinicians, we need to be open to the emotional impact that OCD has on a person and validate that so we're not sitting there saying, "Sorry, you can't use that word. This is not your experience. You can be sad, you can be whatever, but it's not trauma," because I have seen that happen. Kim: Or a clinician saying, "It's not grief because no one died." Jessica: Yeah. It was just hard. That was it. Get over it. Kim: Or look at how far you've come. Even that, it's a positive thing to say. It's a positive thing to say, but I think what we're all saying is, very much, it makes complete sense. What were you going to say, Jessica? Sorry. Jessica: No. I just wanted to point out this one nuance that I see come up and that I think is important to catch, which is that sometimes there can be grief or shame or all these emotions that we're talking about, but sometimes those emotions can also become the compulsion themselves at times. Shala Nicely has a really, really good article about this, about how depression itself can become a compulsion, or I've seen clients engage in what I refer to as stewing in guilt or excessive guilt or self-punishment. What we want to differentiate is, punishing yourself by stewing in guilt is actually providing some form of covert reassurance about the obsessions. Sometimes we need to process the true emotional experiences that are happening as a result of OCD, but we also want to make sure that we're on the lookout for self-punishment compulsions and things like that that can mask, or I don't know. That can come out in response to those feelings, but ultimately are feeding the OCD still. I just wanted to point out that nuance, that if someone feels like, "I'm doing all this processing of my feelings with my therapist, but I'm not getting any better or I'm actually feeling worse," we want to look at, is there a sneaky compulsion happening there? Chris: I was just going to quickly add two things. One, I think what you were saying, Kim, with your clients, I see all the time. "I shouldn't feel this way. It's not okay for me to feel this way. There's people out there that are going through bigger traumas." For some reason, I feel society gives a hierarchy of like, "Oh, if you're going through this you can grieve for this much, but we're going to grief police you if you're going through this. That's much down here." So, my clients will feel guilty. My brother lost an arm when he was younger. How dare I feel bad about the time lost with OCD? I always tell my clients, there's no such thing as grief police and your experience is yours. We don't need to compare or contrast it to others because society already does that. And then second, I'm going to throw in a little plug for Kim. I feel as a clinician, it's my responsibility to keep absorbing things that I think will help my client. Your book that really talks about the self-compassion component, I read that from cover to cover. One thing that I've used when we're dealing with this with my clients is saying like, "We got to change our internal voice. Your internal voice has been one that's been frightened, small, scared, angry for so long. We got to change that internal voice to one that roots for you that has you get up each day and tackle the day." If a client is sitting there saying that they shouldn't feel okay, I always ask them, "What kind of voice would you use to your younger brother or sister that you feel protective about? Would you knock down their experience? No, you would hold that space for them. What if we did that for you? It may feel odd, but this is something that I feel you need at this time." Typically, when they start using a more self-compassionate tone, they start to feel like they're healing. So, that's something that we got to make sure they're doing as well. OCD AND DEPRESSION Kim: Yeah. Thank you for saying that. One thing we haven't touched on, and I will just quickly bring it up too, is I think secondary depression is a normal part of having OCD as well and is a part of the emotional toll. Sometimes either that depression can impact your ability to recover, or once you've gone through treatment, you're still not hopeful about the future. You're still feeling hopeless and helpless about the way the world is and the way that your brain functions in certain stresses. I would say if that is the case, also don't be afraid to bring up to your clinician. Like, I actually am concerned. I might have some depression if they haven't picked up on it. Because as clinicians, we know there's an emotional toll, we forget to assess for depression. That's something else just to consider. Chris: Yeah. I'm a stats nerd and I think it's 68% of the DSM, people with OCD have a depressive disorder, and 76% have an anxiety disorder. I always wonder, how can you have OCD and not be depressed? I was extremely depressed when my OCD was going on, and I think it's because of how it ravishes your life and takes you away from the things you care about the most. And then the things that would make you happy to get you out of the depression, obviously, you can't do. I will say the nice thing is, typically, what I see, whether it's through medication or not medication, but the treatment itself—what I see is that as people get better from OCD, if their depression did come from having OCD, a lot of it lifts, especially as they start to re-engage in life. Kim: All right. I'm looking at the time and I am loving everything you say. I'd love if you could each go around, tell us where we can hear more about you. If there's any final word that you want to say, I'm more than happy for you to take the mic. Jessica? Jessica: I'll start. I think I said in the introduction, but I have a private practice in Los Angeles. It's called Mindful CBT California. My website is MindfulCBTCalifornia.com. You can find some blogs and a contact page for me there. I hope to see a lot of you at the IOCDF conference this year. I love attending those, so I'll be there. That's it for me. Kim: Chris? Alegra: Like I said, if you're in the Southern California area, make sure to check out OCD SoCal. I am on the board of that or the International OCD Foundation, I'm on the board. I'm always connected at events through that. You can find me on my social media, which is just my name, @ChrisTrondsen. I currently work at the Gateway Institute in Orange County, California, so you can definitely find me there. My email is just my name, ChrisTrondsen@GatewayOCD.com. I would say the final thought that I want to leave, first and foremost, is just what I hope you got from this podcast is that all those other mixed bags of emotions that you're experiencing are normal. We just want to normalize that for you, and make sure as you're going through your recovery journey that you and your clinician address them, because I feel much more like a whole person because I was able to address those. You're not alone. Hopefully, you got from that you're not alone. Kim: Alegra? Alegra: You can find me @obsessivelyeverafter on Instagram. I also have a website, AlegraKastens.com, where you can find my contact info. You can find my Ask Alegra workshop series that I do once a month. I also just started a podcast called Sad Girls Who Read, so you can find me there with my co-host Erin Kommor, who also has OCD. My final words would probably be, I know we talked about a lot of really dark stuff today and how painful OCD can be, but it absolutely can get so much better. I would say that I am 95% better than I was when I first started suffering. It's brilliant and it's beautiful, and I never thought that would be the case. Yes, you'll hear from me in July, Kim, but other than that, I feel like I do have a very-- Kim's like, "Oh, will I?" Kim: I've scheduled you in. Alegra: She's like, "I have seven months to prep for this." But other than that, I would say that my life is like, I never would've dreamed that I could be here, so it is really possible. Kim: Yeah. Chris: Amen. Of that. Kim: Yeah. Thank you all so much. This has been so meaningful for me to have you guys on. I'm really grateful for your time and your advocacy. Thank you. Chris: Thanks, Kim. Thanks for having us. Alegra: Thanks, Kim.

Mar 6, 2023

I can barely hold in my excitement! We have a three-day live event where I will teach a new course called Overcoming Depression . I have had all of this passion show up in my body after seeing loved ones and clients struggle and after you guys repeatedly asking for a course on depression. Our new online course called Overcoming Depression is finally here. I will record it live on March 11th, 18th and 25th from 9:00 a.m. to 10:30 a.m. If you are interested, please join me, and I will teach you LIVE, and you can ask all your questions. NOTE: This course will not be considered therapy. Just like all of our courses, it will be educational. Overcoming Depression will be me teaching you the skills I teach my clients when it comes to Psychoeducation and strategies and tools to overcome depression. Head over to CBTSCHOOLcom/depression to sign up! I am so excited to have you guys join me live. Ask your questions in the question box. We will tackle not only your negative thinking but also your behaviors your motivation Self-compassion Long-term recovery techniques I'm so excited and hope to see you there. SIGN UP at CBTschool.com/depression

Mar 3, 2023

OCD TREATMENT OPTIONS Today, we have Elizabeth McIngvale and we are talking all about different OCD treatment options. Elizabeth (Liz) McIngvale is the Director of the McLean OCDI Houston . She has an active clinical and research and leadership role there. McLean OCDI is a treatment center for people with OCD and she talks extensively about different OCD treatment options in this episode. She's the perfect one to talk to in this episode about knowing when you need a higher level of care, particularly related to OCD. In this episode, we walk through the different levels of care from self-help all the way through to inpatient facilities. Elizabeth spoke so beautifully about how to know when you're ready for the next step of care, what to look out for, what you should be interested in, and questions you should ask. This is such an important episode. I'm actually blown away that I haven't addressed it yet, but I'm so grateful we got to talk about it today. Elizabeth McIngvale is also a lecturer at Harvard Medical School. She treats obsessive-compulsive disorders, anxiety disorders. She's got a special interest in mental health stigma and access to mental health care. It was actually such an educational episode and I felt like it actually made me a better supervisor to my staff and a better educator as well. You're going to love this episode if you're really wanting to understand and take the stigma out of increasing your care if that's something that you need. That being said, I'm going to let you listen to Elizabeth's amazing words, and I hope you enjoy this episode just as much as I did. Have a great day, everybody. Kimberley Quinlan: Well, welcome, Liz McIngvale . I'm so excited to have you on for two reasons. Number one, I really want to talk about giving people information about OCD treatment options, but I also understand that you can also bring in a personal experience here. Anytime, someone can share their personal experience, just lights me up. So thank you for being here. Elizabeth McIngvale: Thank you for having me. I'm so excited to be here and yeah, I hope that both my personal but also professional kind of background in this arena might help guide. Some individuals who are kind of wondering what treatment do they need right now and and what does treatment for them look like Kimberley Quinlan: Wonderful. Do you want to share a little bit about your history with OCD and your story as much as you want to share? Elizabeth McIngvale: For sure. Yeah, I'll try to not take up too much time but you know, basically, I grew up here in Houston, Texas, where I'm from, and was diagnosed with OCD right around 12. I started showing lots of different symptoms prior on and off, but nothing that was disruptive nothing. That really would have warranted a diagnosis. I would do things like track the weather, or every time I read a book, I would start at page one because I didn't like the feeling if I picked up in between and things like that… Elizabeth McIngvale: but nothing was really out of the norm normal in the sense that I was still doing okay. And academically you know, Relationship-wise and I was functioning well until I wasn't, you know, until my intrusive thoughts, got louder and the disruption became more and more severe. Here in Houston, we have the largest medical center in the world and we are known for our healthcare and so you would think access to good care would be really accessible, but unfortunately, it just wasn't and granted, this was a long time ago, almost 20 years ago but we really started searching for treatment here in Houston and, you know, I was lucky enough that pretty early on I got a diagnosis and for most of us in the OCD world, we know that that's rare for it to happen that soon. So that was great. That was a huge blessing for me, however we couldn't find good treatment. Every provider would say things like we've never seen a case like this. We don't know how to treat this and there's not help available. You guys should assume that Liz live in a mental health hospital, the rest of her life. And so my parents were just really struggling with What do I do and How do I help my child. And so they kept researching and kept trying to figure it out and actually they got lucky enough that they stumbled across the newspaper article and in that newspaper article talked about an inpatient treatment center at the time which was called the Meninger Clinic and how they had an OCD program. There was a little bitty excerpt and immediately my dad, called my mom, they ended up calling Meninger and learning more and I ended up going to the Meninger clinic when I was 15. I went three days after my 15th birthday, I'll never forget and I talk about this a lot because my treatment stay at Meninger was the first step to my life being changed. It was the first step to me getting appropriate treatment. It didn't cure me, you know, I want to be honest about that. I think sometimes we think, okay, we go do that. We either like get cured or We don't. And, for those of us who live with OCD, we understand that management of our illnesses different than a cure, right? It was a lot of work, but it was also the beginning of a journey where I had to learn to do my own treatment and I had to learn to become my own therapist. And as much as the treatment was super successful for me, I was there for three months and my life changed. I went from being suicidal being hopeless, and not being able to function at all six to eight hour showers and completely, homebound completely riddled by rituals, to being a kid who could fully function. I was able to go back to school. Take five minute showers, do things I never thought I could do again. At the same time, I didn't realize that I had to still take ownership of my illness, I think I thought Oh like the ownership is, I did treatment and that's what it meant. Not that I needed to keep engaging in treatment. And I talk about that because I did relapse later, I ended up going… I ended up doing some outpatient in between and then back to impatient again. And for me, I had to kind of learn what level of care works for me? What does that look like? And how do I manage my illness? And to this day, I still go to outpatient therapy. It's still a big part of my life. Am I actively doing OCD work every week? No I'm doing other stuff right? Family system and boundary setting and things that are important in my life that are tough. But it's been a journey even for myself personally, to know what level of care do I need and at what point. And I think what's really interesting is that when I was 15 I would have told you I'm not going to treatment. My parents had to take me involuntarily and it was a pretty awful day the day they took me to treatment. And, you know, I say this because a lot of times when people hear my story they think Oh, well, y'all did everything right and like, it was just this, like, beautiful path to recovery. That's like, no. It was really messy and it is messy and that's okay. There is no perfect way for us to get treatment in a way that can change our life. And so I really want us to think more about the outcome and what treatment might mean to us versus being super close-minded about the process,… 00:05:00 Kimberley Quinlan: Right. Elizabeth McIngvale: because I think a lot of times we have so much anxiety around I want to go to intensive treatment. I don't want to leave my life. I don't want to put things on hold I don't want to go to this hospital like setting if that's where I'm going and really, it's not about that. It's about what might it give us in the long run, right? Kimberley Quinlan: Right. Elizabeth McIngvale: And just that chance at freedom that maybe outpatient care can no longer do. Kimberley Quinlan: Right? So for the folks who are new here and if just new to us let's sort of just because I feel like I really want to cover this as as much as we can. When you went to Meninger what was the correct OCD treatment in which you received like was it,… Elizabeth McIngvale: Yeah. Totally. Kimberley Quinlan: can you kind of give us a little bit of a view of what that looks like? Elizabeth McIngvale: Yeah. So before Meninger I had gone to outpatient providers and… Elizabeth McIngvale: I remember playing the board game life with a therapist once and I crossed the bridge and I remember her saying Liz, how does that feel? And I was like Well I don't know. Like How does it feel to you? Like what? I remember going to my mom and I was young, right? I was adolescent. I said Mom like this isn't working like we're playing the board game life, I'm not getting better, like this is not therapy and my mom was just like, well, I don't know, she didn't know, she didn't know what she should be doing or not. And so I got to Meninger and I remember there were three things that really put things in perspective for me upon arriving. The first was I met someone else like myself. I met a young girl named Amy who struggled with an eating disorder and OCD and I remember I was crying. I was vomiting. I was so sick. That was so anxious about being there and all she said to me is it's okay. I cried too. And it was the first time in my life. I met someone else like me. And for those of you who know, you know, the the value I believe advocacy has in the OCD world is because we need to feel part of a community, even when we're struggling, And so I got that but it was the first time in my life. I remember, I sat down with my therapists in this conference room and you know, I didn't believe in therapy, candidly. I had gotten really bad therapy for a long time and I just continued to get worse. So I didn't think therapy could help me. I didn't think I could get better and I really was starting to accept that I would just live a life with bad OCD forever and then I would just live in this basically, in the state of misery. And I remember I sat down and for the first time My provider starts asking me all these questions, and he doesn't seem scared. He's like, Oh yeah, no problem. Okay, tell me about this. Tell me about that. And there was this like, not egotistical like this, very humble confidence that. Oh, yeah. Like I know how to treat you, and I was just like, what? And I remember, He said, Yeah, we're gonna do Exposure & Response Prevention (ERP ) I've done this before. You're not the worst case. I've seen, you know, I know how to treat this. I've done all in, It was the first time I realized, Oh my gosh, someone actually knows how to help me. Elizabeth McIngvale: And so my entire treatment was based on exposure and response prevention and you know I think ERPs come a long way as somebody who now works in this field and runs a program doing, you know, runs at the same program. We don't do ERP the same way we did when I did it. Right. When I did ERP, it was an older school model. It was a very habituation model. I remember holding contaminated sweaters and just sitting there for an hour or two, right? We don't do that anymore, but there's something about the basis, right? The core of the treatment hasn't changed and it's it's what changed my life and it's it's really important that I will say, I can't imagine what it had been like if I would have gone to an impatient or a residential setting that wasn't OCD specific and that wasn't doing evidence-based care. I would have believed in treatment even last and I would have been even more helpless. Kimberley Quinlan: Yeah, there is so much beauty to being with someone who's like, Oh yeah, I've had a worst case than you like. I've had so many clients say like that is the best thing anyone has ever said to me. Elizabeth McIngvale: Yeah. Yeah. Like okay not like Oh like I mean literally providers would say to me in Houston like we've never seen a case of severe. We don't know how to help you and it's like, Well what? So like What do I do? Kimberley Quinlan: Right. Elizabeth McIngvale: You know, Can you try and they're like, we don't know, we don't know how to try. Kimberley Quinlan: Right, right? I'm so grateful that you had that experience. This amazing. So, Let's sort of fast forward to now. You of course are an OCD specialist, we know this an amazing one. I first want to look at the term outpatient For some people, they don't know what that means. So what does OCD outpatient treatment look like? Elizabeth McIngvale: Yeah. OCD TREATMENT ONLINE Kimberley Quinlan: And would you also speak to now since covid? We also have like an online version of that so you want to elaborate on OCD treatment online? Elizabeth McIngvale: Yeah, there's so many. So actually, let's have you start first by describing self-help because I think it's. So I think it's really important When we think about levels of care to think about the continuum, right? I look at it as like,… Kimberley Quinlan: Right. Yep. OCD SELF HELP Elizabeth McIngvale: there's self-help options, there's outpatient options and then there's intensive option. Elizabeth McIngvale: Yeah. 00:10:00 Kimberley Quinlan: Beautiful, yeah. Like thats the epitome of me, like even with this podcast, right? How can we provide free or not one one one treat metn for people or in the case of CBT School, how can we help you to do it on your own? RIght, so there are sort of self lead courses or we have the self-compassion workbook for OCD , which is ultimately me as a clinician saying, If I was with a client, this is the steps I would take. So, that's the first step and we offer that all the time. And and I think I don't really actually think we've got that much research on it yet. I think we're in the early stages of that, but that is being really helpful for people who sort of want to become educated, want to understand what's going on and they feel motivated and able to do that on their own. So that's that's the self-help model, then what would we use? Elizabeth McIngvale: Well in one of the things, I want to back up for a second to just and I know you've done so many podcasts on this but for those who've skipped over this one, right, what's really most important is that you're engaging in evidence-based treatment and what we mean by that is that we want to make sure you're getting access to treatment that's been researched and that we know works for OCD. And so there's self-help that is not evidence-based for OCD and they're self-help that is evidence-based for OCD. And one of the beauties of self-help is that you don't have to look at it as a soul intervention, right? Do it while you can, you can do these workbooks, you can do these self-help, you know, in different modalities while you're going to an outpatient therapist. And then one of the things that's really beautiful is that if you live in an area where there isn't OCD providers or OCD specialists your clinicians can actually also use it as a guiding tool in treatment, right? And so again it's allows there to be this rubric of good treatment, all right? This kind of like guide book to,… Kimberley Quinlan: Yeah. Elizabeth McIngvale: you know, or handbook to say. And so Always think of that as kind of our least, invasive level of care and… Kimberley Quinlan: Right. Elizabeth McIngvale: it's a level of care. That's my goal that everyone ends up at right that you're able to get to a place… Kimberley Quinlan: Yeah. Elizabeth McIngvale: where like, yes, you're still actively engaged in a treatment community whether that's through self-help workbooks or podcasts or different ways that you connect because that's really helpful, but that you may not need one-to-one anymore, right? I go to one-to-one therapy because it's important for my soul. I don't need it and… Kimberley Quinlan: Right. Elizabeth McIngvale: that's very different, right? I'm at a place where I can engage the tools inependently, using some resources with and when I need them. And so then the next level is outpatient therapy and traditional outpatient therapy would be oftentimes once a week 45 to 50 minutes session with an OCD specialist in person, one to one in the past three years, that's totally shifted right actually, I would say more commonly it's virtual than it is in person and you know, there's pros and cons. I think most of us Most of us still think in person is better, right? That just if it's feasible, But from a scheduling perspective and feasibilities perspective online is so much easier, right? So most of us, myself included, I do my therapy online because it's, I don't have to schedule the time to drive and get to my clinician and drive back. And so, that's really important. The second piece that's really important to think about is, I would rather you 100 times over be doing virtual sessions with someone who specializes in OCD and knows how to treat OCD then do in person with someone who doesn't. Elizabeth McIngvale: Right, so really, when we think about therapy and interventions, we want to make sure and this is important because a lot of times people will say, Oh well I've tried out patient therapy, It doesn't work for me but they haven't necessarily tried it with an OCD specialist and they haven't been appropriate evidence-based treatment and really we want you to do that first before you start thinking about next level of care or you know some people will want to do like a medication trial and it's like Well you don't get in the research study in a trial if we haven't tried evidence based stuff first, right? So that's really important. With that being said, outpatient can be a continuum, Some outpatient providers can offer two to three sessions a week for 45 minutes, you know? So they can do kind of what we would call like intensive outpatient and that they may make in their own program, but traditionally most clinicians who carry an outpatient case. Load would see someone once a week for 45 minutes session. Kimberley Quinlan: Yeah and I think that's for our center as well once maybe twice if there's more of a crisis but that's the level of care that we that's the kind of clients that we have and that's the level of care that we do provide. So I think and I will say going back to your online is quite a few of the people who take ERP school have therapists, right? It's like 55% of the people who take ERP School are therapist. So therapists are, you know, even though that might be their specialty, Let's say they're the only person in their neighborhood. That is what they're doing, right? They're just doing the best, they can learning whatever skills they can. So that's very positive in my mind. Elizabeth McIngvale: That's right. Yeah, and want people to have a good sound background in ERP but have to mean that they only treat OCD,… Kimberley Quinlan: Right. Elizabeth McIngvale: you know, and I think it's important that you can get really great progress right on an outpatient basis with someone who's knowledgeable and ERP. If you are at a place where outpatient level of care is warranted and important to think about, 00:15:00 Kimberley Quinlan: Right, and that brings me to my next question, how would someone know if they needed a higher level of care for OCD? What would be some symptoms or signs that would be showing up for them? Elizabeth McIngvale: And so the first thing I want you to think about is, Are you seeing somebody who does evidence-based care and are you not getting better, right? That's really the first like thing we need to look at is, Are you going to therapy and have you given in a good therapeutic dose, right? So we're talking, you know, at least a couple months. You don't expect that in two sessions, right? We're like better. Because often it may get worse than better. But at least, you know, maybe a couple weeks to a month or two. Are you on your own saying, I'm not seeing the results that I want, right? That this is, this is not getting me where I want to be. The second question is what level of functioning has your OCD impacted? Elizabeth McIngvale: Traditionally most of our patients in residential care are not working full-time. So their OCD is really impacting their functioning on a level that's disruptive so whether that's either their family life or their job or their school or their career, right? Something is pretty significantly disrupted from their OCD. That once a week may not be enough, right? It again the level of disruption is a little bit too high and then the third thing to really think about is what your provider telling you A good OCD clinician should not be trying to make some sort of a program for you that they don't typically do to keep you on their caseload. Kimberley Quinlan: Right. OCD INTENSIVE TREATMENT Elizabeth McIngvale: They should willing to say to you, You know I think I think you need more right now. And this is what more might look like. And the reality is that you're going to get to go back to them, right? As long as they're doing good ERP and evidence based care, right? You're gonna be encouragedto go back to that outpatient provider but it's about stepping up the level of intensity, right? If we have a medical diagnosis and we're going to our doctor but it starts to warrant the level of hospitalization or certain you know more intensive treatment, we don't want our outpatient doctor to keep seeing us in their private practice, right? We want them to send us to the hospital so that it can get managed and we can get more intensive treatment until we can return back to an outpatient level of management. We cannot treat the brain differently. Elizabeth McIngvale: You know, and I hear people all the time. Well Liz, you know, I don't really want to go to treatment for four six weeks and my answer is like, well, what's 4 6? 12 18. However, many weeks you're at a treatment center if it gives you the rest of your life. Kimberley Quinlan: Right. Elizabeth McIngvale: Right? When we are talking about meeting this level of care, the disruption is not minimal the disruption is significant, right? We know that for patients with OCD, OCD impacts all aspects of your quality of life, right? All facets of it. I'm looking at our data yesterday and all like our 2022 outcomes data. We see significant statistically, significant decrease in OCD scores in phq-9. Kimberley Quinlan: Right. Elizabeth McIngvale: But then also in disability scores, right? Because we want you to be able to get back to functioning and get back to the life, you love, or you deserve, or you're excited about that OCD is taking away from you and so, I always want, I always want you to think about that and often with that means is that you typically can't do the homework, you're being assigned,… Kimberley Quinlan: Yeah. Elizabeth McIngvale: you know, being assigned homework, and you're trying to do it, you're trying to engage in it, but you're struggling and you find that you're you're not able to do that homework independently. And so often times patients in our level of care, need extra support. They need support in the evenings. They need support outside of their behavioral therapy sessions to be able to do this ERP They need extra coaching, they need extra support. They need extra motivation. Kimberley Quinlan: Right. And and recently, we had Micah Howe on the podcast. I was sharing with you before and he was really saying… He said, I went to inpatient thinking that it would be like a new kind of therapy and he's like, it was actually good to see, it's the same therapy, but more, right? Like just so much more. Elizabeth McIngvale: That's right. Yeah, if you're with a good therapist, right? It's same, if you're with someone who's doing evidence-based care, it's the same therapy but more and maybe maybe it's implemented a little bit differently, right? I do believe that we use some different language. We try to get things to stick in different ways, right? That sort of thing, but the model of treatment shouldn't change. OCD INPATIENT TREATMENT Kimberley Quinlan: Okay, so this is all beautiful and I think it all of those points that you made are so important. The homework piece the therapist feeling like that's what they're recommendation is. What would be the next step up from outpatient? OCD treatment, in your opinion? Elizabeth McIngvale: Yeah. So you know I can't speak for all the programs but what I can tell you is that here at the OCD Institute in Houston , Right? Houston Ocdi. We really focus on a super detailed admission process. And so what I mean by that is Kim,… 00:20:00 Elizabeth McIngvale: if you call tomorrow and said Hey I have sever OCD, I need to come to your program. We don't say great, here's our next opening, that's not how it works at all. So for us we require a provider referral form a family referral form. You have to complete intake forms and then we do a one hour zoom session with you And during that zoom session we want to gather information. We want to understand your current symptoms. We want to make sure two things A: You're a good fit for our program and B: that we think this level of cares appropriate for you, you know, just because sometimes people have really bad OCD but they're actually not right yet for this level here. I run my program with this super strong whatever we want to call it…but deep rooted ethical means because it's happened to me in different ways and I'll never do it is I want to make sure that if someone is coming here and using certain resources that aren't you know, They run out. I want to make sure they're having the best chance of Elizabeth McIngvale: Managing their symptoms being able to return and live return to their life or live their life. And so, what I mean by that is that I don't take a patient if they want to come here, but we don't think they're good fit and ethically, I'm never gonna do that, right? I want you to get the right treatment and go to the right providers and the same thing happens when you come here. I think a lot of times people think, Oh, if I go to intensive treatment, I just, you know, they're gonna take my money and hopefully I get better. Absolutely not. You should run from a program that you feel like that programs should be reassessing every week. We have team meeting every day, we have rounds and we're talking about, Is this the right fit? Are we helping move the needle? Is the patient getting better? And so just because you start, somewhere, doesn't always mean you're gonna end somewhere. Sometimes we learn a lot about a patient. And example might be You come here with strong with with really high level OCD. But as you start doing intensive, work we realize. Wow you you're really struggling with emotion regulation and we actually think you need to go get some DBT work first before you're going to be able to effectively engage in ERP. And so we may encourage a patient to discharge,… Elizabeth McIngvale: go do DBT and come back to us so that there's a chance at us being successful. I never want to patient to stay in my level of care and not be successful because it wasn't the right time or they needed to do something else first because then guess what they think treatment doesn't work for them and they think they can't get better when that's not the case. I talked about this with John Abramowitz the other day on a webinar with Chris Johnson and then we were talking about ERP and I said Guys for all intents and purposes there's years if not decades a decade in my life where I could have said to you ERP doesn't work for me. But it's not that ERP didn't work for me. Kimberley Quinlan: Mmm. Elizabeth McIngvale: It's that I wasn't accepting ERP and I wasn't engaging in ERP. I was doing it with one foot in one foot out. And the good news with intensive treatment is, we're going to try to help you get both feet in, right? We're gonna try to increase your motivation, increase your willingness, and we can support you 24 hours a day in that process, which is what outpatient therapy cannot do. An outpatient therapist does not have the capacity to offer that level of support… Elizabeth McIngvale: where we can and we do. At the same time, If we're trying and you're not able to do that right now, we're not going to keep trying the same thing. We're not gonna keep saying Well let's just keep doing ERP because guess what ERP isn't gonna work for you right now, but it's not that ERP doesn't work. It's because we need to get you ready to do ERP even at an intensive level. And so we should be thinking about that as well. And so my point is that it's not a one size fits all model. And if you're looking for intensive or residential programs, be cautious of that, be cautious of programs that, you know, require you to stay a certain amount of time and take all your money up front and they're not going to, you know, customize a plan, you know, that sort of thing. Kimberley Quinlan: Mmm. I love that. I love that. So, just for the sake of people understanding and I actually will even admit, like, I really want to know this too because I've only ever been an outpatient provider. I've never been an inpatient or a residential provider. So could you share Maybe the differences between OCD intensive, outpatient therapy, right? With OCD inpatient treatment or residential treatment. What, what would the day look like? And how would that be different for the person with OCD? Elizabeth McIngvale: Yeah, it's a great question and let's actually walk through. There's a couple levels of care, so there's IOP, which is intensive outpatient, which is often three to five hours a day. Three to five days a week. There's PHP, which is partial hospitalization, which is often five days a week about eight hours a day. And then there's residential level of care, which is 24 hours, a day, 7 days a week. And then there's inpatient level of care, which is also 24 hours a day, seven days a week, but impatient is a little bit different than like what we have here at the Houston OCDI where we're residential. Inpatient can take patients with a higher level of acuity. So impatient is often a locked unit. That's a hospital setting. So they may be able to take patients that are active safety risk, you know, harm of hurting themselves that sort of thing, where residential program like ours, we don't, we don't accept those patients because we can't maintain that level of acuity for them. We are not a facility that can help keep patients safe. And what I mean by that is that while our program operates 24 hours a day. We are a non-locked unit. We have a full kitchen, we've got washer dryers, we get for all intents and purposes, like You're living in a beautiful residential home and you have access to knives, you can leave whenever you want. You can go off site, you can go to the Astros game if you're here in Houston. And we want you to do that. Actually, we want you to start to reintegrate into life, while you're in treatment with us. 00:25:00 Elizabeth McIngvale: And so, the reality is that, we need patients to be at a certain level of acuity right? So they have to be safe, and they have to not be a risk or harm to themselves for us to feel comfortable that they can engage in our level of care safely. And so, the difference between let's say IOP is that often times, we're talking about three to five hours a day, three days a week and so you're doing intensive sessions together, right? Imagine you're going to your therapist and for three hours a day, you're doing some, you know, individual or even group stuff, but you're working together, you're doing exposures and you're getting three hours of support versus 45 minutes. Elizabeth McIngvale: Residential however, is 24 hours a day. And so, for our residential patients, there's programming from 8:45 to 4 pm Monday through Friday, 8:45 to 3 pm on weekends. But there's residential counselors here 24 hours a day, which means that when we do outings with our patients, Wednesday and Saturday night our RCs are going with you. They're encouraging you. They're helping you. They're supporting you. Because for all all of our patients actually with OCD, there's exposures built into outings you know, to going off, site to going and doing enjoyable things. And so you have that support 24 hours. If you need support in the shower, you have that support. If you need support cooking a meal, you have that support doing your laundry, you have that support in a residential setting. So really, if you need extra support around activities of daily living, we want you to be thinking about a residential level of care, compared to more of an outpatient level of care. Even if it's intensive outpatient or PHP, you're gonna go home in the evenings and you're gonna be expected to be able to engage in those activities on your own. Kimberley Quinlan: Right. Right. So just because I'm thinking of the listeners and I'm wondering if they're wondering, Does that mean that when they come into your Houston residential program that, let's say, if they're someone who showers for, let's say, two or three hours, that you're immediately, your therapist on staff are going to be cutting them dance for like down right away. Or What does that look like? Is it gradual? Like How would that like, That's just an example… Elizabeth McIngvale: Oh yeah. Kimberley Quinlan: But what would that look like in the residential format? Elizabeth McIngvale: It's a great question, right? So I can tell you up front, if someone is coming with contamination OCD and they have, Let's just say a two to three hour shower. My goal is definitely gonna be that we're cutting that down, right? And the goal is that you're not going to be engaging in that long of a shower, by the time you leave and that's not your goal, right? Or you wouldn't be coming, but everything is done slowly and systematically and it's done effectively. So, what I mean by that is that we're not gonna push you to do exposures, if you can't engage in response prevention yet. We know, that's not useful. And so, what you would expect really weeks one and two are getting to know our model. You're starting to, you know, engage in readings and videos. And, you know, you have some small exposures. We're starting to do and you're building trust and repor, but you're starting where you want to start. Some of our patients might show up with the two-hour shower, but that's actually not their most distressing compulsion, something else is and that's what they want to work on first and that's where we're gonna meet them, right? We're not gonna start with a place you don't want to start and so we slowly work up to things and we get there together and we do like monitors in the shower and in our staff room so that we can have coached showers. So we might say things. Like If you set a goal of you know I want to be done with shampooing my hair within a five minute period or this, right? We're telling you the time we're communicating with you throughout we're asking you if you need a different level of support, we're talking to you about the amount of supplies you take into the shower prior. So we're doing a lot of planning, a lot of prepping. But I have a lot of rules. For exposures as an OCD clinician and certainly as the program director here. Number one is exposure should never be a surprise? We never throw exposures on someone, right? We talk about it with you. We're all on board. It's not an unplanned exposure by just, you know, say Hey today you're doing this or I just purposely contaminate you. The second is exposures should be agreed upon mutually right? You should be wanting to do it. You should be agreeing to do it. It shouldn't be something that I think makes sense. It should be what you think makes sense. And of course the last is that it should always be something I'm willing to do, right? I'm never ask someone to do an exposure that I'm not willing to do and so that doesn't shift in the residential process, right? Yes. In a residential program, I might be able to push patients a little bit more because I, I know they're gonna have support. I know that we can help them or you're with four hours of activity or people blocks a day compared to you know, 20 minutes within my 45 minute outpatient session. So sure we may be able to push a little bit more or a vote higher levels of distress when we're doing er, 00:30:00 Elizabeth McIngvale: Than what would be comfortable with on an outpatient level but across the board motivation. Willingness that's on the patient, not on us, and it shouldn't be Kimberley Quinlan: And I'm just curious because I don't, this is so wonderful and thank you for sharing all that. Because I think that's true for outpatient and… Elizabeth McIngvale: forced, or Kimberley Quinlan: for residential, but I think is so beautiful in that setting and I'm mainly just curious because I haven't been able to visit your center is,… Elizabeth McIngvale: Yes. Kimberley Quinlan: are they as everyone bunked in rooms together? Like, What does that look like? I know that in and of itself may be scary for people going in, right? Like, Do I have to sleep with somebody because I have compulsions around sleep and I'm afraid I won't sleep like, so, what does that look like? Elizabeth McIngvale: I know it's a great question and it's it's interesting because when I so I actually went to the Meninger clinic when I went impatient at 15 and it was a locked unit, it was a much, lover, level higher, level of acuity. And so it was this like, sterile hospital, like setting, you know, and I remember feeling super upset and anxious and away from my home and One of the things that I don't love about those sort of settings for OCD treatment perspective, is that like, we had a housekeeper there, for example, like there was an access to a washer dryer to a kitchen. So like meals were prepared for you and what laundry was done. And while that's fine or good, actually, for some of us with OCD. It's not good for OCD, right? Because we want patients to actually practice those skills. And so, However, before I jump into what our programs like I do want to say, I still got better. Elizabeth McIngvale: And I will tell you that, if the cost is being in an uncomfortable, sterile hospital setting, but it was me getting my life back. I do it all over again and so I really want us to think about that. Kimberley Quinlan: That's really interesting. Elizabeth McIngvale: You know that I think sometimes we we get so hung up on like, am I gonna be comfortable? What does it look like? What if I have a roommate and at the end of the day, you're getting your life back? So those sort of things are not what's more important, that should not override if it's an OCD specialty program, if you're going to be with other patients with anxiety or OCD, that's more important to me. I want When you're, if you're looking for a higher level of care, you need to be asking questions, like Are all the patients Patients with anxiety OCD are related disorders, is the treatment program specific to that, right? You don't want to be at a program with, you know, people with 20 diagnoses and there's just generalist modalities for groups or generalists, you know, groups and whatnot. You want there to be effective evidence-based care, being taught to you for anxiety and OCD. Elizabeth McIngvale: And so our program is actually so different. So our program is, in a beautiful Mediterranean, you know, 6,000 square foot, beautiful home and with the brand new kitchen, and it's got, you know, two washers too. Dryers and we have 11 beds total. So, six of our I'm sorry, we have six bedrooms, five of the bedrooms, have double beds. So, two queens and those rooms and then one has a single bed, that's our ada room, all of our bedrooms have their own bathroom and it's a really a home like home like experience. I think all of our patients would tell you, I hear this, I do it. Check out with every patient that comes through a program, I run groups and with them all the time, they always say that the entire experience was completely different than what they expected. You know, they were thinking this hospital setting this kind of rigid treatment where it was really instead it's like, hey, you come here and we help together create a supportive environment to get you back to the things you want to be doing in your life. Kimberley Quinlan: Yeah, I love it. I mean, when I used to work in the eating disorder community, it's like a big family. Like and and I think for me from my experience of clients, going through residential programs is, I think they had this idea of What the other people would be like only to find out. Like, these are my people, like, these are my people and and I want to encourage people listening. I know it's scary, the idea of increasing your, at the level of care. But usually, when you increase the level of care, you meet more of your people which is like the silver lining, I don't know, that was just being my experience of people and… Elizabeth McIngvale: I couldn't agree more,… Kimberley Quinlan: what they've said, Elizabeth McIngvale: you know, and we we see our patients and they leave. And we do this mentor support group where they can come back and run them into our group to the newer patients, or the patients currently in the program and it's so great to see. But I cannot tell you how many of our patients are great friends now and they go to the conference together and… Kimberley Quinlan: Yeah. Elizabeth McIngvale: they, you know, connect together and they run a support group for each other outside of when they leave here to keep and hold each other accountable. But you know one of the beauties is that in our home like setting you get to truly practice everything, right? And so you practice, the things you're gonna have to be doing at home, from cooking a meal doing your laundry, cleaning your room, right? All these sort of things that are important skills. We don't want to isolate and create this sterile environment. We want it to feel and to mimic your home. And so, there is so many memories and so much connection that's made when you're cooking together with your residence or when you're sitting in the living room together and watching them a movie, or going out to dinner in the community together and those are some of the most Important impactful and meaningful experiences and treatment, right? Not only because you make peers and connections, but you also get to encourage each other in the treatment process together. 00:35:00 Kimberley Quinlan: Mmm, I love that. Okay. So we've worked our way to the higher level of care. You've done the higher level of care. Let's make sure we finish this story. Well, right? It's like, it's like a movie plot to, the right is, How do we come down the level of care, right? So what does it look like for somebody who's done higher levels of care? What what is like you said at the beginning? It's not just like a one and done, you can sort of dust yourself off and maybe you can, I don't know. What is your experience? What's your suggestions in terms of reducing the level of care, Elizabeth McIngvale: Yeah. So our goal from treatment is that anytime someone discharges from our program, their discharging to an outpatient level of care and at some times for some of our patients, they're going to discharge back to their outpatient provider and they may see them two or three days a week, a first couple weeks and then two days a week and then, you know, to kind of taper back down to traditional outpatient or whatever, their therapist has available. And so that's the goal. But getting there looks different for everyone. So some of our patients will do residential the whole time, they're with us 12 to 16 weeks. However, long, they're in treatment and go straight back to their outpatient level of care, especially if they live out of state, different things that may make the most sense for them, but some of our patients may actually discharge to our day program. So they may, you know, spend eight weeks with us in the residential. And then discharge to our day program, for the last four weeks, especially if they're local, but even if they're not, they may get an airbnb and discharge to that level of care because it might actually be recommended and warranted for them to really practice independent things outside of the treatment day without 24 hours support Elizabeth McIngvale: And then again be able to tailor or taper back down to an outpatient level of care. So for us that is always our goal. One of the questions I get a lot is like Well when will I know if I'm ready to leave Liz and What will that look like? And my response is always the same is that I don't expect or actually want patients to leave here without any OCD. If you're leaving here without any triggers or any anxiety or OCD, then we probably kept you too long, right? Because it's important to remember that. You only should be in this level of care for as long as it's warranted. We should not be keeping you and charging you and having you stay. If you're ready to go to an outpatient level of care at that point. And so, my response is always, I'm, I, I want people to discharge when they're at a place where the treatment team and the patient feels confident that they're going to be able to maintain their progress on an outpatient level. And so the goal is that you've gotten all the tools, you've got the skills, you understand the concepts, you know, the difference between feeding your OCD and fighting your OCD and what that looks Elizabeth McIngvale: Like, you've changed your relationship with anxiety and OCD and now you're ready to keep doing that on your own. And so for a lot of our patients, we recommend and have them do what's called a therapeutic absence. This is typically about three fourths through treatment. We'll ask you to go home for about three to five days. Practice your skills. See how you do, see where you got stuck? Come back. We'll tweak things will help kind of read those final things before you leave, but the goal is that you're gonna discharge to outpatient care and you're gonna discharge to a functioning structured schedule. So this is really important, right? I want you at discharge to have a clear plan for what you're going to be doing, we don't want you to go home without a plan and to, you know, potentially revert back to sleeping in staying in your room, right? Those sort of things we want you to go back to a schedule because one of the benefits of being in our program is how scheduled and structured. It is Kimberley Quinlan: And I love this because as a treatment provider, anytime a client of mine has come back from residential or some kind of intensive treatment, the therapist that they were working with gives me this plan right? Or the The client brings me the plan and so I'm I hit the, what's The saying? Hit the ground running. Like I know what the plan is that we already have it. Elizabeth McIngvale: Yep. Kimberley Quinlan: It's not like we have to go and create a whole nother treatment plan. It's usually coming handed off really beautifully, which makes that process like so easy. Elizabeth McIngvale: that's, Kimberley Quinlan: For an outpatient provider to to take that client back. Elizabeth McIngvale: Our goal, right? Our goal is that if you referred someone to meet him, I'm gonna be talking to you before I start working with them and I'm certainly going to be talking to you as we're getting close to discharge and around the time of discharge to transition that care. Right? Seamless,… Kimberley Quinlan: Right. Elizabeth McIngvale: we want it to be smooth and we want the patient to feel like there's not an interruption in their treatment. Kimberley Quinlan: Right. Oh my gosh. So, good. Is there anything we've missed? Do you feel? Elizabeth McIngvale: Not really, you know, I think I get this question a lot, you know, across the board everything we've talked about just because I've personally experienced this, I do this myself professionally and Here's what I'll tell you guys. Treatment is fair is scary No matter what. It doesn't matter if we're doing on outpatient level or an intensive level, right? We're being asked to face our fears or being asked to do things that terrify us I know and many of our listeners know that treatment can and will save your life. And so if you're questioning if you're ready, if it makes sense, you may not ever feel ready and it may not ever make sense. But what I can promise you is that if you put forth the work,… 00:40:00 Kimberley Quinlan: If? Elizabeth McIngvale: the outcome is incredible. And I am someone who sits right here as Elizabeth McIngvale: Someone who really believes in full circle moments. Because the program that I attended when I was 15 is the program. I now get to run every day. Kimberley Quinlan: It makes me want to cry. Elizabeth McIngvale: And it is, it is I can tell you. I I love my job and every person at our team here at the Houston OCD Institute. We are driven by the opportunity to help individuals change their own life through treatment and it works. I wouldn't you know Kim those of us with lived experiences even if it's different we wouldn't be doing the work that we do. If we didn't know it worked What a friend,… Kimberley Quinlan: All right. Elizabeth McIngvale: what a horrible life if I had to be a fraud every day pretending for didn't, you know, I couldn't but we do this, we make a career out of it and and we get to keep changing lives and keep hopefully doing for others. What some people did for us when we really needed it. And I'm very grateful that I have the opportunity to be at a… Kimberley Quinlan: So beautiful. Elizabeth McIngvale: where I can now help other people. And what I can promise you is that with the right treatment, you can be at a place where you can be doing, whatever it is. You're meant to be doing not what OCD wants you to be doing. Kimberley Quinlan: So beautiful. My curiosity is killing me here. So I'm just gonna have to ask you one more question, is it the same location? Elizabeth McIngvale: It is not. So when I was a patient it was impatient actually at the Meninger clinic. So it was in that hospital setting and they closed their program in 2008 and then it became an offset. And so it's now we're our own facility and a beautiful house. And we're in a beautiful neighborhood in the Heights that you can walk around in Houston. Kimberley Quinlan: Yeah. Elizabeth McIngvale: So it is not a hospital setting but it is the same program for all intensive purposes. Kimberley Quinlan: Right? That is so cool. I am so grateful for you. Thank you so much now um I know you've shared a little bit but do you want to tell us where people can get a hold of you, any social media websites, and so forth. Elizabeth McIngvale: Yes. Yes, please feel free to reach out anytime y'all want my instagram and handle is Dr. Liz OCD. So you can always reach out there or find resources and support but for our website you can go to Houston OCDI.ORG or you can give us a call at 713-526-5055. And what I'll tell you is that I'm always available to help answer questions offer support and that doesn't mean you have to choose our program, but I would love to give good insight into what you should look for. And what I will say is, I know, can you talk about us all the time? You want to make sure the program that you're attending engages in evidence-based care so for OCD that's going to be ERP and often a combination of medication and that they really specialize in treating solely anxiety and OCD and OCD related disorders at the intens Or you want to be cautious? Not to go to a program. That's a really mixed program that says, they can also treat OCD. I don't think that'll be the same experience. Kimberley Quinlan: Agreed agreed, So grateful for you. This I feel like this has been so beautifully. Put like in terms of like explaining the whole step, their questions. I will be I'll be referring patients to this episode all the time because these are common questions we get asked. So thank you so much for coming on.Elizabeth McIngvale: Well, thank you for having me. Anything I can never offer. Please never hesitate to reach out, and thank you for all that you do in the awareness and education you spread in our field.

Feb 24, 2023

Depression is a liar. If you have depression, the chances are, it's lying to you too. Depression is a very, very common mental health disorder, and it tends to be a very effective liar. My hope today is to get you to see the ways that it lies to you—the ways in which depression lies to you, and gets you to believe things that are not true. I believe that this part of depression, this component of managing depression is so important because the way in which depression lies to us, impacts how we see ourselves in the world, how we see the future, how we see other people, how we see our lives playing out. And that in and of itself can be devastating. Today, I want to talk about, number one, the ways in which depression lies to us and what we can do to manage that. Let's get going. THEMES OF DEPRESSION Before we start, let's talk about the themes of depression . Now, the way it was trained to me is that there are three core themes of depression. The first one being hopelessness, the second one being helplessness, and the third being worthlessness. It will often target one, some, or all of these themes. Let's go through those here and break it down. DEPRESSION LIES ABOUT THE FUTURE This is where it can really make us feel very hopeless. Depression says your future won't be good. You won't amount to anything. You won't be successful. You won't have a relationship if that's important to you. You won't have kids if that's important to you. It often will target the things that we deeply value and it'll tell us you won't get those things or you'll be doing those things wrong. Or in some ways, something bad will happen. When it targets the future, that is often when we begin to feel very hopeless. When we think about the way the human brain works, our brain does things right now, even things it doesn't want to do, knowing that it'll get a benefit or a payoff or a wonderful, joyful result. But if your brain is telling you that the result is always going to be bad, that's going to create an experience where you feel like there's no point. What's the point of doing this hard thing if my depression is telling me the future is going to be crummy anyway? What we want to do is get very skilled at catching it in its lies about the future. DEPRESSION LIES ABOUT THE PAST Depression will tell you, you did something wrong. You're terrible. That thing you did really ruined your life or ruined somebody else's life, or is proof that you're a bad person. Depression loves to ruminate on that specific event or an array of events. What we end up doing is cycling and gathering evidence. This is what depression does. It gathers evidence to back its point. What we end up doing is instead of seeing the event for what it is, which is both probably positive and negative, depression likes to magnify all of the things that you did wrong or that didn't go well. And then it wants to disqualify the positive. Often patients of mine with depression will say, "Oh, I'm a terrible person. I did this terrible thing," or "I made this terrible mistake or accident." I'll look and say, "Okay, but what about the other times where maybe you didn't make a mistake and so forth?" They will disqualify that as if it means nothing to them. It does mean something to them, but often the way in fact depression functions is it keeps you looking at the negative. And that's how you get stuck in that cycle of rumination on the negative—feeling worse and worse, feeling more shame, feeling more guilt, feeling more dread, feeling often numb because the depression is so, so strong. Now, this is where I'm going to offer to you to reframe things a little bit and look at helplessness. Depression will also tell us: "There is no one who can help you. There is no amount of support that can help you. You're helpless." Often when people come to me for their first time in session, they will say, "I'm here. I understand you can help me. But at the end of the day, I don't even think you can help me." Maybe they've read one of my articles on the internet or they've listened to a podcast and they go, "You're speaking to exactly what I'm going through, but I still don't even believe you can help me." This is where I can give them all the science and show them that I can help them and that there's treatment for depression, and it's very science-based. The depression will still lie to them and say, "There's no point. You're helpless." Now, the last piece here is about worth, and I'll touch on that here in just a little bit. Before we move into that, I want to share with you that the reason I was so excited to talk about this with you today is I'm in the process of creating a course for OCD. I'm contributing this to a bigger company and I will be creating it. You guys can have access to it too here very soon. As I was creating it, I was really starting to see and talk to a lot of people with depression and talk to people on social media. The biggest message people were saying is, "OCD lies to me. It tells me these things. My friends, my loved ones tell me that that can't possibly be true. They don't see any of these negative things, but to me, it feels so true." I wanted to let you know that we do have an online course for depression. You can go to CBTSchool.com/depression to hear more about it. DEPRESSION LIES ABOUT YOUR WORTH. Remember, one of the themes of depression is worthlessness . What it does there is it tells you, you are bad. Now, we know this can be the voice of shame, but depression and shame go very well together. In fact, they can have a whole party together if we let it go on for too long, telling you, you are bad, there is something innately wrong with you. This is a lie depression will tell you over and over again. When I say it's a lie, believe me, it is a lie. This is what I always will say with my patients—if we went to a court, we put it up with the jury and we said, "This person would like to claim that they are worthless." Then the jury is going to say, "Where is your evidence?" We're not really going to put you up in front of a jury. I don't want that to frighten you. But if we were, they would say, "Show me the evidence." Then the attorney would bring in all of the evidence of the facts that you're a wonderful person, that you're innately worthy, that you do these kind things, that you deeply care about other people, that you're a human being, and just being a human being means you're worthy. We would have all these people come in and bring evidence, but the person with depression, their OCD will gently or very meanly whisper in their ear, "That's not true," despite all the evidence. Now we know if this was an actual court case, the judge would throw this case out. They'd go, "There is a profound degree of evidence that this person is worthy. There is a profound degree of evidence that this person can rebuild their life and get their life back on track even if they're really struggling and functioning with depression." We know this to be true. I've seen it every day in my practice. I've seen people with depression manage it and go on to live wonderfully fulfilling lives. For you, I want you to keep that imagery in your mind, of that jury throwing your case out and that judge throwing your case out because the evidence does not support depression's case. It wouldn't last a second in court. Again, a lot of the points I made there are really important if you're struggling with worthlessness. You being a human being makes you innately worthy. You're not worthy one day because you did well on an exam but not worthy the next day because you crashed your car. It doesn't work like that. We're all worthy. So we have to remember that and keep that in the front of our mind, even if depression has a lot to say about that. DEPRESSION LIES ABOUT WHO YOU ARE Depression—not only does it lie about your future, not only does it lie about your past, not only does it lie about your worth, it lies about you in general. Your job and my job as a therapist is to help our minds. My job as a human, I should say, is to help our minds by being able to observe and be aware of our thoughts and catch when it's in the trend of these areas—worthlessness, hopelessness, and helplessness. If it's got any theme of those and it's very strong and very black and white, chances are, it's depression. We can then work and get tools to manage that. OVERCOMING DEPRESSION Now, as I said, I do have an online course because a lot of you will not be able to have therapy with me. First of all, I'm always going to encourage you, go and see a therapist if you can if you have depression. Over any course I could ever offer you, I would always encourage you to first see if you can get access to a mental health therapist. However, if you don't have access to that, you can go to the course to get some tools, strategies, and depression tips that you could be practicing. We go through and look at changing your thoughts. We go through changing your behaviors, looking at your activity schedule, looking at motivation. We look at a lot of that, but that is not therapy. The course is not therapy. It is not a specific depression treatment. But I will teach you everything that I tell my patients in my office. DEPRESSION TIPS & DEPRESSION TOOLS Now, before we end this, I want to first go through some depression tips & depression tools that I want to send you off with today so that you can get started right away. I really believe Your Anxiety Toolkit is all about giving as many anxiety and depression tips , tools and helpful skills as we can, so I want to send you away with some bite-size ideas on that you can start immediately. Tip #1: Start a self-compassion practice The biggest thing that depression does is it bullies us. It says horrible, mean things that you would never say to not only a loved one, even someone you hate. You probably wouldn't say as many mean things as depression has to say. Number one, start with a self-compassion and mindfulness practice . A part of your self-compassion practice is talking back to depression. Now remember, self-compassion is nurturing, it's kind, but it also doesn't set back and let people push you around. Self-compassion would never have you be bullied. If you were in a compassionate place and you saw someone else being bullied, chances are, you'd step in and say, "Hey, this isn't right," or you'd call someone who could come and assist them. Now, this goes for depression as well. Here I want you to remember, if depression is bullying you and telling you lies, you're going to have to talk back to it. I will say, I do not mind if you swear. I do not mind if you have to get a little aggressive with it. I will share with you personally the most common depressive thought that I have, and I have it a lot—you cannot handle this. I hear it many times in the day. In fact, now it almost makes me laugh a little bit because it's very boring. Depression needs to come up with some new jokes because this is the one it uses with me all the time. Often when it says that, no longer do I believe it and agree with it and go ahead and listen to what it has to say. Now, I come back with evidence and say, "You know what? I can handle it because I've handled it before. In fact, I've handled much worse than this. So depression, you can go and do whatever it is that you need to do, but you don't get to bully me anymore." Some people find that it's better to absolutely swear the biggest profanity and say, "FU, depression. Back off! You know nothing about me and you know nothing about my future and know nothing about my past, and I'm going to politely ask you to sit down because I got this." You can talk to depression in whatever way is helpful to you as long as you're talking to it as separate, not to you in the way where you're saying and swearing at yourself. Now we also know there is some evidence that you can use your name by saying, "No, Kimberley can handle this. Thank you, depression." Using the third person, we've got research and science to show that that is very empowering. I could say to depression, "Thank you, depression, but Kimberley has got this. She is going to do her best. She's going to put one foot forward and please sit down because you don't get to tell her what to do today." That is how we can talk back to depression. Tip #2: Keep your expectations small I know when you're suffering and you're starting to lose your functioning and depression is taking a lot from you. It's taken your friendships, your time, taking you away from events. It's made you miss being present with your children or your family or your loved ones. I know what it can feel like in that you feel like you have to catch up somehow. What I want to offer to you is, yes, I know you want to catch up, but the only way to catch up is to do baby steps. Please don't try and push yourself with pressure to catch up at a rate where it doesn't help you. In fact, when we put a lot of pressure on ourselves, we actually create a lot more depression because it feels scary, it feels more overwhelming, which your depression is already done to you. What I want you to do is make small, realistic expectations for the day and work at keeping the expectations small and then build on them. As you do something that was just baby steps, your depression is going to say, "See, what a loser? You're doing only small steps? You should be doing big steps." This is where you're going to go back and talk to depression and say, "Back off! I'm doing what I need to do today to take you over. I'm taking you down, depression, and I'm going to do it slowly and compassionately. It will work because I'm building habit upon habit, not just pushing myself out of self-punishment and self-judgment, and self-criticism." We know that those behaviors make depression worse, so we're actually going to cheer ourselves on. Tip #3 Celebrate your wins That is the big piece that we need to remember. The best way to change the mindset over depression is to be kind and to cheer ourselves on, to motivate ourselves, to celebrate when you make a baby step. I celebrate you if you're making baby steps. Even listening to this right now, I celebrate you. You're investing in your well-being. We want to make sure we're cheering you on. I call it the kind coach. It's the voice that says, "You can do it. Just a little more. Keep going. I believe in you. Just a little more. What would be right for you? What do you need?" It takes into consideration that, of course, you're going to have challenges. But when you have challenges, it's there to say, "What can we do to strategize? Maybe we need to rethink this. How can we rethink this in a way that makes it possible for you just to get back on track?" Baby steps at a time. I hope that was helpful. I really wanted to go over and really reinforce to you and hopefully get you to see that depression is a wire and depression is lying to you. A big part of that is you recognizing and being aware and observing and catching when it lies to you and having skills so that you can talk back to it, change the way you respond so that you're not contributing and making the depression stronger. Have a wonderful day. You guys always know, I'm always going to say it is a beautiful day to do hard things. I hope that this was helpful and I hope you have a wonderful day.

Feb 17, 2023

Transcript Kimberley Quinlan: Well welcome, I cannot believe this is so exciting. I've been looking forward to this episode all week. We have the amazing. Reverend Katie O'Dunne with us to talk all about scrupulosity and religious obsessions. So welcome, Katie. Katie O'Dunne: Thank you. I'm so excited to be here and to chat about all things Faith and OCD. So thanks for having me. Kimberley Quinlan: Yeah, so let me just quickly share in ERP school we have these underneath every training, every video. There's a little question and answer and I'm very confident in answering them, but when it comes to the specifics of religion, I always try to refer to someone who is, like an expert. And so this is so timely because I feel like you are perfect to answer some of these questions. Some of the questions we have here are from, ERP school . A lot of them are from social media and so I'm so excited to chat with you. Katie O'Dunne: Thank you. Kimberley Quinlan: So tell us before we get into the questions, a little about your story and you know why you are here today? Katie O'Dunne: Yeah. So I've navigated OCD since before I can remember, but just like maybe a lot of folks listening. I was very private about that for a very long time. I had a lot of shame around, intrusive thoughts. I had a lot of shame around religious obsessions that I had, moral related obsessions , harm obsessions. And this shame particularly came because I was pursuing ministry and OCD really spiked in the midst of me going to graduate school, going to seminary. And when I was in seminary and I started really struggling, I wanted to seek treatment for the first time and was told really by a mentor that it would not help me to do that. In my ministry that I wouldn't pass my psych evaluations and that I shouldn't pursue treatment that I needed to keep that on the down low. So as many of us know, that might not get that effective evidence-based treatment I continued to get sicker Katie O'Dunne: And had a really pretty full-blown OCD episode in my first role in ministry. Katie O'Dunne: So I ended up in school chaplaincy working, with lots of students from different faith backgrounds, some of what we'll be talking about today, through an OCD lens. And I was trying to keep my OCD a secret, but in the midst of navigating, some difficult tragedies and traumas with students, my OCD latched on to every aspect of what I was navigating. And particularly in the midst of that, I was experiencing losses and mental health crises with students from different faith backgrounds. And when I came out of my own treatment, where exposure and response prevention, very much saved my life. I felt like, I had an obligation to those students that I worked with to let them know that their chaplain, that their faith leader had gone through mental health treatment and that there was no shame around doing that. And I went from the space, in seminary of being told that I shouldn't seek treatment to a space of having families call me for the first time and say, Oh now we can actually talk to you about what's going on in our life. Can you help us talk with our rabbi or our imam, or our priest about my child's diagnosis? How can we reconcile faith with treatment and that opened the door for me to continue this work in a full-time way. Where moving from those students that I love so much and now work in the area of faith and OCD full-time helping folks, navigate religious scrupulosity and very much lean into evidence-based treatment while also reconnecting with their faith in ways that are value driven to them and not dictated by OCD. Kimberley Quinlan: Hmm, it makes me teary. Just to hear you say that folks were saying, Well, now, I can share with you. That is so interesting to me. You know, I think of a reverend, as like, you can go to them with anything, you know, and for them to say that you're disclosing has open some doors, that's incredible. Katie O'Dunne: And particularly, I worked really heavily with my Hindu and Muslim students. And we had the chance to do some really awesome mental health initiatives for the South Asian community, where students started then doing projects actually in their own faith communities, and opening up about their own journeys, and then giving other space to do the same. And I really, I think about the work I do now, which is very much across faith traditions around OCD. And every person I work with, I think of those awesomely brave students, who started to come to me after my disclosure and say, Okay, we want help and also we want to share our stories and continues to inspire me. DOES RELIGIOUS OCD/SCRUPULOSITY SHOW UP BEYOND THE CHRISTIAN RELIGION? Kimberley Quinlan: Yeah, so cool! It leads me to my first question which is, does this for OCD religious scrupulosity, have you found, and I definitely have, that It goes outside of just the Christian religion. I know we hear a lot about just the Christian religion, but can you kind of give me your experience with some other religions you've had to work with? 00:05:00 Katie O'Dunne: Yeah. And so I always tell folks OCD is OCD, is OCD. And it always loves to latch on to those things that are the most significant and important to us. So it makes a lot of sense, that, that would happen with our faith tradition, whether you're Christian or Muslim or Buddhist or Sheik, or beyond or even atheist or agnostic can really transform into anything, particularly from what, you might be hearing from faith leaders and I always go back to this idea that OCD is just really gross ice cream with a lot of different gross flavors and those flavors might be in the form of the Christian faith or in the Jewish faith or in the Muslim faith. But the really big commonalities is the fact that it's not about what a person actually believes just like, with everything else with OCD. This is very much egoistonic. It's taking their beliefs. It's twisting them and it's actually pushing them further away from the tradition. So, it's just some examples. Katie O'Dunne: That we see, of course, in Christianity, you all might be familiar with obsessions around committing blasphemy against the Holy Spirit, or fear of going to hell or fear of sinning in some way. But we also see lots of different things in Islam, whether that's around not being fully focused during Friday prayers or not doing ritual washing in the appropriate way. In Judaism we see so many different things around dietary restrictions or breaking religious law. What if I'm not praying correctly? Hinduism, even what if I'm pronouncing shlokas or mantras incorrectly? What if I have done something to impact my karma or my dharma? What if I'm focusing too heavily on a particular deity or not engaging in puja correctly. or in Buddhism I see a lot of folks, really focusing on what if I never stop suffering, What if I've impacted my karma in some way? What if I don't have pure intention, alongside that action and… Kimberley Quinlan: Right. Katie O'Dunne: then all the way on the other side. We can see with any type of non-theism or atheism, agnosticism humanism What if I believe the wrong thing? What if I'm supposed to believe in God, what if I'll be punished for for not? So there are all different forms and then with any faith, tradition. I mean any form possible. That OCD could latch onto Kimberley Quinlan: Yeah, absolutely I think there's just some amazing examples I had once a client who felt his frustrations weren't correct. Katie O'Dunne: Yes. Kimberley Quinlan: And got stuck really continue and trying to perfect it so I think it can fall into any of those religions for sure. So you've already touched on this a little bit, but this was one of the questions that came from Instagram. Just basically there was saying like OCD makes me doubt my faith. Like why does it do that? Do you have any thoughts, on a specifically why OCD can make us doubt our faith? Katie O'Dunne: Yeah. I mean OCD is the doubting disorder and we always say the content is irrelevant, but it definitely doesn't feel like it. I think for anybody navigating OCD, you're most likely in a space of saying I could accept uncertainty about any theme except the one that I have right now and that's very much true with faith. If your faith is something that's significant to you and at the center of your life, it makes sense that OCD would latch on to that and that OCD would twist that particularly… Kimberley Quinlan: Right. Katie O'Dunne: because we really don't have a whole lot of certainty around faith to begin with and where there's a disorder that surrounds uncertainty and and doubt. That makes a lot of sense. And yet it's so so challenging, um, because we want to be able to answer all of these questions without OCD making us question every single thing we believe, WHEN OCD DOUBTS MY FAITH Kimberley Quinlan: Mmm. It's sort of like religious obsession. I mean relationship obsessions too in that and you're probably looking at people across the your religious faith hall or wherever going, but they are certain like why can't I get that certainty? Right. But it's like they've accepted a degree of uncertainty for them to feel certain in it. But when you have OCD, it's so hard to accept that uncertainty piece of it. Katie O'Dunne: I'm so glad you said that I actually get this question a lot. And this, this might be a strange answer for folks to hear from a minister. But I always tell folks, I'm not certain I Have devoted my life to faith traditions. I'm ordained. I'm not certain about anything including about the divine. Kimberley Quinlan: Yeah. Katie O'Dunne: I have really strong beliefs, I have strong things that I lead lean into and practices that are meaningful to me. But it doesn't mean that I have certainty. And often, when you hear someone in a faith tradition, say that there are certain, I don't think it means the same thing as what we're thinking, it means from. 00:10:00 Kimberley Quinlan: Yeah. it's Yeah,… Katie O'Dunne: a different context. They are accepting some level of uncertainty . Kimberley Quinlan: that's why I compared it to relationship OCD, You're like, but I'm not sure if I love my partner enough and everybody else is really certain but when you really ask them, they're like, No I'm not completely certain,… Katie O'Dunne: Yeah. WILL GOD PUNISH ME FOR MY INTRUSIVE THOUGHTS? Kimberley Quinlan: like I'm just certain for today or whatever it may be. So I think that that is very much a typical trade of OCD in that, it requires 100%, okay? So, so, This is actually really one of the first common questions we get when we're doing psychoeducation with clients. Which is why do I have a fear that God will punish me for my intrusive thoughts? You want to share a little about that. Katie O'Dunne: Yeah, I mean there are so many, there are so many layers with this and again, latching on to what's the most important but also latching on to particular teachings. Whether it's in a church or a mosque or a synagogue where I always say there are particular scriptures, particular, teachings, particular sermons, where you might hear things that relate to punishment in some way, or relate to rigidity, but I think folks, with OCD hear those, through a very different lens than maybe someone else in that congregation and we might hear something once at age, five or six and for the rest of our lives latch on to this idea that we're doing something wrong or that God is going to punish us, we tend to always see everything through that really, really negative lens and maybe miss all of the other things that we hear about compassion and about love and forgiveness. And I think there's also this layer for individuals with OCD often holding themselves to a higher standard than everyone else and that includes the way that they see God as viewing them. So I'll often ask folks. How do you think, how do you imagine God, viewing a friend in the situation? Just like we might do a self compassion work and they're like, Well, I believe God would be really forgiving of my friend and that they might not be perfect but that they were created to live this beautiful life. And then when asking the same thing about themselves, It's but God called me to be perfect and I have to do all of these things right. I'll ask often ask folks, What does it look like to see yourself through the same loving eyes through which God sees you or which you imagine that God sees those around you which is something we don't often do with OCD. Kimberley Quinlan: And what would they often say? Katie O'Dunne: Ah well it's so I'll actually use self-compassion practices to to turn things around. And I'll say I'll ask someone to name three kind things about themselves and then to put their hand over their heart and actually say it through the lens of God saying that to them. So I'll have them say something like The Divine created me to be compassionate, the Divine believes that I am a kind person, the Divine wants me to have this beautiful life and to be a good runner or a good baseball player or whatever that is. And it's always really difficult at the beginning just like any self-compassion practice. And then I'll watch folks start to smile and say Well maybe God does see me in that way. Kimberley Quinlan: That's lovely. Katie O'Dunne: Maybe create me in a beautiful way. DO NOT FEAR…SHOULD I TURN MY FEARS OVER TO GOD? Kimberley Quinlan: Mmm. That's what it's bringing them. Back to their religion and their faith when they do that, which is so beautiful, isn't it? Mmm. Okay, This question is very similar but I really think it was important to to address is there are some scriptures where people here that they aren't allowed to fear or that they must turn their fears over to God. Do you have any thoughts or you know, responses that you would typically use for that concern? Katie O'Dunne: Mm-hmm. Katie O'Dunne: Yeah, I think, you know, it looks very different across faith traditions and across scriptures and individuals, of course, view Scripture and in very different ways but depending on their denomination, or depending on their sect, but I think sometimes, unfortunately, those scriptures are used out of context. We see this often where there might be a particular verse that's pulled that from a translation perspective isn't necessarily really about anxiety in the same way that we're defining anxiety through an OCD lens or isn't really about intrusive thoughts, in the way that we're defining it through the lens of OCD. And I think it's really unfortunate when we hear religious leaders or folks in communities say, Well, you aren't allowed to fear or if you just prayed a little bit harder, your anxieties would be able to be turned over to God. And I think we're hearing that or they're using that and maybe a different way than the passage was intended. And then we're hearing this through a whole nother another layer where it actually could be flipped. And instead, when you're you're saying, Don't fear. I always tell folks. So what does it look like instead to not fear treatment or to do it even if you're afraid. To ask God, to give you strength in the midst of that fear and to approach that in a different way. But I think sometimes those who are taking particular passages out of context, might not fully understand the weight of OCD, or what comes with that condition. 00:15:00 HOW DO I KNOW IF IT IS OCD OR IN LINE WITH THE RULES OF MY FAITH? Kimberley Quinlan: Right. Right. I love that. Thank you for sharing. That was actually the most common question, I think. So like four or five people off the same question. So I know that's a such an important question that we addressed. Quite a few people also asked how to differentiate like, you know with OCD treatment, it's about sort of understanding and being aware of when OCD is present and how it plays its games, and it's tricks in its tools that it uses. How would people know whether something is OCD or actually in line with the rules of their faith? Do you have any sort of suggestions for people who are struggling with that? Katie O'Dunne: Yeah, so I'll actually often show folks a chart when we start to work together and we'll put things in different buckets of what are things that you're doing, because they are meaningful because they bring you hope because they bring you comfort because they bring you joy. And then on the other hand, What are things that you're doing out of fear? Out of anxiety things, that feel urgent things that are really uncomfortable. And of course, there is never any certainty around anything, which is very much one of the tricky parts with with treatment, right? We want to have certainty but I invite folks to really make the assumption that probably those things that bring joy and meaning and hope and passion and connection are the authentic versions of their faith. Versus the things that we're doing out of fear or anxiety. And, you know, I was doing a training, a couple months ago for clinicians in this area and I was, I was talking about how, you know, we don't necessarily want folks to pray out a fear and someone had a really great question. They said. Okay. But if a plane is going down and someone's praying because they're afraid like that's not because it's OCD, I'm like No that's that's very true. But in that situation they are praying because they're afraid to bring meaning and hope they're not praying because they're afraid of not praying and… Kimberley Quinlan: Yeah. Katie O'Dunne: there's a very big distinction there. Are you doing the practice? Because you're afraid of not doing it or not or you're afraid of not doing it perfectly, or are you engaging in that practice even in moments that are tough in order to bring you peace and meaning and joy and comfort. WHEN PRAYER BECOMES A COMPULSION Kimberley Quinlan: And that if that, maybe I've got this wrong so please check me on this, but it feels like too, when people often ask me that similar question but not around compulsive praying of like, but if there is a problem, shouldn't I actually do something about it? And I'm like, Well, this that's a difference between doing something about something when there is an actual problem compared to doing something because maybe something might happen in the future, right? It's such a trick that OCD plays. Is it gets you to do things just in case. So would that be true of that as well? Katie O'Dunne: Okay. Yeah. And I often tell folks just again because it's just another form of OCD that's latching on to something that significant very similar. I tell folks, if it's really a problem that you need to address, most likely you would do it without asking the question to begin with. But it's I think the unfortunate thing that the other example I give is well, if we think most traditions we think of God as a parent figure and I ask folks, who are our parents to imagine their relationship with their own child, and do you want your child to connect with you throughout the day out of meaning and out of hope and out of genuine, a genuine desire for love or because they're afraid of not talking to you and… Kimberley Quinlan: Right. Katie O'Dunne: those are two. Those are two very, very different things. Kimberley Quinlan: Right. As it's like a disciplinarian figure. Yeah, that's a really great example. I love that. Yeah. Okay. This is, this was one of the questions that I got, but it's actually one of the cases that I have had in my career, as well, which is around the belief that thoughts are equal to deeds, right? Like that. If I think it, it must mean, I love it, I like it, or I want it or I've done it. Can you give some perspective to that from from specifically related to religious obsessions? Katie O'Dunne: 00:20:00 Katie O'DunneYeah this can be really hard for folks and of course with OCD thought actions fusion can be really challenging anyway and there is often, for folks in a faith context this belief that because I had this though, because I had what might be perceived as a sinful thought, I must be committing blasphemy, or I must be committing this particular sin and that can make it really really tought to do diffusion work with you clinician because its like I had this thought it must actually mean that I have done this thing that is in opposition to God and I always tell folks that of course I am not going to reassure you fully that those things are completely separate but I would invite you to lean into the possibility that a thought is just a thought. Just like any other aspect of OCD we have a jillion different thoughts a day that pass into and out of our minds and I actually think from a faith perspective that it is pretty cool that our brains produce alot of different thoughts, that we see things and make different associations. Ill tell folks way to do God we see things and make all sorts of connections. But, having thought doesn't equate to having a particular action even if we are looking on the form of most scriptures. It is really referencing things that we are doing, ways that we are actually engaging with those thoughts and taking that into our actions. And again from the pulpit, you might hear someone talk about thoughts or intrusive thoughts in ways that are not equivalent to how we're talking about them through an OCD lens,… Kimberley Quinlan: Mm-hmm. Katie O'Dunne: something very different and they're really talking about more of an intentional act, in something that you're you're doing, as opposed to what we're thinking about. It's just a biological process of thoughts, moving through your mind. ARE THOUGHTS EQUAL TO DEEDS? Kimberley Quinlan: Right. And and what I be right in clarifying here, is it important to differentiate between a thought you had compared to a thought that's intrusive, is that an important piece or do we not need to go to that level? Katie O'Dunne: Do you mean, in the religious context? I, I don't know. I mean, I, I'm curious what you think from a clinical I go back to thoughts or thoughts or thoughts and… Kimberley Quinlan: Yeah. Katie O'Dunne: they are intrusive because we're labeling them as intrusive. Unfortunately, sometimes in religious context, and I hear this a lot, someone might go to… I hear actually from sermons all the time, where someone is saying that intrusive thoughts or in some way sinful and really what they're thinking are just regular thoughts that people are giving value to and… Kimberley Quinlan: Yeah. Yeah. Katie O'Dunne: it makes it makes it really challenging for folks where they're giving more value to their thoughts and then thinking, well my preacher said that if I have a thought that's quote unquote bad that it means something about me. EXPOSURE & RESPONSE PREVENTION (ERP) FOR RELIGIOUS OBSESSIONS/SCRUPULOSITY Kimberley Quinlan: I think you just hit the nail on the head, when we apply judgment to a thought as good or bad, then we're in trouble, right. That's when things start to go sticky. Yeah. Okay, excellent. Okay. Let's talk about specific treatment for religious obsessions and exposure examples. I know for those listening we have done an episode with Jud Steve, I will link that in the show notes. He did go over some but I just love for you to go over like what are some examples of exposures? And how might we approach exposure and response prevention, specifically related to these religious obsessions? Katie O'Dunne: Yeah, so his health folks, I'm not I'm not a clinician, but I work alongside a lot of really amazing clinicians in religious scrupulosity to develop exposure hierarchies. And one of the big fears when I'm working with someone is often, how could I possibly engage in exposure and response prevention because what if someone asked me to do something that's in opposition to my faith? And I want to go ahead and just put that on the table right now… I know that's a big fear and I want you to know that a good OCD specialist or an ERP therapist is really gonna work with you not to go against or to oppose your faith. But to do some things that are a little bit uncomfortable in service of you, being able to get back to your faith in a value-driven way. Katie O'Dunne: I really believe we are never going to be incredibly excited about exposures. When I was on my own exposure and response, prevention journey, I never once walked into the office and said, Yes, I get to do this really scary exposure today. It's gonna be so fun. Well, I guess I did say that because my therapist made me pretend to be excited about exposures, but that's different. That's a different conversation was not necessarily genuine. And so i'll often ask folks, I know that this isn't something that you want to do, but why don't you want to do it? And if the answer is well, I'm afraid that it might upset God or I'm afraid something bad might happen. That's probably a good exposure. If the immediate response is Well, no, I'm not gonna do that. No one else in my tradition would do that. That's completely in opposition to everything we believe, probably not something that that we would ask you to do and often clinicians will use the 80/20 rule of what would 80% of the folks within your congregation be willing to do and that can be really helpful working with a faith leader as well or with other folks within your particular sect or denomination to establish that. 00:25:00 Katie O'Dunne: The same time there. Oh my goodness, so many different exposures that we can go into. But a lot of things that I see folks commonly working on are things like praying imperfectly maybe speaking or speaking of blasphemous thought aloud or thinking through that in an intentional way, writing an aspect of that, not completing ritual washing again and again only doing it once and even thinking through the fact that it might not have been perfect that time or maybe even intentionally diverting your attention in the midst of a prayer. Sometimes for folks who are avoiding Scripture that is intentionally reading that aspect of Scripture and then maybe thinking intentionally about something that they've thought as a bad thought or that they've defined in that way. But again it very much depends for each person and I really want folks to know that it doesn't mean that you are going to be asked to eat something that goes against your dietary restrictions or to deface a religious text. Those are the two things I hear folks, very fearful of and that isn't something that you need to do in order to get better. It's about having conversation and handing over the keys to your clinician to do some uncomfortable stuff in favor of getting back to your faith in a value-driven way. Kimberley Quinlan: Yeah, I love that. I'll tell a quick story, when I was a new intern treating OCD having no clue really what I was doing. I'm very happy to disclose that was the facts, but I had amazing supervisors and I grew up in an Episcopalian denomination and I had a client who was of similar denomination in the Christian faith. And my supervisor said, Well, okay, you're gonna have him go and say the blasphemous words and in my mind, this being my first case going like are we allowed, like side eye.And he said Okay this is your first go around. I want you to ask your client to go and speak with their religious leader and say, This is what I'm struggling with. AndI have this diagnosis and this is the treatment, it's the gold standard and Kimberley's gonna go with you and do we have permission to proceed and the minister was so wonderful. He said, If that is what's gonna bring you closer to your faith, go as hard as you can. And for me, it was just such a beautiful experience as a new clinician to have. He knew nothing about OCD but he was like if that's what you need to do to get closer, go. Like he had so much Faith himself in, I know it'll bring you to the right place and so it's so beautiful for me and that kind of helped me guide my clients to this day. Like go and get permission speak to your minister if that helps you to move forward, do you have any thoughts on that? Katie O'Dunne: Oh yes, and this is really my favorite thing that I get to do with folks in addition to working with clinicians and clients and developing exposures, also in faith traditions that are not my own, but then I might have studied make connections to other faith leaders so we can talk about what makes the most sense in this particular set so that someone can fully live into their faith tradition while well, maybe being a little uncomfortable in this moment or doing something tough and I deeply believe whatever that looks like for you, even if the exposure seems a little bit scary, that God can handle our exposures. Across faith traditions. We see the divine as this big, wonderful powerful all knowing force and with everything going on in the world, I deeply believe theologically that the exposure that we're doing over here, which might seem really hard for us, that God can handle that as a way for us to get back to doing the things that we were actually created to do. And in that way, similar to the minister that you talked with that said, Hey, go for it. I'll even tell folks, I see ERP as a spiritual practice because a spiritual practice is defined as anything that helps you to reconnect or get closer with the divine and in that way, doing ERP really does that because it's breaking down the OCD so that you almost stop worshiping OCD and actually reconnect with God in a way that's value driven for you. That's actually what I'm getting ready to start. My doctoral research on is actually redefining ERP as a spiritual practice across faith traditions in ways that are accessible for a diverse population. Kimberley Quinlan: And that's so beautiful, I love that. Okay, let's see. Okay, This is actually the last question, but this is actually the one I'm most excited to ask. This is actually from someone I deeply care about. They have written in and said, When I get anxious, I try to submit it to God knowing of his love and power. So, by writing a script, which is an ERP practice, for those of you who don't know, it seems I'm in conflict with my religious belief. Do you have any like points, final points, you want to make about that? 00:30:00 Katie O'Dunne: Yeah. So two big things, one going off of what I was just sharing a second ago. I would encourage you to know, or maybe not to know, for sure but, we can lean into uncertainty around this right? But to accept all of the uncertainty, while also leaning in and believing that God can handle this difficult script that you're writing or this difficult exposure that you're doing in favor of you getting to live the life that you were created to live. Not defined by OCD and that you still can pray and ask for God's support as a part of that. I would never ask someone not to continue to connect with God during some of sometimes, the most difficult process of their life which treatment can be, I know it was for me, it was incredibly scary. But rather than asking for reassurance, or asking for God, to undo any of that exposure work we're doing or or saying, oof, disregard this script I just did. We're not, we're not going to do any of those things, but rather, I would invite you to say, in whatever way makes sense to you, Dear God, please help me to lean into the uncertainty, please help me to sit with this discomfort associated with this exposure, on the way to getting back to this big, beautiful, awesome life that you've created me to live. It's really hard right now. This is really tough, but please walk with me as I sit with all of it, helping me not to push away that anxiety, but rather to be with it as I reclaim my life. Amen. Or something of that nature. Yeah. Kimberley Quinlan: Yeah, that's beautiful. So thank you, really. I get teary again, this is such a beautiful conversation. Okay, so number one, thank you so much for coming on, really, it's a blessing to have you here and you know, I think this will help so many folks. Is there something that we didn't cover that you you know that point that you just made alone, I feel like it's like mic drop. But is there anything else you want to add before we finish up? Katie O'Dunne: Yeah, um, and just, and this is a little bit more Christocentric, but I think it goes across faith traditions, I often talk about the recovery Trinity and just to leave folks with this as well. That I deeply believe that it's possible to have faith in yourself, faith in the divine and faith in your treatment all at the same time and that those three pieces coming together, allowing those to be together, actually can be a huge key with religious scrupulosity, and taking a step towards your life during treatment. Kimberley Quinlan: That's beautiful. And I've never heard that before. That is so beautiful. I'll be sure to get my staff all trained up in that as well. Thank you. oh, Katie,… Katie O'Dunne: Oh sorry, one more thing. Sorry, as I say that and I know we're closing out. I also always want folks to know that ERP. This is, this really is my last thing. I promise. Kimberley Quinlan: Oh no, no. Go for it. You've got the mic go. Katie O'Dunne: No. Um that I've worked with a lot of folks across traditions with religious scroup and I would say um a majority of the folks that I've worked with have moved through ERP and at the other side actually have a deeper relationship with their faith then maybe they did before and I would encourage you to hear that that actually leaning into that uncertainty translates far beyond OCD sometimes into a closer relationship with God. And I've worked with folks who have moved through ERP that end up going into ministry because that's meaningful to them in a way that isn't driven by OCD. So just knowing that it doesn't ever mean, you're stepping away from your faith, you're taking actually this leap of faith to reconnect with it in a way that's actually authentic to you. Kimberley Quinlan: Mmhm. I'm so grateful that you added that. Isn't that some of the truth, with OCD in general, like the more you want certainty, the less of it you have. And the more you let go of it, the more you can kind of have that value driven life. I love it. Okay, I can't thank you enough, really, this has been such a beautiful conversation. I probably nearly cried like four times and I don't, I don't often get to that. It's just so, so beautiful and deep. And I think it's, it's wonderful. Thank you. Where will people hear about, you get to know you reach out to you and so forth. Katie O'Dunne: Yeah, so folks are more than welcome to reach out to me via Instagram at @RevkRunsBeyondOCD or on my website at RevKatieO'dunne.com . I do lots of work again with clinicians and faith, leaders and clients but also have free weekly faith and OCD support groups along with interfaith prayer services for folks navigating what it means to lean into their faith traditions from a space of uncertainty and an inclusive environment. And then I would also encourage folks to check out our upcoming Faith and OCD conference with the Iocdf in May along with a really awesome resource page that we were so proud to put out last year. I had the chance to work with a really great team of clinicians and faith leaders to create a resource page for all of you to see what scrupulosity might look like in your faith tradition along with resources. So check out all of those wonderful things. 00:35:00 Kimberley Quinlan: Amazing. We will have all that linked in the show notes. Thank you, Katie, really! It's such an honor to have you on the show.Katie O'Dunne: Thank you. This was lovely. Thank you so much.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you. Hello and welcome back everybody. Today, I'm going to share some updates about a recent medical issue I have had, and I'm going to share specific tips for dealing with health anxiety (also known as hypochondria). A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I've had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. Here I'm going to share with you five specific tips, but I think in total, there's 20-something tips all woven in here. I've done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I'm also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you're experiencing that at this time. Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I've been having these what I call surges. They're like adrenaline surges. They wake me up. My heart isn't racing. It's not like it's racing fast, but the only way I can explain it is I feel like I have like a racehorse's heart in my chest, like this huge heart that's beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn't experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. WHAT HEALTH ANXIETY FEELS LIKE Before we get started, be sure to make sure you're not avoiding doctors. Make sure you're not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We'll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I'm very, very skilled at identifying what is anxiety and what is not. I've become very good at catching that by experience, folks. It's not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. For me, for the health anxiety piece, it's really this sort of anxiety that is a sense of catastrophization and it's usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, "Well, my heart's beating really heavily and I feel dizzy. Oh my gosh. And I've been having a headache. Yeah, you're right, I've been having a headache. Oh my gosh." I call it 'gathering.' That's not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I'm panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. Let's now talk about how to manage these symptoms and some tips and tools that you can use. Tip #1: No Googling Let me tell you what has recently happened to me. I've been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, "It's not a big deal. I can handle these symptoms." I'm feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it's taking a long time. She's asking me these strange questions like, "Why are you here again," as she's doing it. She's checking, she's looking, she's squinting at the screen. "Why are you here again? What are your symptoms?" Click, click, click, looking at the heart, whatever. Again, I'm in my mind going, "Kimberley, let your brain have whatever thoughts it wants. We're not going to catastrophize." I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, "Great, you've got 24 hours and then the doctor will email you with your results." And then yesterday afternoon, I get a call from the nurse saying, "We need to book you a video appointment with the doctor to discuss your results." As you can imagine, my brain went berserk. My health anxiety thoughts were saying, "This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?" Of course, my brain did that. I'm grateful my brain does that because that's my brain being highly functioning and aware. But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this. That is tip #1 for you. I'll tell you why. A lot of my patients say, "But why? It's no harm. I'm not doing any harm." And I'll say, "Yes." I've actually just seen my cardiologist. But now that I've had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don't. Some go, "This could be very normal." Other ones say, "This could be cancer, cancer, cancer, cancer." This is why I'm telling my patients all the time, don't Google because what you read is different. It's not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they've included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They've just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm. Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they've encouraged you to do research, do not Google. TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES I've actually categorized this in a bigger category and I've called it important health anxiety CBT techniques, because there are some important CBT tools that you're going to need here and here we go. While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I'd experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What's going on with her? I wonder what she meant. What I want to encourage you to do is acknowledge and catch when you're checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I'm doing there is mind reading because I have no idea what she's thinking. I was laughing at myself because she was squinting and looking concerned. I was like, "I wonder if she's trying not to pass gas." We could mind read that she thinks I have cancer and that there's a big problem, or maybe she's just trying not to pass gas right now. Maybe she's thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I'm being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, "So, you'd let me know if there was..." I paused because what I was going to say is, "You'll let me know if there's something wrong, right?" I was going to say that. And then I was like, "No, no, no." I stopped myself and said, "You know what? I know the deal. I've done these enough times. I know I have to wait for the doctor." But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, "No, you're fine. Everything looks good," or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you're in the office with a doctor, you may find yourself at the end of the session going, "I'll be fine, right? It's not bad, right?" It's okay, we're all going to ask some of those questions. I'm not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we're engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear. Now, another CBT technique or sort of rule that we often set in clinical work when I'm talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor's appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, "There are some issues. It could be this, it could be that, it could be this." He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever. When they give you these three or four or five options on what the problem might be, it's very important that you be mindful and aware of how you're trying to sway the doctor to give you certainty. This is what my doctor said, and I'm going to be brief. I'm not going to bore you with my medical stuff, but he'll say, "It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it's so, we'll treat that. It could also be that there could be some rheumatoid arthritis and that's a longer treatment. And then the final thing, which we don't think so, but it also could be cancer. "Let's say he lists off these four options. Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn't ignore big issues, but we have to be careful that we don't spend their time and our time going, "You think it's the first one, right? It's probably just the first one. I probably just had a virus, right?" I'm really swaying him towards giving an answer when he's already told us that he or she doesn't know yet. He's already said, "I don't know yet. We're going to need to do extra tests." Catch yourself trying to get them to reassure you and confirm that it's definitely not the C word. The cancer word is what I'm saying there. Catch yourself when you're doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. Now, one other thing I want you to also catch is if you're coming to them with something, let's say you are coming to them with a concern that you've pretty much know is your health anxiety, but you want reassurance that it's not, also be careful that you don't overly list things to convince them that something is wrong. A lot of you don't do this, I know, but I have had a lot of clients who've come back to me after seeing the doctor and said, "Do you have any other symptoms," and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn't say it all, if they didn't include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that. That's some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions. TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR'S VISIT This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don't want to even go too over in terms of pathologizing that. I think that's a normal thing for anybody to experience. The first thing I want you to practice is validating your anxiety. It's a part of self-compassion practice. It's going, "It makes complete sense, Kimberley, that this is concerning you." That's one of the most important self-compassionate statements you could make for yourself. "It makes complete sense that this is hard, this is scary. Of course, it's making you uncomfortable." It's validating. You might even move to a common humanity, going, "Anybody in this situation would have anxiety." Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn't mean there's danger or there's a catastrophe. It's my body's natural response to create anxiety when it feels threatened. That keeps me alive. That's a good thing. But just because I'm anxious and having thoughts about scary things doesn't mean they're facts. Remember, thoughts are not facts. The next thing here is also being able to just observe them, again, while you're sitting in the waiting room. They were playing the movie, what's it called? Moana. And I love Moana. I remember watching it as a child. I'm sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. A part of my mindfulness practice was to go, "I am noticing I'm having these catastrophic thoughts, but I'm also noticing Moana, and I'm going to choose which one I give my attention to." I'm not going to push them away. I'm not going to make the thoughts go away because they're naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn't go in saying, "Oh gosh, I hope the next 24 hours aren't filled with thoughts." I was like, they're going to be, "Hello thoughts, welcome. I know you're going to be here," and I'm going to train my brain to put attention on what matters to me. In this case, I'm not going to make these thoughts important. I'm going to watch Moana. I'm going to look at the colors, I'm going to listen to the sounds, I'm going to notice whatever it is that I notice. I'm going to notice the fabric of the seat underneath me as I'm waiting in the room. Last night as I went to bed, I'm just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario. There's one important point here, which is my mind kept saying, "By nine o'clock tomorrow, your life might change." You guys know what? If you're listening, I'm guessing you know what that's like. You're like, "After this appointment, this appointment may change your life for the worse." My job was to go, "Maybe, maybe not. It could be that he just wants to tell me everything's okay." It is what it is. It will be what it will be. I will work through it and solve it when it happens. I'm not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We're not going to live your life through the lens of the worst case. We're going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don't know. MEDITATION FOR HEALTH ANXIETY Now, other options for you, I'm just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you're going to have some anxiety. That's okay. Really what we want to do is we want to be working in the most skillful fashion as we can. And then the last one, this one's a little controversial. Some people don't agree with this piece of advice, so take what you need and leave what doesn't help. But for me, when I'm anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, "Take a breath, Kimberley, when you need. Take a breath when you need." TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER? Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I'm just going to say it's basically what to do if you're panicking and the advice goes the same as it is whether there's a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let's break it down. If you're having anxiety, and you are saying, "This is bad, I don't want it, it shouldn't be here," you're actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it's going to pump out more and more anxiety because you've told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. You can talk to your anxiety. There's actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I've had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, "Oh yeah, and by the way, you might have cancer. Ha-ha-ha!" You know what I mean? Of course, your brain's going to tell you that. In that moment, I used the skill and the research around talking to myself in the third person. I said, "Kimberley, there's nothing you can do right now. It makes total sense that you have anxiety. Let's not push it away. Let's bring your attention to what you can control, which is how kind you are to yourself, whether you're clenching your body up, whether you're breathing, whether what you're putting your attention on. You can't control anything. You can't control this earthquake. You can't control what's happening tomorrow. All you can do is be here now." Using a third person, using your name as the third person like, "Kimberley..." and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that's actually science-based. TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we're anxious, when we have health anxiety, it's very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don't want to go out. And so I almost was starting to say, "Maybe I'll ask my husband to drop off my daughter and my son so I can stay home." I recognize that would be me doing a fear-based behavior. I would be doing that only because I don't want to face fear today. I just want to make it small. Number one, it's okay. If you need to do that, that's totally okay. But for me personally, I caught myself and I said, "No, you value being someone who drops off your daughter and shows up and doesn't let anxiety win. You love dropping off your daughter. If you stayed home, you'd only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off." And so engage in that. Another value-based behavior for me personally is humor. I'm texting friends and I'm telling them jokes about what I'm going to do to my doctor if he says something wrong or something, or I'm making jokes about some of the questions and statements that the nurses made. I'm making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I'm making jokes about what we'll do if it's cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I'm not doing that as depressed bad things are going to happen. I'm doing it because I'm literally saying, it will be what it will be. Let's just move forward and let's actually bring some light and joy and some laughter to this. Now you might not like that. If that's not your values, don't do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn't here? And then do those behaviors. It's really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It's very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places. HEALTH ANXIETY JOURNAL PROMPTS This is really important. I know I've given you the top five, but that's more like 20 points. Let's talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. What is in my control right now? What is in my control? My behaviors, my reactions. That's ultimately what is in your control. What's not in your control is how much anxiety you have and what thoughts you have about them. What is not in my control? You can be very specific here. In my case, it's like, what's not in my control is what the doctor says. What's not in my control is what my health condition is. What's not in my control is when he calls. You know what I mean? What's not in my control is the treatment plan. I'm going to have to wait for him to do that. I'm identifying what is in my control and what is not. How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? For me, I know that Googling is going to be a full sense of control and doesn't help my long-term recovery, so I'm not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it's not helpful. It's not helpful. It doesn't help my long-term recovery, it doesn't help my long-term mental health, so I'm not going to do it. What will help my long-time health anxiety goals, it's going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. How willing am I to be uncertain right now? You guys are going to have to tolerate a lot of uncertainty. That's what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would've Googled was because I wanted certainty. Really, really important. What would the non-anxious me do right now? She'd get up and she'd go and drop her daughter off, and then she'd call your friend because that's what you do every Wednesday morning. She'd respond to emails, she'd call. Do whatever it is that you're doing. What would the non-anxious you do? How can I be kind and gentle towards myself as I navigate this experience? Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn't reassure me, he just says, "I got you." If your partner is giving you a lot of reassurance, you might want to mention to them, "That actually doesn't help my long-term health anxiety. I just need you to be next to me and support me." And so it's very important that we make sure our partners aren't giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. That's it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could. I hope you have a wonderful day. Please do not worry about me. I am actually fine. There's a joke between my best friend and I. We say, "Are you fine number one or fine number two?" Fine number one is you actually are fine and fine number two is you're not fine, but you're saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I'll see you next week.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you. Hello and welcome back everybody. Today, I'm going to share some updates about a recent medical issue I have had, and I'm going to share specific tips for dealing with health anxiety (also known as hypochondria). A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I've had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. Here I'm going to share with you five specific tips, but I think in total, there's 20-something tips all woven in here. I've done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I'm also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you're experiencing that at this time. Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I've been having these what I call surges. They're like adrenaline surges. They wake me up. My heart isn't racing. It's not like it's racing fast, but the only way I can explain it is I feel like I have like a racehorse's heart in my chest, like this huge heart that's beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn't experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. WHAT HEALTH ANXIETY FEELS LIKE Before we get started, be sure to make sure you're not avoiding doctors. Make sure you're not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We'll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I'm very, very skilled at identifying what is anxiety and what is not. I've become very good at catching that by experience, folks. It's not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. For me, for the health anxiety piece, it's really this sort of anxiety that is a sense of catastrophization and it's usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, "Well, my heart's beating really heavily and I feel dizzy. Oh my gosh. And I've been having a headache. Yeah, you're right, I've been having a headache. Oh my gosh." I call it 'gathering.' That's not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I'm panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. Let's now talk about how to manage these symptoms and some tips and tools that you can use. Tip #1: No Googling Let me tell you what has recently happened to me. I've been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, "It's not a big deal. I can handle these symptoms." I'm feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it's taking a long time. She's asking me these strange questions like, "Why are you here again," as she's doing it. She's checking, she's looking, she's squinting at the screen. "Why are you here again? What are your symptoms?" Click, click, click, looking at the heart, whatever. Again, I'm in my mind going, "Kimberley, let your brain have whatever thoughts it wants. We're not going to catastrophize." I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, "Great, you've got 24 hours and then the doctor will email you with your results." And then yesterday afternoon, I get a call from the nurse saying, "We need to book you a video appointment with the doctor to discuss your results." As you can imagine, my brain went berserk. My health anxiety thoughts were saying, "This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?" Of course, my brain did that. I'm grateful my brain does that because that's my brain being highly functioning and aware. But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this. That is tip #1 for you. I'll tell you why. A lot of my patients say, "But why? It's no harm. I'm not doing any harm." And I'll say, "Yes." I've actually just seen my cardiologist. But now that I've had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don't. Some go, "This could be very normal." Other ones say, "This could be cancer, cancer, cancer, cancer." This is why I'm telling my patients all the time, don't Google because what you read is different. It's not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they've included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They've just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm. Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they've encouraged you to do research, do not Google. TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES I've actually categorized this in a bigger category and I've called it important health anxiety CBT techniques, because there are some important CBT tools that you're going to need here and here we go. While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I'd experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What's going on with her? I wonder what she meant. What I want to encourage you to do is acknowledge and catch when you're checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I'm doing there is mind reading because I have no idea what she's thinking. I was laughing at myself because she was squinting and looking concerned. I was like, "I wonder if she's trying not to pass gas." We could mind read that she thinks I have cancer and that there's a big problem, or maybe she's just trying not to pass gas right now. Maybe she's thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I'm being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, "So, you'd let me know if there was..." I paused because what I was going to say is, "You'll let me know if there's something wrong, right?" I was going to say that. And then I was like, "No, no, no." I stopped myself and said, "You know what? I know the deal. I've done these enough times. I know I have to wait for the doctor." But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, "No, you're fine. Everything looks good," or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you're in the office with a doctor, you may find yourself at the end of the session going, "I'll be fine, right? It's not bad, right?" It's okay, we're all going to ask some of those questions. I'm not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we're engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear. Now, another CBT technique or sort of rule that we often set in clinical work when I'm talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor's appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, "There are some issues. It could be this, it could be that, it could be this." He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever. When they give you these three or four or five options on what the problem might be, it's very important that you be mindful and aware of how you're trying to sway the doctor to give you certainty. This is what my doctor said, and I'm going to be brief. I'm not going to bore you with my medical stuff, but he'll say, "It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it's so, we'll treat that. It could also be that there could be some rheumatoid arthritis and that's a longer treatment. And then the final thing, which we don't think so, but it also could be cancer. "Let's say he lists off these four options. Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn't ignore big issues, but we have to be careful that we don't spend their time and our time going, "You think it's the first one, right? It's probably just the first one. I probably just had a virus, right?" I'm really swaying him towards giving an answer when he's already told us that he or she doesn't know yet. He's already said, "I don't know yet. We're going to need to do extra tests." Catch yourself trying to get them to reassure you and confirm that it's definitely not the C word. The cancer word is what I'm saying there. Catch yourself when you're doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. Now, one other thing I want you to also catch is if you're coming to them with something, let's say you are coming to them with a concern that you've pretty much know is your health anxiety, but you want reassurance that it's not, also be careful that you don't overly list things to convince them that something is wrong. A lot of you don't do this, I know, but I have had a lot of clients who've come back to me after seeing the doctor and said, "Do you have any other symptoms," and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn't say it all, if they didn't include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that. That's some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions. TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR'S VISIT This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don't want to even go too over in terms of pathologizing that. I think that's a normal thing for anybody to experience. The first thing I want you to practice is validating your anxiety. It's a part of self-compassion practice. It's going, "It makes complete sense, Kimberley, that this is concerning you." That's one of the most important self-compassionate statements you could make for yourself. "It makes complete sense that this is hard, this is scary. Of course, it's making you uncomfortable." It's validating. You might even move to a common humanity, going, "Anybody in this situation would have anxiety." Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn't mean there's danger or there's a catastrophe. It's my body's natural response to create anxiety when it feels threatened. That keeps me alive. That's a good thing. But just because I'm anxious and having thoughts about scary things doesn't mean they're facts. Remember, thoughts are not facts. The next thing here is also being able to just observe them, again, while you're sitting in the waiting room. They were playing the movie, what's it called? Moana. And I love Moana. I remember watching it as a child. I'm sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. A part of my mindfulness practice was to go, "I am noticing I'm having these catastrophic thoughts, but I'm also noticing Moana, and I'm going to choose which one I give my attention to." I'm not going to push them away. I'm not going to make the thoughts go away because they're naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn't go in saying, "Oh gosh, I hope the next 24 hours aren't filled with thoughts." I was like, they're going to be, "Hello thoughts, welcome. I know you're going to be here," and I'm going to train my brain to put attention on what matters to me. In this case, I'm not going to make these thoughts important. I'm going to watch Moana. I'm going to look at the colors, I'm going to listen to the sounds, I'm going to notice whatever it is that I notice. I'm going to notice the fabric of the seat underneath me as I'm waiting in the room. Last night as I went to bed, I'm just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario. There's one important point here, which is my mind kept saying, "By nine o'clock tomorrow, your life might change." You guys know what? If you're listening, I'm guessing you know what that's like. You're like, "After this appointment, this appointment may change your life for the worse." My job was to go, "Maybe, maybe not. It could be that he just wants to tell me everything's okay." It is what it is. It will be what it will be. I will work through it and solve it when it happens. I'm not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We're not going to live your life through the lens of the worst case. We're going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don't know. MEDITATION FOR HEALTH ANXIETY Now, other options for you, I'm just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you're going to have some anxiety. That's okay. Really what we want to do is we want to be working in the most skillful fashion as we can. And then the last one, this one's a little controversial. Some people don't agree with this piece of advice, so take what you need and leave what doesn't help. But for me, when I'm anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, "Take a breath, Kimberley, when you need. Take a breath when you need." TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER? Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I'm just going to say it's basically what to do if you're panicking and the advice goes the same as it is whether there's a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let's break it down. If you're having anxiety, and you are saying, "This is bad, I don't want it, it shouldn't be here," you're actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it's going to pump out more and more anxiety because you've told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. You can talk to your anxiety. There's actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I've had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, "Oh yeah, and by the way, you might have cancer. Ha-ha-ha!" You know what I mean? Of course, your brain's going to tell you that. In that moment, I used the skill and the research around talking to myself in the third person. I said, "Kimberley, there's nothing you can do right now. It makes total sense that you have anxiety. Let's not push it away. Let's bring your attention to what you can control, which is how kind you are to yourself, whether you're clenching your body up, whether you're breathing, whether what you're putting your attention on. You can't control anything. You can't control this earthquake. You can't control what's happening tomorrow. All you can do is be here now." Using a third person, using your name as the third person like, "Kimberley..." and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that's actually science-based. TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we're anxious, when we have health anxiety, it's very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don't want to go out. And so I almost was starting to say, "Maybe I'll ask my husband to drop off my daughter and my son so I can stay home." I recognize that would be me doing a fear-based behavior. I would be doing that only because I don't want to face fear today. I just want to make it small. Number one, it's okay. If you need to do that, that's totally okay. But for me personally, I caught myself and I said, "No, you value being someone who drops off your daughter and shows up and doesn't let anxiety win. You love dropping off your daughter. If you stayed home, you'd only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off." And so engage in that. Another value-based behavior for me personally is humor. I'm texting friends and I'm telling them jokes about what I'm going to do to my doctor if he says something wrong or something, or I'm making jokes about some of the questions and statements that the nurses made. I'm making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I'm making jokes about what we'll do if it's cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I'm not doing that as depressed bad things are going to happen. I'm doing it because I'm literally saying, it will be what it will be. Let's just move forward and let's actually bring some light and joy and some laughter to this. Now you might not like that. If that's not your values, don't do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn't here? And then do those behaviors. It's really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It's very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places. HEALTH ANXIETY JOURNAL PROMPTS This is really important. I know I've given you the top five, but that's more like 20 points. Let's talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. What is in my control right now? What is in my control? My behaviors, my reactions. That's ultimately what is in your control. What's not in your control is how much anxiety you have and what thoughts you have about them. What is not in my control? You can be very specific here. In my case, it's like, what's not in my control is what the doctor says. What's not in my control is what my health condition is. What's not in my control is when he calls. You know what I mean? What's not in my control is the treatment plan. I'm going to have to wait for him to do that. I'm identifying what is in my control and what is not. How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? For me, I know that Googling is going to be a full sense of control and doesn't help my long-term recovery, so I'm not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it's not helpful. It's not helpful. It doesn't help my long-term recovery, it doesn't help my long-term mental health, so I'm not going to do it. What will help my long-time health anxiety goals, it's going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. How willing am I to be uncertain right now? You guys are going to have to tolerate a lot of uncertainty. That's what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would've Googled was because I wanted certainty. Really, really important. What would the non-anxious me do right now? She'd get up and she'd go and drop her daughter off, and then she'd call your friend because that's what you do every Wednesday morning. She'd respond to emails, she'd call. Do whatever it is that you're doing. What would the non-anxious you do? How can I be kind and gentle towards myself as I navigate this experience? Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn't reassure me, he just says, "I got you." If your partner is giving you a lot of reassurance, you might want to mention to them, "That actually doesn't help my long-term health anxiety. I just need you to be next to me and support me." And so it's very important that we make sure our partners aren't giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. That's it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could. I hope you have a wonderful day. Please do not worry about me. I am actually fine. There's a joke between my best friend and I. We say, "Are you fine number one or fine number two?" Fine number one is you actually are fine and fine number two is you're not fine, but you're saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I'll see you next week.

Feb 10, 2023

5 TIPS FOR HEALTH ANXIETY DURING A DRS VISIT If you want my five tips for health anxiety during a Drs visit, especially if you have a medical condition that concerns you, this is the episode for you. Hello and welcome back everybody. Today, I'm going to share some updates about a recent medical issue I have had, and I'm going to share specific tips for dealing with health anxiety (also known as hypochondria). A lot of you who have been here with me before know I have postural orthostatic tachycardic syndrome. I also have a lesion on my left cerebellum and many other ups and downs in my medical history where I've had to get really good at managing my health anxiety. I wanted to share with you some real-time tips that I am practicing as I deal with another medical illness or another medical concern that I wanted to share with you. Here I'm going to share with you five specific tips, but I think in total, there's 20-something tips all woven in here. I've done my best to put them into just five. But do make sure you listen to the end of the podcast episode because I'm also going to give some health anxiety journal prompts or questions that you can ask yourself so that you can know how to deal with health anxiety if you're experiencing that at this time. Before we get into it, let me give you a little bit of a backstory. Several months ago, I did share that I've been having these what I call surges. They're like adrenaline surges. They wake me up. My heart isn't racing. It's not like it's racing fast, but the only way I can explain it is I feel like I have like a racehorse's heart in my chest, like this huge heart that's beating really heavily. Of course, that creates anxiety. And so then I would question like, is it the heartbeat or is it just my anxiety? You go back and you go forward trying to figure out which is which. But because this was a symptom that was persisting and was also showing up when I wasn't experiencing a lot of stress or anxiety, I thought the right thing to do is to go and see the doctor. WHAT HEALTH ANXIETY FEELS LIKE Before we get started, be sure to make sure you're not avoiding doctors. Make sure you're not dismissing symptoms. We do have to find a very, very wise balance between avoiding doctors but also not overdoing it with doctors. We'll talk about that a little bit here in a minute. But first, I wanted to just share with you what health anxiety feels like for me. Because for me, I'm very, very skilled at identifying what is anxiety and what is not. I've become very good at catching that by experience, folks. It's not something that comes naturally, but by experience, I can identify what is health anxiety and what is a real medical condition or what is something worthy of me getting checked out. For me, for the health anxiety piece, it's really this sort of anxiety that is a sense of catastrophization and it's usually in the form of thoughts like, what if this is cancer? What if this is a stroke? All the worst-case scenarios. What if this is life-threatening? What if I miss this and you are responsible, you should have picked it up. These are very common health anxiety intrusive thoughts or health anxiety thoughts that I think you really need to be able to catch and be aware and mindful of. First of all, that is the biggest symptom for me. The other thing is when you have health anxiety, you do tend to hyper-fixate on the symptom and all of the surrounding symptoms that are going with that. And then you can really catastrophize those like, "Well, my heart's beating really heavily and I feel dizzy. Oh my gosh. And I've been having a headache. Yeah, you're right, I've been having a headache. Oh my gosh." I call it 'gathering.' That's not an actual clinical term, but I do use it with my clients. We gather data that is catastrophic to make it seem like, yeah, we actually have a really big point, and this is actually a catastrophe. Some other health anxiety symptom that I experience is panic. When you notice a symptom, it is very common to start panicking. And then again, you go back to this chicken or the egg or is it the horse or the carriage in terms of I'm panicking, and now the panic has all these symptoms. Are these symptoms an actual medical condition or are they actually just anxiety and panic? You could spend a lot of time stuck in that cycle trying to figure that out. Let's now talk about how to manage these symptoms and some tips and tools that you can use. Tip #1: No Googling Let me tell you what has recently happened to me. I've been having these symptoms. I made an appointment to see my cardiologist. It was two months out and I was like, "It's not a big deal. I can handle these symptoms." I'm feeling super confident about my ability now to just ride out some pretty uncomfortable sensations and not catastrophize. I go in for my checkup, they do an echocardiogram, and it's taking a long time. She's asking me these strange questions like, "Why are you here again," as she's doing it. She's checking, she's looking, she's squinting at the screen. "Why are you here again? What are your symptoms?" Click, click, click, looking at the heart, whatever. Again, I'm in my mind going, "Kimberley, let your brain have whatever thoughts it wants. We're not going to catastrophize." I was doing really, really well. I got up and I answered her questions. I did the whole appointment. She cleaned me off when I was done and said, "Great, you've got 24 hours and then the doctor will email you with your results." And then yesterday afternoon, I get a call from the nurse saying, "We need to book you a video appointment with the doctor to discuss your results." As you can imagine, my brain went berserk. My health anxiety thoughts were saying, "This is really bad. Why would he need to make a video appointment? This can only end badly. This must be cancer. This must be heart problems. Am I going to have a heart attack and so forth?" Of course, my brain did that. I'm grateful my brain does that because that's my brain being highly functioning and aware. But the number one rule I made with myself in that exact moment, even though that was very anxiety-producing, is no Googling. Kimberley, you are not allowed to pick up the computer or the iPhone and Google anything about this. That is tip #1 for you. I'll tell you why. A lot of my patients say, "But why? It's no harm. I'm not doing any harm." And I'll say, "Yes." I've actually just seen my cardiologist. But now that I've had my appointment, he encouraged me to do a little research. What was hilarious to me is every single website is different and some catastrophize and some don't. Some go, "This could be very normal." Other ones say, "This could be cancer, cancer, cancer, cancer." This is why I'm telling my patients all the time, don't Google because what you read is different. It's not like this is going to be a factual thing. Most of the time people who have articles that rank high on Google searches are the ones who have optimized their website to be very easy to Google. The reason they have become number one on the Google algorithm is because they've included keywords like cancer for blah, blah, blah, and all of these health issues and health names. The ones that are at the top, some of them are very reasonable, helpful, and accurate, but a lot of them are not. They've just really done a great job of putting in lots and lots of keywords that makes them highly searchable and come up high on the algorithm. Please, number one, do not Google. Go to your doctor for questions if you have any. Unless they've encouraged you to do research, do not Google. TIP #2: FOLLOW IMPORTANT HEALTH ANXIETY CBT TECHNIQUES I've actually categorized this in a bigger category and I've called it important health anxiety CBT techniques, because there are some important CBT tools that you're going to need here and here we go. While I was in getting my echocardiogram, I was laying and I was having some anxiety because she was squinting and asking some strange questions, not in the normal of what I'd experienced. I could feel the pull to check her face for reassurance like, does she look concerned? Does she look relaxed? What's going on with her? I wonder what she meant. What I want to encourage you to do is acknowledge and catch when you're checking their face to try to decipher what the nurse or the assistant or the doctor is doing and saying. Because really, all I'm doing there is mind reading because I have no idea what she's thinking. I was laughing at myself because she was squinting and looking concerned. I was like, "I wonder if she's trying not to pass gas." We could mind read that she thinks I have cancer and that there's a big problem, or maybe she's just trying not to pass gas right now. Maybe she's thinking about a fight she just had with her partner. My attempt to analyze her facial expression is a complete waste of my time. You could use that tip anytime you want. The next tip for you is no reassurance seeking with nurses or doctors. Now, I actually felt almost into this trap. If I'm being completely honest, I did fall into this trap, but I caught myself really quickly. As she was finishing up, she took off her gloves and got ready to discharge me, and I said, "So, you'd let me know if there was..." I paused because what I was going to say is, "You'll let me know if there's something wrong, right?" I was going to say that. And then I was like, "No, no, no." I stopped myself and said, "You know what? I know the deal. I've done these enough times. I know I have to wait for the doctor." But I caught myself wanting to get confirmation from the nurse and I already know that nurses are not allowed to give me any diagnosis anyway. I caught myself wanting to get some expression of relief from her like, "No, you're fine. Everything looks good," or whatever. Sometimes they accidentally give you that reassurance. But I caught myself seeking reassurance from her. In addition to that—let me talk to you a little later about how we do that with doctors as well—often if you're in the office with a doctor, you may find yourself at the end of the session going, "I'll be fine, right? It's not bad, right?" It's okay, we're all going to ask some of those questions. I'm not going to be the reassurance-seeking police with you. But what I want you to do is really drop down into catching when we're engaging in reassurance seeking and using it too much to reduce our own anxiety about it, to take away our own anxiety or fear. Now, another CBT technique or sort of rule that we often set in clinical work when I'm talking with my clients who have health anxiety is also not swaying the doctor or the nurse to answer things in the way that you want. A lot of people fall into this trap. For me, I just had my doctor's appointment. We are working through and there are some little problems that we will work out. But I caught myself there wanting to sway him to be very positive. We had talked about it ultimately. He had said, "There are some issues. It could be this, it could be that, it could be this." He listed off three or four options. Some were very, very small, and of course, the third one is always like, it could be cancer. They always say at the end, like whatever. When they give you these three or four or five options on what the problem might be, it's very important that you be mindful and aware of how you're trying to sway the doctor to give you certainty. This is what my doctor said, and I'm going to be brief. I'm not going to bore you with my medical stuff, but he'll say, "It could be that you recently had COVID or an illness or a virus. It could also be this other condition, which is common, and if it's so, we'll treat that. It could also be that there could be some rheumatoid arthritis and that's a longer treatment. And then the final thing, which we don't think so, but it also could be cancer. "Let's say he lists off these four options. Now, this is very common. Doctors will do this often because their job is to educate us on all of the possibilities so that we can create a treatment plan that doesn't ignore big issues, but we have to be careful that we don't spend their time and our time going, "You think it's the first one, right? It's probably just the first one. I probably just had a virus, right?" I'm really swaying him towards giving an answer when he's already told us that he or she doesn't know yet. He's already said, "I don't know yet. We're going to need to do extra tests." Catch yourself trying to get them to reassure you and confirm that it's definitely not the C word. The cancer word is what I'm saying there. Catch yourself when you're doing those behaviors in the office with either the nurses or the technician or the doctors. Very, very important. Now, one other thing I want you to also catch is if you're coming to them with something, let's say you are coming to them with a concern that you've pretty much know is your health anxiety, but you want reassurance that it's not, also be careful that you don't overly list things to convince them that something is wrong. A lot of you don't do this, I know, but I have had a lot of clients who've come back to me after seeing the doctor and said, "Do you have any other symptoms," and they would list even minor symptoms that they had a month ago that they knew had nothing to do with it. But they felt like if they didn't say it all, if they didn't include every symptom, every stomach ache, every headache, everything, they could miss something. So also keep an eye out for that. That's some sort of overall general CBT techniques we use for health anxiety that help guide people into not engaging in those health anxiety compulsions. TIP #3: HEALTH ANXIETY HELP DURING YOUR DOCTOR'S VISIT This is a really important part of it. From the minute that I got the call from the nurse that he wanted a video call with me, my mind went to, again, the worst-case scenario. It just does. It just does. I think that that is actually really, really normal. I really do. I think that is what happens naturally for anybody. First of all, I don't want to even go too over in terms of pathologizing that. I think that's a normal thing for anybody to experience. The first thing I want you to practice is validating your anxiety. It's a part of self-compassion practice. It's going, "It makes complete sense, Kimberley, that this is concerning you." That's one of the most important self-compassionate statements you could make for yourself. "It makes complete sense that this is hard, this is scary. Of course, it's making you uncomfortable." It's validating. You might even move to a common humanity, going, "Anybody in this situation would have anxiety." Then you can also move into mindfulness skills, which is—this was one that I hold very true—just because I feel anxious doesn't mean there's danger or there's a catastrophe. It's my body's natural response to create anxiety when it feels threatened. That keeps me alive. That's a good thing. But just because I'm anxious and having thoughts about scary things doesn't mean they're facts. Remember, thoughts are not facts. The next thing here is also being able to just observe them, again, while you're sitting in the waiting room. They were playing the movie, what's it called? Moana. And I love Moana. I remember watching it as a child. I'm sitting in the seat and my mind is offering me all of these health anxiety intrusive thoughts, and my mind really wants me to pay attention to them. A part of my mindfulness practice was to go, "I am noticing I'm having these catastrophic thoughts, but I'm also noticing Moana, and I'm going to choose which one I give my attention to." I'm not going to push them away. I'm not going to make the thoughts go away because they're naturally going to be there. I basically knew from yesterday afternoon until 9:00 AM this morning that the thoughts were going to be there and I accepted them there. I didn't go in saying, "Oh gosh, I hope the next 24 hours aren't filled with thoughts." I was like, they're going to be, "Hello thoughts, welcome. I know you're going to be here," and I'm going to train my brain to put attention on what matters to me. In this case, I'm not going to make these thoughts important. I'm going to watch Moana. I'm going to look at the colors, I'm going to listen to the sounds, I'm going to notice whatever it is that I notice. I'm going to notice the fabric of the seat underneath me as I'm waiting in the room. Last night as I went to bed, I'm just going to notice the feeling of the cushions underneath me. This is mindfulness and this is so important—being present and paying attention to what is currently happening instead of the worst-case scenario. There's one important point here, which is my mind kept saying, "By nine o'clock tomorrow, your life might change." You guys know what? If you're listening, I'm guessing you know what that's like. You're like, "After this appointment, this appointment may change your life for the worse." My job was to go, "Maybe, maybe not. It could be that he just wants to tell me everything's okay." It is what it is. It will be what it will be. I will work through it and solve it when it happens. I'm not going to live the next 24 hours or the next 12 hours coming from a place of the worst-case scenario until I have actual evidence of that. So we are not going to live your life as you wait for your appointment. We're not going to live your life through the lens of the worst case. We're going to live through it through being uncertain and accepting that in this moment, nothing is wrong. Until we know, we don't know. MEDITATION FOR HEALTH ANXIETY Now, other options for you, I'm just going to add a couple here, is I have found meditation for health anxiety to be very, very helpful, particularly when health anxiety is taking over. That has been very beneficial for me—to find a meditation that can actually sometimes give me some concrete skills to use in the moment to stay present. We are not going towards staying calm because maybe you're going to have some anxiety. That's okay. Really what we want to do is we want to be working in the most skillful fashion as we can. And then the last one, this one's a little controversial. Some people don't agree with this piece of advice, so take what you need and leave what doesn't help. But for me, when I'm anxious, I tend to shallow breathe a lot. I hold my breath a lot. For me, it was just reminding myself just to breathe. Not breathe in any particular fashion or deep breathing, but just be like, "Take a breath, Kimberley, when you need. Take a breath when you need." TIP #4: WHAT TO DO WHEN HEALTH ANXIETY TAKES OVER? Tip #4 is what to do when anxiety takes over in the biggest way, and that ultimately means, what can you do when your brain is setting on the full alarm. Now in this case, I'm just going to say it's basically what to do if you're panicking and the advice goes the same as it is whether there's a health anxiety panic attack or a regular non-health anxiety panic attack, which is do not try to push the anxiety away. Let's break it down. If you're having anxiety, and you are saying, "This is bad, I don't want it, it shouldn't be here," you're actually telling your brain that the anxiety is dangerous. Not just the health issue, but also the presence of anxiety is dangerous, which means it's going to pump out more and more anxiety because you've told it that anxiety is dangerous. Your job here is to let the anxiety be there. Try not to push it away. What we know is what you try to push away comes stronger. You can talk to your anxiety. There's actually research to show that when you talk to your anxiety and you talk to yourself in the third person, it can actually empower you and feel more of a sense of empowerment and mastery over that experience. For me, unfortunately, I've had quite the 24 hours. We actually had a very large earthquake last night here in southern California, which woke me up, so I had some anxiety related to that. And then of course, my brain was like, "Oh yeah, and by the way, you might have cancer. Ha-ha-ha!" You know what I mean? Of course, your brain's going to tell you that. In that moment, I used the skill and the research around talking to myself in the third person. I said, "Kimberley, there's nothing you can do right now. It makes total sense that you have anxiety. Let's not push it away. Let's bring your attention to what you can control, which is how kind you are to yourself, whether you're clenching your body up, whether you're breathing, whether what you're putting your attention on. You can't control anything. You can't control this earthquake. You can't control what's happening tomorrow. All you can do is be here now." Using a third person, using your name as the third person like, "Kimberley..." and saying what you need to do. Coaching yourself has been incredibly helpful for me and I know for a lot of people because that's actually science-based. TIP #5: ENGAGE IN VALUE-BASED BEHAVIORS The next thing I want you to do, and this is the final one before we go through some questions that I want you to ask yourself, is to engage in value-based behaviors. Now what that means is when we're anxious, when we have health anxiety, it's very normal for us to want to engage in safety behaviors. One for me was every morning, I drop my daughter off and my husband drops my son off at school and I could feel my anxiety wanting to stay home. I don't want to go out. And so I almost was starting to say, "Maybe I'll ask my husband to drop off my daughter and my son so I can stay home." I recognize that would be me doing a fear-based behavior. I would be doing that only because I don't want to face fear today. I just want to make it small. Number one, it's okay. If you need to do that, that's totally okay. But for me personally, I caught myself and I said, "No, you value being someone who drops off your daughter and shows up and doesn't let anxiety win. You love dropping off your daughter. If you stayed home, you'd only be doing the dishes, circling around, maybe catastrophizing, just trying to get past time. You love taking your daughter to drop off." And so engage in that. Another value-based behavior for me personally is humor. I'm texting friends and I'm telling them jokes about what I'm going to do to my doctor if he says something wrong or something, or I'm making jokes about some of the questions and statements that the nurses made. I'm making jokes about it, not to catastrophize, not to put them down, not to minimize my own discomfort, but humor is a very big part of my values. I'm making jokes about what we'll do if it's cancer and will you come to my funeral and silly things. Again, I really want to make sure you understand, I'm not doing that as depressed bad things are going to happen. I'm doing it because I'm literally saying, it will be what it will be. Let's just move forward and let's actually bring some light and joy and some laughter to this. Now you might not like that. If that's not your values, don't do it, but identify, what would the non-anxious me do right now? What would I do if this fear wasn't here? And then do those behaviors. It's really, really important that you make sure you hit this in as many ways as you can because fear can cause us just to clam up and sit still and ruminate. It's very important that you practice not just ruminating and cycling and going over and over and over and over all of the worst-case scenarios because your brain will take you to some very dark places. HEALTH ANXIETY JOURNAL PROMPTS This is really important. I know I've given you the top five, but that's more like 20 points. Let's talk about some hypochondria or health anxiety journal prompts or questions you can ask yourself to stay as skilled as you can. What is in my control right now? What is in my control? My behaviors, my reactions. That's ultimately what is in your control. What's not in your control is how much anxiety you have and what thoughts you have about them. What is not in my control? You can be very specific here. In my case, it's like, what's not in my control is what the doctor says. What's not in my control is what my health condition is. What's not in my control is when he calls. You know what I mean? What's not in my control is the treatment plan. I'm going to have to wait for him to do that. I'm identifying what is in my control and what is not. How am I going to gain a sense of control that is helpful to both my long-term health anxiety recovery goals and my health anxiety treatment plan? For me, I know that Googling is going to be a full sense of control and doesn't help my long-term recovery, so I'm not going to do it. I know that me ruminating and doing tons of mental compulsions is going to give me a sense of control, but it's not helpful. It's not helpful. It doesn't help my long-term recovery, it doesn't help my long-term mental health, so I'm not going to do it. What will help my long-time health anxiety goals, it's going to be all the tips that we covered today—no Googling, no checking faces, no reassurance seeking, no swaying the doctor, practicing my mindfulness, being as compassionate as I can, maybe taking some breaths. All of those are going to make me stronger in my health anxiety recovery instead of weaker the ones which would be ruminating and doing all of these. Not very helpful safety behaviors. How willing am I to be uncertain right now? You guys are going to have to tolerate a lot of uncertainty. That's what this is all about. From the minute I got the call from that nurse saying that I needed to have this video appointment, from the minute he got onto the video appointment, all I had to focus on is, am I willing to be uncomfortable? Am I willing to be uncertain? Because the only reason I would've Googled was because I wanted certainty. Really, really important. What would the non-anxious me do right now? She'd get up and she'd go and drop her daughter off, and then she'd call your friend because that's what you do every Wednesday morning. She'd respond to emails, she'd call. Do whatever it is that you're doing. What would the non-anxious you do? How can I be kind and gentle towards myself as I navigate this experience? Another code question for that is, what do I need right now that is skillful? What do you need? The most beautiful thing about this is my husband. He is the most gorgeous man. He sits down. He doesn't reassure me, he just says, "I got you." If your partner is giving you a lot of reassurance, you might want to mention to them, "That actually doesn't help my long-term health anxiety. I just need you to be next to me and support me." And so it's very important that we make sure our partners aren't giving us a whole bunch of reassurance and a whole bunch of certainty-seeking behaviors that keep us stuck. That's it guys. There are my five tips for health anxiety which turned out to be more like 20, I know, but I try to always overdeliver. I really wanted to jam in as many skills as I could. I hope you have a wonderful day. Please do not worry about me. I am actually fine. There's a joke between my best friend and I. We say, "Are you fine number one or fine number two?" Fine number one is you actually are fine and fine number two is you're not fine, but you're saying you are, and I am fine number one. I actually have a lot of faith in my doctors. I have a lot of faith in my ability to handle these things and these are just another bump on the road in terms of being someone who has postural orthostatic tachycardic syndrome. So all is well. All is well. I am fine number one and I hope you are fine number one as well. I am sending you so much love. Do not forget, it is a beautiful day to do all the hard things, and I'll see you next week.

Feb 3, 2023

Today, we're talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they're beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys. Now, that doesn't mean there are no bumps. That doesn't mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn't mean we don't have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. Before we proceed, I want to say, these mightn't work for you. I think they work well, but I don't want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don't match you. So take what you need here. Leave what isn't helpful for you; if it's useful for you, wonderful. If it doesn't sit right, one of them doesn't sit right, that is not a problem. It's totally okay to use what helps you. When I'm talking on this podcast, I'm giving you ideas, so be curious and consider them, but it doesn't mean that I'm always right, I think I'm right, or I know what's right for you. All right, here we go. I'm going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they've gotten me through some of the hardest periods and seasons of my life. So, let's see if they're helpful for you. 1. It is not your job or my job to manage our family's emotions. Their emotions are their responsibility, and it is their job to regulate their emotions when they're upset with us. And it's our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you're allowed to have them. We're not saying that no one's allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren't true, saying 'you' statements like, "You're so blah, blah, blah." We want to use 'I' statements like, "I feel this way about that," or "I would like this thing to happen." So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 2. It is not your job to please the people you are in relationship with. Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they're so hurt. They're like, "You've harmed me by saying that. I'm so hurt by what you said." But the person gets to have their thoughts and their feelings. It's not our job to manage it, and it's not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It's as long as we're able to do it respectfully. And when I say respectful, I'm not saying it in a people-pleasing way either. It is not our job to please people. It's just not. Here's a deeper one. Let me just jump into this a little: I'm still working on this and I get therapy. I have a lot of practice and I've read about the idea of my happiness. That's my job. My happiness is my job. And I easily get caught up in, "No, if my partner would just do A, B, and C, then I can be happy," or "If my kids just do A, B, and C, then I can be happy." And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It's all up to them. Your life is in their hands. Your happiness is in their hands. And so, I like to think about, yeah, people can't always please me, like I just said, and people are going to upset me. And then it's my job to decide what I want to do with that, and it's my job to determine how I'm going to cope today with the fact that they may not be living up to the way I want them to. So that's really important. 3. They are allowed to have their feelings about our choices. This is a big one for my husband and I. We say this to each other all the time. It's like, "You're allowed to have your feelings about that and so am I." This one is so hard for me, especially in my marriage because if I upset him, I'd be like, "You shouldn't be upset." And he's like, "I'm allowed to be upset. I'm allowed to have my feelings about it." And I'm like, "No, but you shouldn't." And he's like, "Yeah, but I am. I do." It is okay if they don't like everything about us and if they disagree. It is our job to live according to our values, which doesn't always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. "But that has been so beautiful for me." To say, "You're allowed to have your feelings about me, specifically me as a public person." When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, "Oh, how dare they say something so mean? How could they disagree with me or not like me?" It was so painful because I had made this rule that they should only have good feelings about me. And now I'm okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, "I'm going to let everyone have permission to have their feelings about me." That's okay. I'm not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You're allowed to have your feelings about me. So important. 4. It is okay if they struggle to understand us. In fact, I encourage you to accept that they will not always understand us. Sometimes people won't have the capacity to understand us, and that doesn't make us wrong. And it also doesn't mean that you won't be able to find a way to coexist and still love each other unconditionally. That's so true. I always tell my patients, let's say I come in and I'm wearing my favorite boots, which are a bit sassy, and you come in, and you're like, "I hate your boots. They're the ugliest boots ever." I could even say, "Ah, you're supposed to love my boots." Or I could say, "That's cool. You don't have to love my boots. You get to have your feelings about them. And it's okay if you don't understand how rocking my boots are." Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they're respectful, they don't cross any boundaries, and they're not abusive. They get to be upset, and it's okay that they don't understand us. As I said, some people can't understand us. So important. 5. You get to (and they get to) change their mind or change, period. Again, this one was so hard for me. Now, for those of you who don't know me, I've been married almost 20 years. It will be 20 years this year, which means my husband's done a ton of changing, and so have my family, my friends, and so have you guys. There's a lot of change. But they get to change. If somebody changes, we can't go, "Wait, that's not fair. I didn't go into this relationship with you being this new version of you. You have to be the old version of you." That's not a real relationship. That's saying you must stay the same and can't express and be who you are. We could say, "You've changed, and these are my feelings about it," as long as I'm doing it, not in a judgmental way or not in a way that's trying to change them back because people get to change. They get to change their mind. So that's another big one for me, is if someone says, "I like this," and then they come back and say, "I actually really don't," I have to remind myself they're allowed to change their mind because they're allowed to have their feelings. And it's okay that they don't understand us, and they're going to manage their own emotions, and I'm going to manage mine. We can't hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. So those are the five relationship rules that have changed my life. Now, here's the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I'm allowed to swear, but it's some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn't have to pretend to be somebody else or he didn't have to pretend to like something and get resentful because he actually didn't like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn't a problem anymore. The biggest problem, the biggest pain, the most suffering came when I was like, "No, they shouldn't feel this way about me. That's not fair"! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn't be perfect, but I'm not perfect. You guys, I could add a fifth or sixth one here. I didn't write this one in the email, but I'm not perfect, and neither are they, and that's okay. Sometimes I would say, "No, but they need to be this way because that's the right way. This is the right way to be." And I get it. Yeah, there is sometimes real right and wrong, like you shouldn't harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a "bad" thing. I think cancel culture has taught us a lot in this idea of like, "You're dead to me. You're done. You're canceled." Relationships don't work like that. We're human beings. We make mistakes. I've made a million mistakes. I've actually-- okay, now I'm going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It's a humble thing to do. It's not fun, not fun at all, but we can also say we're sorry too. So that's it, you guys. There's a humbling; there's a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. Now there will be situations if you say, "I don't like that," and they will not respect you. You may need to make a limit and a boundary with them where they don't have as much access to you. That's 100% valid. And again, I'm not here telling you to accept other people's bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they're communicating respectfully, kindly, compassionately, or at least they're trying. At least they're trying. So that's it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it's helpful. It is a beautiful day to do hard things, and I will see you next week.

Feb 3, 2023

Today, we're talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they're beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys. Now, that doesn't mean there are no bumps. That doesn't mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn't mean we don't have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. Before we proceed, I want to say, these mightn't work for you. I think they work well, but I don't want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don't match you. So take what you need here. Leave what isn't helpful for you; if it's useful for you, wonderful. If it doesn't sit right, one of them doesn't sit right, that is not a problem. It's totally okay to use what helps you. When I'm talking on this podcast, I'm giving you ideas, so be curious and consider them, but it doesn't mean that I'm always right, I think I'm right, or I know what's right for you. All right, here we go. I'm going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they've gotten me through some of the hardest periods and seasons of my life. So, let's see if they're helpful for you. 1. It is not your job or my job to manage our family's emotions. Their emotions are their responsibility, and it is their job to regulate their emotions when they're upset with us. And it's our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you're allowed to have them. We're not saying that no one's allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren't true, saying 'you' statements like, "You're so blah, blah, blah." We want to use 'I' statements like, "I feel this way about that," or "I would like this thing to happen." So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 2. It is not your job to please the people you are in relationship with. Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they're so hurt. They're like, "You've harmed me by saying that. I'm so hurt by what you said." But the person gets to have their thoughts and their feelings. It's not our job to manage it, and it's not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It's as long as we're able to do it respectfully. And when I say respectful, I'm not saying it in a people-pleasing way either. It is not our job to please people. It's just not. Here's a deeper one. Let me just jump into this a little: I'm still working on this and I get therapy. I have a lot of practice and I've read about the idea of my happiness. That's my job. My happiness is my job. And I easily get caught up in, "No, if my partner would just do A, B, and C, then I can be happy," or "If my kids just do A, B, and C, then I can be happy." And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It's all up to them. Your life is in their hands. Your happiness is in their hands. And so, I like to think about, yeah, people can't always please me, like I just said, and people are going to upset me. And then it's my job to decide what I want to do with that, and it's my job to determine how I'm going to cope today with the fact that they may not be living up to the way I want them to. So that's really important. 3. They are allowed to have their feelings about our choices. This is a big one for my husband and I. We say this to each other all the time. It's like, "You're allowed to have your feelings about that and so am I." This one is so hard for me, especially in my marriage because if I upset him, I'd be like, "You shouldn't be upset." And he's like, "I'm allowed to be upset. I'm allowed to have my feelings about it." And I'm like, "No, but you shouldn't." And he's like, "Yeah, but I am. I do." It is okay if they don't like everything about us and if they disagree. It is our job to live according to our values, which doesn't always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. "But that has been so beautiful for me." To say, "You're allowed to have your feelings about me, specifically me as a public person." When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, "Oh, how dare they say something so mean? How could they disagree with me or not like me?" It was so painful because I had made this rule that they should only have good feelings about me. And now I'm okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, "I'm going to let everyone have permission to have their feelings about me." That's okay. I'm not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You're allowed to have your feelings about me. So important. 4. It is okay if they struggle to understand us. In fact, I encourage you to accept that they will not always understand us. Sometimes people won't have the capacity to understand us, and that doesn't make us wrong. And it also doesn't mean that you won't be able to find a way to coexist and still love each other unconditionally. That's so true. I always tell my patients, let's say I come in and I'm wearing my favorite boots, which are a bit sassy, and you come in, and you're like, "I hate your boots. They're the ugliest boots ever." I could even say, "Ah, you're supposed to love my boots." Or I could say, "That's cool. You don't have to love my boots. You get to have your feelings about them. And it's okay if you don't understand how rocking my boots are." Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they're respectful, they don't cross any boundaries, and they're not abusive. They get to be upset, and it's okay that they don't understand us. As I said, some people can't understand us. So important. 5. You get to (and they get to) change their mind or change, period. Again, this one was so hard for me. Now, for those of you who don't know me, I've been married almost 20 years. It will be 20 years this year, which means my husband's done a ton of changing, and so have my family, my friends, and so have you guys. There's a lot of change. But they get to change. If somebody changes, we can't go, "Wait, that's not fair. I didn't go into this relationship with you being this new version of you. You have to be the old version of you." That's not a real relationship. That's saying you must stay the same and can't express and be who you are. We could say, "You've changed, and these are my feelings about it," as long as I'm doing it, not in a judgmental way or not in a way that's trying to change them back because people get to change. They get to change their mind. So that's another big one for me, is if someone says, "I like this," and then they come back and say, "I actually really don't," I have to remind myself they're allowed to change their mind because they're allowed to have their feelings. And it's okay that they don't understand us, and they're going to manage their own emotions, and I'm going to manage mine. We can't hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. So those are the five relationship rules that have changed my life. Now, here's the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I'm allowed to swear, but it's some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn't have to pretend to be somebody else or he didn't have to pretend to like something and get resentful because he actually didn't like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn't a problem anymore. The biggest problem, the biggest pain, the most suffering came when I was like, "No, they shouldn't feel this way about me. That's not fair"! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn't be perfect, but I'm not perfect. You guys, I could add a fifth or sixth one here. I didn't write this one in the email, but I'm not perfect, and neither are they, and that's okay. Sometimes I would say, "No, but they need to be this way because that's the right way. This is the right way to be." And I get it. Yeah, there is sometimes real right and wrong, like you shouldn't harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a "bad" thing. I think cancel culture has taught us a lot in this idea of like, "You're dead to me. You're done. You're canceled." Relationships don't work like that. We're human beings. We make mistakes. I've made a million mistakes. I've actually-- okay, now I'm going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It's a humble thing to do. It's not fun, not fun at all, but we can also say we're sorry too. So that's it, you guys. There's a humbling; there's a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. Now there will be situations if you say, "I don't like that," and they will not respect you. You may need to make a limit and a boundary with them where they don't have as much access to you. That's 100% valid. And again, I'm not here telling you to accept other people's bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they're communicating respectfully, kindly, compassionately, or at least they're trying. At least they're trying. So that's it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it's helpful. It is a beautiful day to do hard things, and I will see you next week.

Feb 3, 2023

Today, we're talking about the Top 5 Relationship Rules I have that have changed my life. This episode was inspired by a letter I wrote to all of you. For those of you who signed up for my newsletter, I give you tools and tips, and stories, and I tell you funny jokes sometimes. But I was writing the newsletter while I was in Australia just before I left when I was there in December, and I was reflecting on how beautiful my relationships are with my family now. And I was reflecting on why. Why are they so beautiful? Well, number one, they're beautiful people. But number two, more importantly, I have learned these relationship rules, which have allowed me to have the most beautiful relationship with my family and the most beautiful relationship with my husband, my kids, my friends, and you guys. Now, that doesn't mean there are no bumps. That doesn't mean there are no arguments. A few weeks ago, I wrote in the newsletter about how I had an argument with my husband. Of course, I was joking about how wrong he was and how right I was. But it doesn't mean we don't have conflict, but we get to coexist because of these relationship rules, and I want to share them with you. Before we proceed, I want to say, these mightn't work for you. I think they work well, but I don't want you to feel guilty, ashamed, embarrassed, angry, or whatever the feelings are if you feel like these don't match you. So take what you need here. Leave what isn't helpful for you; if it's useful for you, wonderful. If it doesn't sit right, one of them doesn't sit right, that is not a problem. It's totally okay to use what helps you. When I'm talking on this podcast, I'm giving you ideas, so be curious and consider them, but it doesn't mean that I'm always right, I think I'm right, or I know what's right for you. All right, here we go. I'm going to go through them quickly and then elaborate a little later once we get through, okay? But I want to remind you that these relationship rules help me stay solid in my relationships, and they've gotten me through some of the hardest periods and seasons of my life. So, let's see if they're helpful for you. 1. It is not your job or my job to manage our family's emotions. Their emotions are their responsibility, and it is their job to regulate their emotions when they're upset with us. And it's our job to regulate and manage our emotions when we are upset. Now, what does regulate mean? It means you're allowed to have them. We're not saying that no one's allowed to be upset, but we have to communicate and share with them and regulate by not throwing things, lashing out, saying unkind things, saying things that aren't true, saying 'you' statements like, "You're so blah, blah, blah." We want to use 'I' statements like, "I feel this way about that," or "I would like this thing to happen." So, we want to regulate as best as we can. Our job is to regulate what shows up for us, and their job is to regulate what shows up for them. 2. It is not your job to please the people you are in relationship with. Now, they get to have expectations and they get to communicate with you on what their expectations are, and you get to have expectations and you get to communicate their expectations. Now, this is so important, then we can have a respectful conversation. A lot of the time these days, I see people in relationships or even online where somebody disagrees and they're so hurt. They're like, "You've harmed me by saying that. I'm so hurt by what you said." But the person gets to have their thoughts and their feelings. It's not our job to manage it, and it's not our job to please them either. So you get to have your beliefs and thoughts and ideas, and you get to disagree with other people as well. It's as long as we're able to do it respectfully. And when I say respectful, I'm not saying it in a people-pleasing way either. It is not our job to please people. It's just not. Here's a deeper one. Let me just jump into this a little: I'm still working on this and I get therapy. I have a lot of practice and I've read about the idea of my happiness. That's my job. My happiness is my job. And I easily get caught up in, "No, if my partner would just do A, B, and C, then I can be happy," or "If my kids just do A, B, and C, then I can be happy." And that is true to a degree. But the problem with that rule, if you want to keep that rule, is you have no empowerment and no responsibility. It's all up to them. Your life is in their hands. Your happiness is in their hands. And so, I like to think about, yeah, people can't always please me, like I just said, and people are going to upset me. And then it's my job to decide what I want to do with that, and it's my job to determine how I'm going to cope today with the fact that they may not be living up to the way I want them to. So that's really important. 3. They are allowed to have their feelings about our choices. This is a big one for my husband and I. We say this to each other all the time. It's like, "You're allowed to have your feelings about that and so am I." This one is so hard for me, especially in my marriage because if I upset him, I'd be like, "You shouldn't be upset." And he's like, "I'm allowed to be upset. I'm allowed to have my feelings about it." And I'm like, "No, but you shouldn't." And he's like, "Yeah, but I am. I do." It is okay if they don't like everything about us and if they disagree. It is our job to live according to our values, which doesn't always align with their expectations of us. Our job is to go and live our lives and let them have their feelings about it. Then, we can communicate respectfully about our misalignment. "But that has been so beautiful for me." To say, "You're allowed to have your feelings about me, specifically me as a public person." When I used to speak at a conference, or online or on Instagram, and someone would say something negative, I used to be like, "Oh, how dare they say something so mean? How could they disagree with me or not like me?" It was so painful because I had made this rule that they should only have good feelings about me. And now I'm okay. You can have all your feelings about me. You might like me, or you might hate me. You might like me one day and not like me the next. You might agree or not agree, and you get to have your feelings about me. I give you permission. It is so freeing to say, "I'm going to let everyone have permission to have their feelings about me." That's okay. I'm not for everyone. That sentence literally has healed me on the deepest level, probably more than any sentence. You're allowed to have your feelings about me. So important. 4. It is okay if they struggle to understand us. In fact, I encourage you to accept that they will not always understand us. Sometimes people won't have the capacity to understand us, and that doesn't make us wrong. And it also doesn't mean that you won't be able to find a way to coexist and still love each other unconditionally. That's so true. I always tell my patients, let's say I come in and I'm wearing my favorite boots, which are a bit sassy, and you come in, and you're like, "I hate your boots. They're the ugliest boots ever." I could even say, "Ah, you're supposed to love my boots." Or I could say, "That's cool. You don't have to love my boots. You get to have your feelings about them. And it's okay if you don't understand how rocking my boots are." Now, this also goes for who you are. They get to have their feelings about who you are. They get to not like who we are, as long as they're respectful, they don't cross any boundaries, and they're not abusive. They get to be upset, and it's okay that they don't understand us. As I said, some people can't understand us. So important. 5. You get to (and they get to) change their mind or change, period. Again, this one was so hard for me. Now, for those of you who don't know me, I've been married almost 20 years. It will be 20 years this year, which means my husband's done a ton of changing, and so have my family, my friends, and so have you guys. There's a lot of change. But they get to change. If somebody changes, we can't go, "Wait, that's not fair. I didn't go into this relationship with you being this new version of you. You have to be the old version of you." That's not a real relationship. That's saying you must stay the same and can't express and be who you are. We could say, "You've changed, and these are my feelings about it," as long as I'm doing it, not in a judgmental way or not in a way that's trying to change them back because people get to change. They get to change their mind. So that's another big one for me, is if someone says, "I like this," and then they come back and say, "I actually really don't," I have to remind myself they're allowed to change their mind because they're allowed to have their feelings. And it's okay that they don't understand us, and they're going to manage their own emotions, and I'm going to manage mine. We can't hold ourselves to the expectation that will never change. As we go through different seasons in our life, we will change. And that might feel scary. But we can try using our mindfulness skills and our regulation skills to navigate the change and the emotions you have to feel. So those are the five relationship rules that have changed my life. Now, here's the kicker. None of it is fun. None of it. This is some hard work. I nearly said that S word, which is fine. I'm allowed to swear, but it's some hard shit. This is some terrible stuff to work through, but with it comes stronger and more unconditionally loving relationships. When I gave my husband permission to have his feelings about me, he was happier, and he loved me more because it meant that he didn't have to pretend to be somebody else or he didn't have to pretend to like something and get resentful because he actually didn't like it. When I allowed myself to be different from my family, and I accepted that they might have feelings about that, and I gave them permission to have feelings about that, there wasn't a problem anymore. The biggest problem, the biggest pain, the most suffering came when I was like, "No, they shouldn't feel this way about me. That's not fair"! But, it is fair. They get to have their feelings based on their own personal and their upbringing and their own incapacities and their own limitations. They get to have their feelings. It mightn't be perfect, but I'm not perfect. You guys, I could add a fifth or sixth one here. I didn't write this one in the email, but I'm not perfect, and neither are they, and that's okay. Sometimes I would say, "No, but they need to be this way because that's the right way. This is the right way to be." And I get it. Yeah, there is sometimes real right and wrong, like you shouldn't harm people or say horrible things or critical things or racist things or misogynist things. We get that, and I agree with all that. But at the end of the day, the people in our lives will be imperfect, and we have to get better about not being black and white and cutting them off because they did a "bad" thing. I think cancel culture has taught us a lot in this idea of like, "You're dead to me. You're done. You're canceled." Relationships don't work like that. We're human beings. We make mistakes. I've made a million mistakes. I've actually-- okay, now I'm going on and on. But we also have to learn to accept that we make mistakes and be willing to apologize for it. It's a humble thing to do. It's not fun, not fun at all, but we can also say we're sorry too. So that's it, you guys. There's a humbling; there's a humanity that we connect with when we can allow everyone to have their feelings, when we can allow ourselves to have our feelings when we can have limits and boundaries and clearly communicate that with our loved ones, but then also understand that sometimes they may not get it. Now there will be situations if you say, "I don't like that," and they will not respect you. You may need to make a limit and a boundary with them where they don't have as much access to you. That's 100% valid. And again, I'm not here telling you to accept other people's bad behavior. Absolutely not. But we can accept that they have some feelings about it, as long as they're communicating respectfully, kindly, compassionately, or at least they're trying. At least they're trying. So that's it, folks. The five relationship rules that have literally changed my life and my relationships. I hope it's helpful. It is a beautiful day to do hard things, and I will see you next week.

Jan 27, 2023

One of the most common questions I get asked is what do I do during or after an exposure? Number One, it's so scary to do an exposure, and number two, there's so many things that people have brought up as things to do, even me, this being Your Anxiety Toolkit. Maybe you get overwhelmed with the opportunity and options for tools that it gets too complicated. So, I want to make this super easy for you, and I want to go through step by step, like what you're supposed to do during or after an exposure. Now, I think it's important that we first look at, there is no right. You get to choose, and I'm going to say that all the way through here, but I'm going to give you some really definitive goals to be going forward with as you do an exposure, as you face your fear. Now, make sure you stick around to the end because I will also address some of the biggest roadblocks I hear people have with the skills that I'm going to share. Now, a lot of you know, I have ERP School if you have OCD and I have Overcoming Anxiety and Panic if you have panic, and I have BFRB School if you have hair pulling and skin picking. These are all basically courses of me teaching you exactly what I teach my patients. So, if you want a deeper in-depth study of that, you can, by all means, get the steps there of how to build an exposure plan, how to build a response prevention plan. Today, I'm going to complement that work and talk about what to do during and after an exposure. So here we go. Let's say you already know what you're going to face. Like I said, you've already created an exposure plan. You understand the cycle of the disorder or the struggle that you are handling, and you've really identified how you're going to break that cycle and you've identified the fear that you're going to face. Or just by the fact of nature being the nature, you've been spontaneously exposed to your fear. What do you do? Now, let's recap the core concepts that we talk about here all the time on Your Anxiety Toolkit, which is, number one, what we want to do is practice tolerating whatever discomfort you experience. What does that mean? It means being open and compassionate and vulnerable as you experience discomfort in your body. A lot of people will say, "But what am I supposed to do?" And this is where I'm going to say, this is very similar to me trying to teach you how to ride a bike on this podcast. Or I'll tell you a story. My 11-year-old daughter was sassing me the other day and I was telling her I wanted her to unpack the dishwasher, and she said, "How?" She was just giving me sass, joking with me. And I was saying to her, "Well, you raise your hand up and you open your fist and you put your hand over the top of the dishwasher and you pull with your muscles down towards your--" I'm trying giving her like silly-- we're joking with each other, like step by step. Now, it's very hard to learn how to do that by just words. Usually—let's go back to the bike example—you have to get on the bike and feel the sensation of falling to know what to do to counter the fall as you start to lean to the left or lean to the right. And so, when it comes to willingly tolerating your discomfort, it actually just requires you practicing it, and if I'm going to be quite honest with you, sucking at it, because you will suck at it. We all suck at being uncomfortable. But then working at knowing how to counter that discomfort. Again, you're on the bike, you're starting to feel yourself move to the right and learning to lean to the left a little to balance it out. And that's what learning how to be uncomfortable is about too. It's having the discomfort, noticing in your body it's tightening, and learning to do the opposite of that tightening. It is very similar to learning how to ride a bike. And it's very similar in that it's not just a cognitive behavior, it's a physical thing. It's noticing, "Oh, I'm tight." For me, as I get anxious, I always bring my shoulders up and it's learning to counter that by dropping them down. So, it's tolerating discomfort. Now, often beyond that-- I'm going to give you some more strategy here in a second. But beyond that, it's actually quite simple in that you go and do whatever it is that you would be doing if you hadn't faced this hard thing. Here is an example. The other week during the holidays, one of my family members-- I'll tell you the story. My mom and dad took a trip to Antarctica. This is a dream trip for them. They're very well-traveled and they were going through what's called the Drake Passage, which is this very scary passage of water. It took them 36 hours to sail through it and it can be very dangerous. And I noticed that the anxiety I was feeling in my body about the uncertainty of where they are and how far they've got to go and are they safe and all these things is I was sitting on the couch and I wasn't engaging in anything. My kids were trying to talk to me and I was blowing them off. And I was scrolling on my phone instead of doing the things I needed to do. I was stuck and I was holding myself in this stuckness because I didn't want to let go of the fear, but I did want to let go of the fear. It was this really weird thing where I was just stuck in a sense of freeze mode. And I had to remind myself, "Kimberley, they're sailing through the Drake Passage. There's nothing you can do. Go and live your life. Holding yourself on this couch is not going to change any outcome. You thinking about it is not going to change any outcome. Just go ahead with your life." And so, what I want to offer to you is—I've said this to my patients as well when they say, "What am I supposed to do now? I've done the exposure. What am I supposed to do?"—I say, do nothing at all. Just go about your day. What would you do if anxiety wasn't here? What would you be doing if you didn't do this exposure? What would the non-anxious you go and do? And as you do that-- so let's say you're like, "Well, I need to do the dishes or I need to unpack the dishwasher," as you do that, you will notice discomfort rise and fall. And just like riding a bike, you are going to practice not contracting to it. Just like if you were riding a bike and you started to lean to the right, you would be practicing gently leading to the left. And if you go too far to the left, you would practice gently leading to the right. And that's the work of being uncomfortable. Now, you're not here to make the discomfort go away. You're here to practice willingly allowing it and not tensing up against it while you go and live your life. And I literally could leave the podcast there. I could sign off right now and be like, "That's all I need you to know," because that is all I need you to know, is practice not contracting. Meaning not tensing your muscles, not trying to think it away, fight it away, push it away. What you're really doing is allowing there to be uncertainty in your life or discomfort or anxiety in your life and just go and do what you love to do. To be honest, the biggest finger, like the bird, I don't know what you call it. Like the biggest in-your-face to anxiety, whatever anxiety you're suffering, is to go and live your life. And so, I could leave it at that, but because I want to be as thorough as I can, I want to just check in here with a couple of things that you need to know. Often when, and we go through this extensively in ERP School and in Overcoming Anxiety and Panic, is when you are uncomfortable, there are a set of general behaviors that humans engage in that you need to get good at recognizing and create a plan for. And these are the things we usually do to make our discomfort go away. So, the first one is a physical compulsion. "I'm uncomfortable. How can I get it to go away? I'll engage in a behavior." So, remember here that exposures are really only as good as the response prevention . Now for those of you who don't know what response prevention is, it's ultimately not doing a behavior to reduce or remove the discomfort you feel that's resulted from the exposure. So, you do an exposure, you're uncomfortable, what behaviors would you usually do to make that discomfort go away? Response prevention is not doing those behaviors. So, the first one is physical compulsions. So, if you notice that you're doing these physical repetitive behaviors, chances are, you're doing a compulsion of what we call a safety behavior and you're doing them to make the discomfort go away. So, we want to catch and be aware of those. We also want to be aware of avoidance . Often people will say, "Okay, I faced the scary thing, but I don't want to make it any worse so I'm going to avoid these other things until this discomfort goes away." Now, first of all, I'm going to say, good job. That's a really good start. But we want to work at not doing that avoidant behavior during or after the exposure as well. In addition, we want to work at not doing reassurance-seeking behaviors during or after an exposure. So, an example that that might be, let's say you're facing your fear of going to the doctor. But as you're facing your fear of going to the doctor, you're sitting there going through WebMD or any other health Google search engine and you're trying to take away your discomfort by searching and researching and getting reassurance or texting a friend going, "Are you sure I'm going to be okay? Are you sure bad things aren't going to happen?" Now, one of the things that are the most hardest to stop when you've done an exposure or during an exposure is mental compulsions. So, I want to slow down here for you and I want to say, this is a work in progress. We're going to take any win that we can and celebrate it, but also acknowledge that we can slowly work to reduce these mental compulsions. Now a mental compulsion is rumination, problem-solving, thinking, thinking, thinking. Like I said to you, when I was on the couch, I was just sitting there going over all the scenarios going, "I wonder if they're going up or down or what they're doing. And I hope they're avoiding the big waves and I hope they're not stuck and I hope they're not scared and I hope they're okay." All the things. All that I hope they are was me doing mental compulsions. And so, you won't be able to prevent these all the time. But for me, it was observing again, when I'm contracting. The contraction in this case was mental rumination. And then again, just like a bike, noticing, I'm focusing in, very, very zoomed in on this one thing. How can I zoom out, just like it would be leaning from left to right if I was riding a bike—zoom out into what's actually happening, which is my son's right in front of me asking me to play Minecraft or play Pokemon or whatever it is that he was asking, and the dishes need doing. And I would really love to read some poetry right now because that's what I love to do. So, it's catching that and being aware of that. And again, it's not something I can teach you, it's something you have to practice and learn for yourself in that awareness of, "Ooh, I'm contracting. Ooh, I'm zooming in. I need to zoom out and look at the big picture here. I need to look at what my values are, engage in what I want to be doing right now." The last way that we contract is self-punishment . We start to just beat ourselves up. So, you did the exposure, you're feeling uncertain, you might be feeling other emotions like guilt and shame and embarrassment and all the emotions. And so, in effort to avoid that, we just beat ourselves up. I have a client who does amazing exposures, but once they've done the exposure, they beat themselves up for not having done the exposure earlier. It's like, ouch. Wow. So, you're doing this amazing thing, facing this amazing fear, practicing not contracting, doing actually a pretty good job, but then engaging in punishing themselves. "Why didn't I do this earlier? I should have done this years ago. I could have saved myself so much suffering. I could have recovered earlier. I could have gotten to college earlier. I could have succeeded more." Again, that's a contraction that we do during exposure to fight or react to the fact that you have discomfort in your body. And what I really want to offer you, again, let's go back to basics—this is just about you learning to be a safe place while you have discomfort. So, you're having discomfort, you're riding the bike. Please don't just use this podcast as a way to fill your brain with all the tools and not implement it. I will not be able to teach you to metaphorically ride a bike until you put your little tush on the bike seat and you give it a go and you fail a bunch of times. And so again, this is you learning to sit on the bike metaphorically, doing an exposure, noticing you're falling to the right and learning to be aware of that and learning what the skill you need to use in that moment and then learn how to adjust in that moment. And that's the work. That's the work—gently, kindly, compassionately, tending to what shows up to you as if you really matter because you really, really matter. Let me say that again. You're going to tend to yourself. I'm saying it twice because I need you to hear me. You're going to tend to yourself compassionately because you matter. This matters. You are doing some pretty brave things. Right now, I'm wearing my "It's a beautiful day to do hard thing" t-shirt. It's what I wear every Wednesday because it's my favorite day to record podcasts and to do this with you. So yeah, that's what we're going to do. We're going to sit together, we're going to do the hard thing, we're going to do it kindly. But again, let me come back to the real simplicity of this, is just go do you and let it be imperfect. Exposures are not going to be perfect. You're not going to do them perfect. Just like if I learn to ride a bike for the first time, probably going to crash, but the crashes will teach me what to do next time I'm almost about to crash. Now, as I promised you, there are some common roadblocks, I would say, that get in the way and they usually are thoughts. Now if you have OCD , we go through this extensively in ERP School because it does tend to show up there the most, but it does show up with panic as well a lot, is there are roadblocks or thoughts that pull us back into contraction because when we think them, we think they're real. An example would be, what if I lose control and go crazy? That's a really common one. A lot of times, that thought alone can make us go, "Nope, I refuse to tolerate that risk," and we contract, and we end up doing compulsions. And the compulsion or the safety behavior takes away the benefit of that initial exposure. Another one is, what if I push myself too hard, like have a heart attack or my body can't take it and I implode? As ridiculous as it sounds, I can't tell you how many of my patients and clients in the 10-plus years I've been practicing—way more, close to 15 years—I've been practicing as a therapist, clients have said, "I've completely ejected from the exposure because of the fear I will implode," even though they know that that's, as far as we know, not possible. Again, I've never heard of it before, I've never seen it before, except on cartoons. So, again, it's being able to identify, I call them roadblocks, but there are things that come up that make us eject out of the exposure like you're in Top Gun. I loved that movie, by the way. But that whole idea of like, you pull a little lever and you just boom, eject out of the exposure like you're ejecting out of an airplane or a flight, fast jet, because of a thought they had. And so, your job, if you can, again, is to be aware of how you contract around thoughts that are catastrophic. A lot of people, depending on the content of their obsessions, every little subtype of anxiety, every different disorder have their own little content that keep us stuck. Your job is to get really good at being aware of, specifically, I call them allowing thoughts. They're thoughts that we have that give us permission to do, to pull the eject handle. I call them allowing thoughts. So, it might be, "No, you've done enough. You probably will lose control if you do that. So, you can do the safety behavior or the compulsion." That's an allowing thought. Your job is to get used to yours and know yours and be familiar with them so that you can learn to, again, have good skills at countering that and responding. Again, think of the bike. That allowing thought is you tilting to the right a little bit when you're like, "Oops, nope, I'm going to fall if I keep tilting. I'm going to have to work at going against that common behavior I use that is continually contracting against tolerating discomfort." Other bigger roadblocks are fear of panic, which is a common one. Again, mostly, people's thoughts around "I can't handle this." You're going to have specific ones. Again, I don't want to put everyone in the same category. Everyone's going to have different ones. But please get used to your roadblocks or become aware of them, okay? And that's it, you guys. I feel silly saying it, but that is it. Your job is to lean in. One other thing I would say, and I often give my patients the option, is I'll say to them, "Here are your choices. You've done an exposure. You ultimately have three choices." So, let's pretend—we'll do a role-play—we're in the room together or we're on Zoom, and the client has willingly done the exposure and then they start to freak out, let's say, in one specific situation. And I'll say, okay, you got three choices. You could go and do a compulsion and get rid of it. Go and make this discomfort go away if that's in fact possible for you. The other option is you could practice this response prevention and practice not contracting. That's another option for you. You get to choose. And there is this very sneaky third option, and I will offer this to you as well. The third option is, you could go and make it worse. And I have hats off to you if you want to choose that option. So, the go and make it worse would be to find something else to expose yourself to in that moment. Make it worse. Bring it on. How can we have more? What thoughts can I have that would make this even more scary? How could I do flooding? How could I find ways to literally say to your fear, "Come on fear, let's do this. I have so much more fear facing to do and I am not afraid and I'm going to do it." So you have three options. Please be compassionate about all three because you may find that you're choosing the first or the second or the third depending on the day, but they're yours to choose. There is no right. There is more ideal and effective. Of course, the latter two options are the most effective options. But again, when we learn to ride a bike, no one does it perfectly. We fall a lot. Sometimes if you've ridden a bike for a very long time and you are a skilled bike rider-- in fact, we have evidence that even bike riders who do the Tour de France still fall off their bike sometimes for ridiculous reasons, and we are going to offer them compassion. And if you are one of those who are skilled at this, but fall off your bike sometimes, that's not because anything's wrong with you. That's because you're a human being. Okay? So that is what I'm going to offer you. The question, what do I do after and during I've done an exposure, is be aware of your contractions in whatever form they may be. Be kind. And if all else fails, just go and live your life. Go and do the thing you would do if you hadn't have that, didn't have that fear. It doesn't matter if you're shaking, doesn't matter if you're panicking, doesn't matter if you're having tightness of breath, you're dizzy, all the things. Be gentle, be kind, keep going. Do what you can in that moment, and you get to choose. You get to choose. So, that is what I want you to hear from me today. I hope it has been helpful. I feel so good about making an episode just about this. Number one, I get asked a lot, so I really want to have a place to send them. And number two, I admit to making the mistake of sometimes saying go do an exposure and not actually dropping down into these very common questions that people have. For those of you who are interested, we do have ERP School, Overcoming Anxiety and Panic, BFRB School. We've got time management courses, all kinds of courses that you can get. The link will be in the show notes. I do encourage you to go check them out if you're wanting step by step structural trainings to help you put together a plan. If you've got a therapist already or you're just doing this on your own, that's fine too. Hopefully, this will help lead you in the direction that's right for you. All right. You know I'm going to say it. It's a beautiful day to do hard things. And so, I hope that's what you're doing. I am sending you so much love and so much well wishes and loving-kindness. Have a wonderful day and I'll see you next week with a very exciting piece of news.

Jan 20, 2023

MINDFULLY TENDING TO ANGER & RESENTMENT Welcome back. I am so happy to have you here with me today to talk about mindfully tending to feelings of anger and resentment. Sometimes when we have relentless anxiety and intrusive thoughts , anger can feel like the only emotion we can access. For those of you who don't know me, well, you might be surprised to hear maybe not to know that I actually have quite a hot temper. I get hot really quick emotionally, and I don't know if it's because as a child I didn't really allow myself to feel anger. I think societally, I was told I shouldn't be angry. And so, when it comes up inside me, it heats up really quick to a boiling point. And my goal for this year is not—let me be very clear—is not to say I am going to stop being angry because that is actually the problem. It is not to say I can't feel angry and I shouldn't feel angry. It's actually to tend to my anger and start to listen to what anger is trying to communicate to me. My goal with you today is to walk you through how you can do that. And I'd love if you would stay with me for a short meditation where we mindfully tend to anger and resentment. IS ANGER & RESENTMENT HEALTHY? I think the first thing I want to mention here is that anger and resentment are actually really normal healthy emotions . Nothing to be guilty of, ashamed of, annoyed by, nothing to judge, that the anger and resentment are actually healthy emotions. They come from a place of wishing things could be better or improved, and they usually show up when we experience some kind of injustice in the world or in our daily life. Maybe someone hurt your feelings or they acted in a way that made you feel unsafe. Maybe someone stopped you from succeeding. Maybe somebody judged you and you experienced that as a threat. WHY DO I FEEL SO ANGRY? Anger can show up for many reasons. Maybe it's because you're noticing the injustices in the world and that makes you angry. That political things can really make people show up in anger. And again, that doesn't mean there's anything wrong, but expressing it in a healthy way can be really useful because bottling it up, it usually numbs other feelings, it can wear down your mental health, and it can mean—and I have learnt this the hard way—is that we then explode and end up saying things we don't mean, or doing things we don't want to do that don't align up with our values or showing up the way that we want. And for me, that's a big part of my goal this year. Now, the reason I actually am doing this, this is not a scheduled podcast, is yesterday my husband and I were having a disagreement. And sometimes I have to remind myself like, disagreements aren't a problem. Because in my mind, disagreement is like, "Oh my gosh, terrible things are about to happen and I'm very scared. Please love me forever." You know what I mean? And my husband has to keep gently saying like it's okay that we don't agree on everything. We were having a disagreement and I could feel the anger showing up in my body. And I was trying to really focus on just being mindful of that experience, because when I don't do that, my immediate response is, "Fight. Let's go to war. Let me show you how you are wrong. Let me be very clear in my boundary that you cannot cross," which is all fine. Again, none of that's wrong, but I could feel myself heating to a boiling point in a very, very short amount of time. I've been really trying to instead of acting on anger in certain situations-- again, there's nothing wrong if you need to act on anger. WHEN IS ANGER APPROPRIATE? Sometimes if you're in a dangerous position, you need to act on anger. But I'm really working on allowing anger, befriending and tending to anger. Anger can be our friend . Like, what's the problem? Let's actually have it, Kimberley. Let's actually feel it. Let's actually feel it go through my body. Let's allow it to burn itself off. And let's do that, not because we got to make our point and make sure they know we're right, but because you actually felt it. You allowed it, you rode the wave of it, it burnt off. And it always burns off. That's the thing. That's mindfulness—to recognize that everything is temporary. If you say-- I'm talking to myself here. If you say what you say when you're angry, you mightn't have said it in a way that is effective as if you had said that thing a few moments later when you've let a little bit of that anger burn off. Again, I'm not saying here that there's anything wrong with just saying what you need to say, but for me personally, I'm really trying this year. One of my biggest goals is respect through my words. Respect through my words. Really pausing and being really intentional with my words. And I know that when I'm angry, that is absolutely not happening. So, we know that expressing anger is fine. We know that bottling it in is usually problematic. Pretending you're not mad is also inauthentic. Sometimes my husband's like, "You're so clearly mad." And I'm like, "No, I'm not." And he's like, "Yeah, it's all over your face, my friend." People can sense it. And then they're questioning like, "Why isn't she being honest with me?" WHY DOES ANGER FEEL DANGEROUS? But I want to acknowledge that anger can feel like an emotional rollercoaster. It does stress out the body. Anger can feel very dangerous sometimes. It can feel very scary to some people, particularly if you have anxiety about it. Some people are really afraid of what they'll do if they get angry and so they avoid anger and they avoid confrontation and they avoid setting boundaries in fear that anger will come up. Now, there are a few ways you can bring mindfulness to anger, and that is, first, to recognize it, to observe it. Another way you can diffuse anger is to use your body. This is a big one for me because when I'm angry, I have so much adrenaline pumping through my body, which is a healthy response. We need that. Like if there was a burglar at my door, anger would show up and my brain would send out adrenaline and that would allow me to either fight or run away or wrestle him or whatever it may be. So, I feel a lot of that adrenaline in my body and it does take time to burn off. And so, sometimes moving my body can be really helpful—stretching, taking a walk, taking some breaths, which we're going to do today. Some people want to journal, chat with a friend. That irritation and frustration that we feel in our body, it's okay to move your body and tend to it in that way. The last thing I would add is often when we are angry or if we haven't been mindful in the emotion and sensations and experiences that lead up to anger, we can actually notice that our thoughts are very distorted. Here is an example. My husband and I are having a disagreement about a very normal thing. It was a very pretty non-issue issue. But in my mind I could. Once I was really being mindful, I could notice thoughts like, we should agree, we're going to always fight if we don't agree. It's like, okay, that doesn't have to be the case. I was also having thoughts like if he doesn't agree, well then, I won't get my way and then I'll be held down. I'm having this very catastrophic thought—I'll be held down and ruled by my husband. It's like, well, that's not true either. He's never going to do that. I'm noticing all these thoughts. If he disagrees with me, that means he's judging me and thinking I'm bad. Can we actually look at that distortion as well? Because maybe that's me mind reading. I'm just giving you some examples. I'm not saying these are all ways happening, but these are some examples. Sometimes we have thoughts like, no, you should not think that way. You need to think my way. My way is the only way. PS, I do that a lot sometimes. I'm just telling you the truth here. But again, that doesn't mean we have to act on those thoughts. If we can just acknowledge them and be like, "Okay, let's be in choir." Is that in fact true? Do we all have to agree? How wonderful is it that my husband and I don't agree on some things because he has actually taught me how to change the way I think about some things that have benefited me. It just took a lot of stubbornness on my part to be flexible enough to see his side of the story. And so, if we can observe the distortions of our thinking, sometimes that can be really helpful. But let's also reserve some space here for the situations where you don't have any distortions and the person is being very unkind and they are hurting you. That's different. Then, what we can do is we can use that anger as information so that we know what we need to do to protect ourselves. Sometimes it's setting a boundary. "You can't speak to me like that." Sometimes it's saying, "You can't come into my house and do these things to me." Sometimes it's saying, "I'm going to not follow you on Instagram if it makes me angry." Or if you're seeing a bunch of things that's not helpful to your mental health and is making you compare and get angry, maybe you might want to not follow that person anymore. And so, anger, again, if you can see it for what it is, is an opportunity to listen to what is going on and be mindful and just acknowledge, and then if need be, make some changes gently that line up with your values. And so, that's really important for us to recognize. IS ANGER MASKING ANOTHER EMOTION? Now there's one-- again, I keep saying that. There's one other thing I want you to think about, which is, sometimes underneath anger is another emotion—fear, shame, guilt. For me, I actually realized about a month ago, and I'll just share this with you, sorry, is I was noticing a lot of resentment showing up, particularly—if I'm being completely honest with you all, which I always want to be—a lot of resentment around the fact that I live in America. And I was noticing it showing up and going, "This is really weird. Why is resentment showing up? I chose to live here. I knew that was my choice, but a lot of resentment was showing up." And through talking with a dear friend underneath this anger and resentment, and I felt myself having a tantrum over it, I realized I was deeply grieving and missing my family. Usually, I just feel miss like I'm missing them and I feel sad, but the anger and resentment was masking me from it. And when I acknowledged that, I realized I'm staying in anger because the sadness was "too painful." In my mind, it felt unbearable. And so, my brain presented to me an opportunity to stay in resentment and anger and really cycle and ruminate on that instead of dropping down into the sadness that I felt. So, again, anger is complex but also quite simple if we talk about it, like two opposing things at the same time. But what I want to offer to you is, all of these feelings are completely normal. If we can just simply acknowledge them with a sense of kindness, if we can stay with the sensation, if we can stay in compassion for ourselves, we can actually write out these emotions and they can be, what I say to myself, it's not a problem. That's my new thing. I keep saying to myself like, "Oh, I'm noticing anger. That's not a problem. It's totally okay for you to feel this, Kimberley." "Oh, I'm noticing anxiety. That's totally not a problem, Kimberley. Let's stay with it. Let's feel it." ANGER AND RESENTMENT MEDITATION And so, let's begin with a short meditation to where you may practice that. Now, if you're driving, number one, please do not close your eyes. Number two, if you're feeling an urge to turn off this podcast now and be like, "I got what I needed," please just listen. You don't even have to practice. I just want you to listen to what I'm saying and see if anything lands. Here we go. We're going to mindfully tend to feelings of anger and resentment. Bring your awareness to whatever is going on for you right now... and allow your body to rest as you feel the pool of gravity down on the chair or the bed or whatever it is that you're resting on. And as you are aware of your weight sinking down to that point of contact between you and the floor, the chair, or the bed, I want you to notice what sensations are you noticing right now. Where does anger show up for you? Where does resentment show up for you? Are they the same or are they different? And just take some time to notice any resistance towards noticing anger and resentment. And if you notice any tension or resistance, gently turn towards them. Maybe you offer a gentle hello to them. Good morning. Good evening. And as you notice them rise and fall in your body, offer some acceptance as best as you can that they're there. If you notice that you're tensing up around them with each outbreath, see if you can let go or release any tension in your muscles or in your mind. Again, not trying to get rid of them, but also not holding on to them. Soften your body as best as you can, bringing acceptance to those sensations. Continuing to breathe in no particular fashion at all, except whatever feels easy for you. Notice any thoughts as they arise and they pass through your mind. Notice if there's any thoughts of blame or shame or guilt or aggression. And notice them for what they are, which is emotions, sensations. See if you can let them come and go, rise and fall without over-identifying with the content of those thoughts, without engaging with the content. Just note them. "Oh, I'm noticing blame. I'm noticing the urge to punish that person. I'm noticing the urge to create justice. I'm noticing the experience or urge to neutralize the pain they've caused me by punishing them." And see if you can just notice them, maybe as clouds in the sky just floating by. No need to rip them out of the sky. Just notice them. And as you notice they're floating by, can you let go of them? Can you let go of needing to control them or make them go away? And we want to do this kindly and gently. Sometimes it's helpful to gently bring the sides of your mouth up and gently smile. Not to make the feelings again go away, but to let your brain know that you're here, that you're not going to judge it for what it's experiencing, and that you've got your back here. And now, allow your awareness to broaden and gather the whole experience of breathing into your body with ease. As you breathe in, knowing that you're breathing in, and breathing out, knowing that you're breathing out. Can you feel an awareness that flows through you as you breathe? And can your breath be an anchor in this present moment? Noticing each breath as you inhale and exhale. Noticing any judgment you have for yourself as you have these sensations, any self-criticism. Again, just note them, acknowledge them. Try to remind yourself that anger is a normal and healthy emotion. You may also want to congratulate yourself for tending to your anger in this moment, instead of internalizing it or displacing it onto other people. And every time you notice your mind has wandered, gently bring your mind back to the breath or the awareness of these sensations in your body. Now again, expand your awareness back to feeling gravity pull you down as it sits and stands or lies. If there's anything left behind here, some pain, some discomfort, let's set the intention to keep this practice going where we're going to be non-judgmental and compassionate towards this experience. We're going to cultivate acceptance and acknowledgment of this and your entire experience. Gently allow the breath to bring you back to the present. I want to thank you for having the courage to do this exercise with me. The more you offer this practice to your mind, the more the mind will start to see anger again as nothing but an emotion that is knowledge and information for us to make decisions about how we want to move forward. It's a healthy action towards decision-making, boundary-setting, self-compassion, acceptance. And you're doing this for the benefit of yourself and for the benefit of others. Slowly come back. Open your eyes. Notice what's around you. And I'm going to offer to you to keep going into the day with this practice. Okay. Thank you for practicing with me today. I wish you nothing but a beautiful day of joy and kindness and warmth and love. Please also remember, it is a beautiful day to do hard things. I will look forward to seeing you next week. Thank you for spending your very valuable time with me today. I hope this was helpful.

Jan 13, 2023

In this week's podcast, I talked with Lynn Lyons about her new book, The Anxiety Audit (7 Sneaky Ways Anxiety Takes Hold and How to Escape Them). We discuss: How repetitive negative thinking disguises itself as problem-solving How catastrophic thinking makes the world a dangerous place and demands you react accordingly How big conclusions and an all-or-nothing approach make the world smaller and harder to navigate. How a fear of judgment isolates and disconnects us from people How being busy and overscheduled both adds and masquerade anxiety and stress How we blame others when we are irritable How self-care becomes not self-care at all Transcript This editable transcript was computer generated and might contain errors. People can also change the text after it is created. Kimberley Quinlan: Okay, good. Well, welcome, Lynn Lyons. I am so thrilled to have you on the show today. Okay, so very exciting. Lynn Lyons: Oh well, thanks for having me. Kimberley Quinlan: You just wrote another book. I will say another book. It's amazing. Please tell me before we get started. Why did you choose that as the title? Lynn Lyons: Well, what happened was we have a podcast called flusterclux . And I do that with my sister-in-law Robin; she's married to my brother. And during the pandemic, one of the courses we created together, she called it the anxiety on it because we wanted to go through the patterns that maybe people were experiencing and they didn't, they didn't have words to them, they didn't know what was going on. And so we did this course, and we put it out there, and then my publisher said, Do you want to write a book? And I said, "Oh, okay". And Robin and I said, Well, why don't you just make the course we did into a book? It'll be easy because she's never written a book before. Um, so that sort of was the genesis of it. So the publisher like the title, the anxiety on it. So the book ended up being much more expanded than the original course, but the title was from Robin. And the course we did for the podcast. Kimberley Quinlan: Right. And I loved it because there is a degree of going through your book. We're going to talk today about the seven sneaky ways anxiety takes hold and how to escape that, but I love how it is. It feels like an audit, right? You're kind of auditing through these sneaky ways anxiety can take hold. So, I love that. So, let's go through today's those seven points, and then we will go deeper if we have time. Can you tell me a little about this first main concept of how repetitive thinking disguises itself as the problem? Lynn Lyons: Yeah, it disguises itself as problem-solving. So when you are doing repetitive negative thinking,… Kimberley Quinlan: Aha. Lynn Lyons is just the lingo we use to describe worrying and ruminating . We generally distinguish between worrying and ruminating in which direction and time they head. So if you are a worrier, you tend to worry about things that haven't happened yet. And if you're a ruminator, you're going back over things, which tends to be both. It can feel pretty obsessive. A ruminator will go back over things and ask those questions. And did I say the right thing? Did I do the right thing? Did I buy the right refrigerator? Did I make the right decision? Lynn Lyons: Repetitive Negative thinking. The problem with it is that the thinking feels like the solution. Remember, anxiety seeks that certainty. If I just go over it, if I just think about it, if I just talk about it, if I just ask people about it, if I just get more information about it, that will lead me to a solution. But what we know is that the thinking is actually the problem because when you overthink, Lynn Lyons: You're caught in that repetitive cycle. You're seeking that certainty. So you don't move forward, and you don't take action. It just feels like you're doing something productive. But unfortunately, you're when people go to therapy, if they have this kind of obsessive thinking and they get caught in it, is that the therapist will unknowingly say, Well, let's think about this, or Let's talk about this, some more. Let's explore this. Or What could that mean and the anxieties? Like, Yeah, I love this lady. Now we get to do our thing. Lynn Lyons: What we know about people that tend to overthink and get into this repetitive negative thinking is that they are less likely to act on a solution if they come across one in their thinking. So they're saying, "Oh, I'm thinking to figure this out," but then they never take the necessary action. Yeah. So it's a way to trick you into thinking you're doing the right thing. When you're just feeding your rumination feeding your worry, Kimberley Quinlan: I love it, and you mentioned in your book Chewing the mental card, which I thought was just classic and… Lynn Lyons: Mmm. M. Kimberley Quinlan: hilarious. I grew up on a farm, so that was very appropriate. I love it. Let's go to number two, how catastrophic thinking makes a world, the world a dangerous place and demands. You react accordingly,… Lynn Lyons: Sure. So catastrophic thinking this is like the meat of the anxiety sandwich… Kimberley Quinlan: do you want to share about that? Lynn Lyons: You're always wondering, worrying about, or vividly imagining the worst thing that could happen. And again, this feels like a solution. So if you are a parent and you have this catastrophic way of thinking, you're thinking, all right, so if I can imagine every bad thing that could happen to my child, then I can be ready for it. I can prepare for it; I can prevent it. But what we know is that the more catastrophic you are, the more you think about the bad things that could happen. 00:05:00 Lynn Lyons: The more fearful you are, doesn't mean that you're better prepared to manage things; it means that you start to avoid and remove things from your life. So, Yeah. So it just becomes again. It becomes this way of the anxiety dictating what you do and don't do. Kimberley Quinlan: Right? You talked in this chapter about the pain. The Pain Catastrophizing Scale and… Lynn Lyons: Mmm. Kimberley Quinlan: that's something that I didn't know a lot about, which I found. Very fascinating. Do you want to share your little thoughts on that? Lynn Lyons: Sure. So what we know from pain and pain is such an interesting phenomenon, isn't it? It's such a rich place for research and study. If you could testify about your pain. So if you anticipate that your pain is going to be terrible, You will respond as if the pain is worse than it is. And one of the things that's interesting is I work a lot with kids and a lot with families and parents. One of the fascinating things is that, say, you've got a child in pain, and you ask the parent to rate the child's pain. Say the child rates their pain as a four. The parent weighs the child's pain as an eight. Lynn Lyons: The parent's rating of the pain is a predictor of impairment in the child. Kimberley Quinlan: Huh. Lynn Lyons: Completely independent of, you know, maybe the child says Oh my pain is a two and the parent says, Oh the truck might try. I'm so worried about my child. I think their pain is an eight that parents catastrophizing about the pain. Predicts whether or not that child goes to school whether or not they predict an activities how much of their life is impaired by the pain. Even though the child is saying, Well like that, my mom thinks the pain is a lot worse than it is. It's the parents' catastrophizing that actually has the impact. Yeah. Kimberley Quinlan: That is so interesting. And so what what really showed up for me was is that also true of like the pain of the suffering of anxiety, right? Like is if we are catastrophizing how painful the anxiety will be does that? That still the same concept scientifically Lynn Lyons: Well, I don't know about the research in terms of the way they lay it out, so clearly with with pain but here's what we do know. Catastrophic parents being a catastrophic parent about anything. Is a high risk factor for developing anxiety as a chart for children. So, if you have a catastrophic parent, it increases your risk of creating an anxious child. We also know that parents who are anxious have a six to seven times greater risk of having an anxious child. We've got some genetics in there… Kimberley Quinlan: Right. Lynn Lyons: but there's an awful lot of modeling. So when we when we look at how parents talk about the world. one of the things that when parents talk about the world as a dangerous place, when they talk about their child as being incapable of functioning, Lynn Lyons: When they step in so that their child doesn't have the opportunity to get to the other side, doesn't have the opportunity to independently problem solve, all of those things increased anxiety. And because we know that anxiety, untreated is one of the top predictors of depression, by the time you hit adolescence and young adulthood, we know that that that's that cycle is just going to continue. So when I am,… Kimberley Quinlan: Mmm. Lynn Lyons: when I am working with families and I am trying to interrupt this cycle, one of the things just as you said, one of the things I want to really target is, Is this parent catastrophizing? Lynn Lyons: About their child's ability to function and it may be catastrophizing about their mood catastrophizing about them, being upset or being nervous, right? So so my child is so anxious about this. There's no way I can send them off on this field trip or there's no way I can send them off to this summer camp because look they're so anxious. It absolutely is contagious for sure. 00:10:00 Kimberley Quinlan: And that's true of ourselves too. So if we're catastrophizing, when less likely to go on the field trip, ourselves is correct. Yeah. Lynn Lyons: That's right. Yeah, well, so say, say you're gonna get on an airplane. And you're thinking, Oh gosh I'm going go on this airplane and you start catastrophizing and imagining bad things happening on the plane or the plane crashing and you activate your whole system. So you're having these symptoms and your your stomach feels weird and your heart is pounding. You say to yourself, Oh my gosh, if I feel this bad just thinking about getting on the airplane, it's going to be horrible. When I actually get on the airplane, I better not do it. Right. So we're just watching this scary movie and… Kimberley Quinlan: Yeah. Lynn Lyons: it makes sense if you're sitting there watching a terrible movie with a horrible outcome, Of course you want to avoid that thing but we have to recognize that that catastrophic thinking is a pattern of thinking not an actual predictor of outcome. Yeah. Kimberley Quinlan: Right. Kimberley Quinlan: Yeah, and you talked about that about sleep as well. Lynn Lyons: Oh, yeah, well, the thing that most the thing, that people who are have difficulty sleeping people with insomnia, the number one thing they worry about is sleeping, right? So you can't sleep. And then you start worrying about not being able to sleep and off off the cycle goes. Yep. Kimberley Quinlan: Yeah. Yeah of for me actually I remember when I had my newborn baby. It was the fear of being tired. Lynn Lyons: Mmm. Kimberley Quinlan: So I would I would pressure myself to sleep because I'd catastrophized, what tiredness was gonna feel like,… Lynn Lyons: Yes. Yes,… Kimberley Quinlan: right. Yeah. Lynn Lyons: I've certainly many people have that. I interestingly had this client long ago who catastrophized the feeling of being hungry. That she couldn't tolerate feeling hungry so you can you can grab onto anything in catastrophize about it for sure. Kimberley Quinlan: Right. Kimberley Quinlan: Yeah. Fantastic. I agree. Yeah. Okay. Now this is cool and we've talked a little bit about this in the show before but let's just go over it really quick. How big conclusions and all or nothing approach make the world smaller and harder to navigate. Lynn Lyons: Mm-hmm. Kimberley Quinlan: You talk about going global. Do you want to share a little bit about that? Lynn Lyons: Yeah. So so global thinking, so if you have a global attributional style or a global cognitive style it means that you come to big conclusions. Usually about yourself or other people, right? So oh I never get what I want or I always screw up or nobody understands me. These are these big huge words that then if you believe that well nobody likes me. Well then you're not gonna you're not gonna step out there and take any kind of risks or reach out to people because you've already come to the conclusion. So when people are global in their thinking, they're much more likely to one break things down into parts, so they can recognize, well, there's a sequence to making friends or there's a sequence to getting a new job, or there's a sequence to cleaning out my basement. So they, they get into this place of like, Well, it's a disaster. I, you know, I can't do it and then they also begin to believe that about other people. So when you're global about other people, it shuts, Lynn Lyons: Off. Right. Well, that group of people could never like me. Or that group of people is this or that group of people, is that So, the opposite of global and we know that global thinking huge risk factor for anxiety and depression. When we're confronted with that, or when we notice that we're doing with doing that, we want to back up from it and say, Okay, so I just heard myself using that global language, right? I just heard myself say, Oh, I'll never get this done. Oh, there it was right now. Why am I saying that? Well, I'm feeling a little overwhelmed. It does look like a big project in front of me. Maybe it is a big project in front of me. So now I'm gonna break it down and I'm gonna recognize there's the beginning and a middle and an end, there's a sequence, right? And that moves us out of that big global way of thinking that's just absolutely paralyzing. Yeah. Kimberley Quinlan: Mmm. Yeah, I love that. Okay. How anxieties fear of judgment isolates, and disconnects us from the from people, right? And I, I will, if you could speak to where you also touched on the disconnection, happens on the inside. You won't share a little about that. Lynn Lyons: Yeah. So so interestingly when when when people are lonely It can be in two categories, one is that it's situational. So you've just moved to a new city. You don't know anybody. You're starting college and you're there by yourself or it can be more of a pattern of the way you interact with the world. And again the conclusions that you come to, so you look at the way that the world is connecting and interacting and you conclude that one is that everybody does it better than you,… Kimberley Quinlan: If? Lynn Lyons: right? That it's easy for everybody that it comes naturally to everybody and that it's not gonna work for you. Lynn Lyons: And you go inside and I always say, You know, you have a meeting with your anxiety inside you're having meeting and and during the meeting, you say, You know that. Well there's this is, this is terrible. I don't have the skills. Nobody wants to connect with me and also you fear the judgment of other people. So one of the mistakes that we often make with somebody who's feeling this way who's feeling isolated, who doesn't feel like they can connect is we try and talk them out of it. 00:15:00 Lynn Lyons: By saying things like, Well people don't judge or, um, you know, nobody's paying attention to you or, Oh, people aren't thinking that, right? That's just not true. People do judge, they judge all the time, and we notice people. And if I'm, if I'm on an airplane and somebody has this really crazy hairdo, I'm gonna be like, Wow, look at that hairdo. Or if I, you know, got an airplane and somebody has this really funky tattoo on their face, I'm gonna say, like, well I wonder how they decided to put that tattoo on their face. We do it all the time. And so what we have to develop is the ability to tolerate being vulnerable and we can do it in small steps, you know, you don't have to, you know, you don't want to share your life story with the person you met two minutes ago. Lynn Lyons: But recognizing that when our anxiety shows up and says, I can't take a risk, I can't be vulnerable, everybody can connect, but me, you go inside and you convince yourself, not based on what's happening on the outside, but what's happening on the inside that you aren't capable of connecting? And then boy,… Kimberley Quinlan: Right. Right? Lynn Lyons: it just snowballs Kimberley Quinlan: I love it and so true of the pandemic and where we're at in the World,… Lynn Lyons: You yeah, yeah. Kimberley Quinlan: Right? Yeah. Okay. The next two chapters were my favorite. okay, and… Lynn Lyons: Yeah. Kimberley Quinlan: so I wanted to talk about this a little bit, you talked about how being busy and over scheduled, Which like I raised my hand to ads and… Lynn Lyons: Mm-hmm. Awesome. Kimberley Quinlan: masquerades anxiety and stress. Lynn Lyons: Yeah, so the interesting thing about busy and I raise my hand too. I'm you know so I get it. Um, We love the idea of being busy it because it's, it's this currency now, right? We can't, we can't really brag about how money, how much money we make. We can't say to, you know, if you ran into a friend on the street you and they said, Oh, how are you doing? Kimberley you and say, like, Oh, I'm doing great. I am making so much money this year, it's fabulous because they say, Oh my gosh, that's so tasteless. Why is she saying that? But you can say, Oh I am so busy. My life is so crazy. That's become sort of our currency of importance. Lynn Lyons: Of how busy we are. So the more busy we are the more we feel like we're worthy and the more busy we are the more we don't have time to feel things that we're going to feel so we keep ourselves busy as a way to just keep that that brain of ours in motion and we have difficulties sort of settling back in but it is interesting. It you know, when I was doing the research for this chapter it a few things were really we're really kind of amusing to me and true you read this. They say of course of course is it a life of leisure that used to be something to brag about right back in the old days… Kimberley Quinlan: Yeah. Lynn Lyons: because the farmers and the labors and the coal miners, right? But if you, if you could sit back and and relax and drink a mint julep, right? That meant you had social status, well, sort of flip. Now, we don't really admire people that sit back and… Kimberley Quinlan: Yeah. Lynn Lyons: don't work. So, that's an interesting thing I found and then the other Lynn Lyons: Interesting thing I found is that people who brag a lot and sometimes it's that humble brag, right? Oh I wish I weren't so busy. Oh my gosh. Yeah. Um people who brag a lot about how much they work are very inaccurate about the hours that they work and the more hours that you say you work oftentimes the more you're off. So people say Oh I work a hundred hour week and I always think to myself No you don't right? Because Even if you worked 12 hours a day, seven days a week, that's not even a hundred hours a week. Kimberley Quinlan: Right. Lynn Lyons: And so what what they found is those people who say Oh I work 70 hours a week really are working about 40 But it's just it's just indicative of how much we want to keep ourselves busy. Lynn Lyons: And how how often times it's it sounds kind of backwards in paradoxical but it's true that we really like that feeling of chaos that we create because it means that we don't have to sit back and sort of look at how things are really going. And we do it. Kimberley Quinlan: Right. Lynn Lyons: We do it with our kids, for sure. And a lot of kids right now, believe that the way that life is supposed to be in the way that we measure our success is, how busy we are. Kimberley Quinlan: Yeah, I always think of like I I remember moments where I in early in my own anxiety recovery where I could feel and I've talked about this on the podcast like feel myself, typing really fast and it's funny when you're so focused on what you're doing. You do tend to have less anxiety so it feels like a relief. Almost it's a compulsion, right? It's a relief to your anxiety. 00:20:00 Lynn Lyons: It is, yeah. Yeah. Well. Kimberley Quinlan: Like I don't have to be up here if I'm typing like crazy or I'm focusing. Lynn Lyons: That's right. Kimberley Quinlan: And I think that that you use the word masquerade down, anxiety, and stress. I think that, that is right on the money, right, that where we are. Busying as an avoidant compulsion. Lynn Lyons: Mmm. That's right. Kimberley Quinlan: Do you agree with that? Lynn Lyons: Yeah. Well because if you're, you know, if you're if you're if you've got a lot going on in your head, And maybe your thoughts are saying, You know, you're not good enough, you're not busy enough, you should be doing this right? You're shooting on yourself, you're doing all this stuff and if you can keep your brain in your body busy and occupied, And almost as if like, you can't keep up and you've got, you've got this little feeling of of urgency or emergency. Oh, I've got to do this, I've got to do this, it really distracts and sort of satisfies. Those thoughts in your head of, I, you know, what's gonna happen next. And it allows you to not really experience the worry and the anxiety because you're just busy, busy, busy busy. Well yeah,… Kimberley Quinlan: Right. Lynn Lyons: one of the things it's interesting. We did a podcast episode on this a little while ago, this this term high functioning anxiety. Kimberley Quinlan: Yeah. Lynn Lyons: Which is sort of amusing to me, right? Because it's the city right, everybody wants to have these new categories, right? It's not this. It's this high functioning anxiety and they had this list of The list of symptoms this checklist, I saw in this article which was just silly like you know you chew your lip or you chew gum or you don't make eye contact, you know it's just silly but but when we look at it, high functioning anxiety is no different than any other kind of anxiety. It's just that you're getting the job done and… Kimberley Quinlan: Yeah. Lynn Lyons: then people are giving you a lot of positive feedback for that,… Kimberley Quinlan: Yeah. Right. Lynn Lyons: right? So yeah. Kimberley Quinlan: Right. A busyness is another form of like, avoidance of the fear, right? Yeah. Yeah. Lynn Lyons: That's right, that's right. And it because of the way our culture works It, it feels good in the moment and you get the payoff of somebody saying,… Kimberley Quinlan: Yeah. Lynn Lyons: Oh my gosh, you are so busy. How do you do all that you do? Oh gosh, I've never met anybody. You know what? If we want a job done, we got to give it to Kimberley, she's gonna get it done and… Kimberley Quinlan: Right. Right. Lynn Lyons: all of that feels so good, but it totally burns you out, if you, if you keep it up for sure. Kimberley Quinlan: They'd like No, I'm just over here doing a bunch of avoidant compulsions. Lynn Lyons: Yeah, right. Kimberley Quinlan: That's why Right. Lynn Lyons: We don't say that. Right? Oh my gosh. You're doing so much Kimberley. Oh no, I'm just avoiding compulsing. Yeah, no. We don't say that. Yeah. Yeah, they would. They would they be like, Oh okay. So maybe we won't give her that next assignment then. Yeah. Kimberley Quinlan: Right. Well, and that brings me to the next part of this which again these were my two favorite pots and concepts mainly, I think because it's I still like, ooh, there's some truth there. I need to be listening. And I think it links so well together with the last one about being over scheduled and busy talking about irritability, right? Because And you had said here and I'll use your your terms exactly how irritability likes to blame others but can be a red flag for you. Do you want to share that? Because I feel like they go hand in hand with that over scheduling. Lynn Lyons: Yes. Yeah. Kimberley Quinlan: Do you tell me your thoughts? Lynn Lyons: No, I agree. And in fact, like all of these patterns, sort of overlap, don't they? Kimberley Quinlan: You know. Lynn Lyons: Because we can be catastrophic and over scheduled at the same time. Yeah, irritability is, is a red flag. So irritability. I talk about all these patterns and irritability is a sign that perhaps you're really not addressing what you need to address. One of the, the definitions of irritability that I talk about in the book is that it's described as blocked goal attainment. Okay, so that's it. A research term is that you can't get… Kimberley Quinlan: Yeah. Lynn Lyons: what you want and something is in the way the other term that I read, and it's in the book, is they defined irritability as feeling angry and the ability to sustain that anger? Kimberley Quinlan: and, Lynn Lyons: So it's this constant sense of not getting what you want, not being able to feel satisfied. And what happens is you start looking outside to find out why you're so irritable. It must be because my kids aren't doing what I told them to do. It must be because my partner is not fulfilling the agreement that we made. It must be because my boss is such a jerk, it must be because of the traffic, it must be because of the weather, it must be because of this and what we really want to step back and look at is How is this constant level of irritability? Kimberley Quinlan: You. 00:25:00 Lynn Lyons: How are you sustaining it? What are you doing? Is it your perfectionism is it the fact that you want to compuls and people are getting in the way of your compulsing because you're in your mind if I can only compulsa and I'll feel better but people aren't letting you do what you want to do. Lynn Lyons: Is it because inside there is a constant conversation with you about how you're not meeting your own expectations. How are you creating this level of Sort of low-grade simmering this low-grade dissatisfaction that is just eating away both at you and and your your relationships. It's hard to hang out with somebody who's irritable all the time. Kimberley Quinlan: And what would you suggest somebody do? If they've caught this red flag of irritability, how would you encourage them to navigate that? Lynn Lyons: So, the first thing you want to do, and I think I say this about a lot of the patterns in the book. Is you just want to talk about it? Openly with the people you live with, because one of the things that's enormously helpful is for you to own your own stuff, right? So if you know that you're struggling with irritability or even just on a busy day you come home and you're feeling particularly irritable to say to the people that you love the people who are in your orbit. Hey you know what, I had a rough day. I'm feeling irritable, it is not you, it's me it's not your fault. So you're really gonna pay attention to that blaming and you can even say to the people around. You give me a few moments, right? I've got to go for a walk or I'm gonna listen to some music or man. I just need to eat a peanut butter and jelly sandwich. Lynn Lyons: And then give yourself permission and, and more than permissions, sort of give yourself a little kick in the hello. That says, I'm gonna, I'm gonna work on releasing this irritability without going after other people. And that diffuses it very quickly and… Kimberley Quinlan: Mmm. Lynn Lyons: then if you're a parent, you're modeling that for your kids, which is a wonderful thing and… Kimberley Quinlan: Yeah. Lynn Lyons: then you really have to look and see if it's a chronic thing. What do you keep doing over and over and over again? That's making you irritable. Lynn Lyons: How are you going to recognize that and accept that? Because a lot of times people say, Well I don't know why I'm so irritable and then we talk about it. And it's pretty obvious why they're so irritable. Now that means you have to adjust or adapt and it might be your schedule. Maybe you're not getting enough sleep. Maybe you're saying yes, too often. When you want to say, no, maybe you are ruminating in your head about how other people have, let you down all the time, maybe you're catastrophizing. So those horrible stories about what the world is going to look like are really making you irritable. So it's it's a way for you to to step back and say What am I doing? That's resulting in this state that I'm in. Yeah. Kimberley Quinlan: And yeah, yeah. And I'll just for being transparent. I have found as soon as I'm irritable, it's because I'm refusing to feel some feeling like that is for me. I'm like, I don't want to feel this feeling. Lynn Lyons: You. Kimberley Quinlan: So I'm gonna be like Real shop and all edgy around everything. So I think that's just such a great point. It's like, I don't want to feel the anxiety. I'm feeling so I'm just like,… Lynn Lyons: Yeah. Kimberley Quinlan: frightened reactionary. So I think that that is such a common. I see it a lot with my patients as well. Just a deep sense of frustration of like you said, they won't let me compuls and… Lynn Lyons: and, Kimberley Quinlan: that. Okay, that's means that you're gonna have to feel some anxiety,… Lynn Lyons: Right. Right. Now. Kimberley Quinlan: right? So I you're on the money there. I love. Okay. This was an interesting one and the last point how self-care is hijacked and becomes not self-care at all. Lynn Lyons: If well, and I think that you you sort of teed this up for me very well because oftentimes what we call self-care is really means of avoidance. Right trying to eliminate. So I'm trying to get rid of some feeling. I'm trying to avoid something that I need to address. I don't want to feel this way. We, I talk a lot about our elimination culture and how we're really focused on trying to get rid of things like feelings or discomfort or right. So we take on these practices that we call self care, that are really about getting rid of something or avoiding something and so that can be Lynn Lyons: Anything from drinking or using other substances to spending money, you don't have to binging on Netflix and not getting the sleep. You need, because you feel like you want to escape, what's going on? When you are doing something that in the moment you're saying, you know what? This is really for me. And then the next day you feel regret about it, probably not self care. Right self-care. Kimberley Quinlan: Mmm. Lynn Lyons: If you do it consistently. After after I do something that is truly, you know, one of my good self-care things. I don't say to myself. Oh, I can't believe I did. I can't believe I got eight hours of sleep last night like, Oh, what a loser. I can't believe I went for a walk with my friend. Oh, right. But if I 00:30:00 Lynn Lyons: Spend too much money, or if I stay up too late, or if I skip my exercise, that helps me so much, or if I eat half the chocolate cake. The next day, I'm probably gonna say, Oh honey, like do that, You know,… Kimberley Quinlan: Mmm. Lynn Lyons: I should. So that's one of the easy ways to sort of determine for yourself whether or not you're engaged in self-care or self medication, but self care isn't a one hit wonder, right? It's not, it's not a quick fix. It's a consistent pattern. Moving. Kimberley Quinlan: Right. Right. Yeah, I talk I wrote a book about self compassion and I talk about the same thing as people say. Well this is the self compassionate thing to do to not face my fear or… Lynn Lyons: You. Kimberley Quinlan: to not, you know, to not get out of bed and yes, I understand some days we have to be gentle but I think we also rely on self compassion. Sometimes as a, as a way to avoid our feelings and… Lynn Lyons: That's right. Kimberley Quinlan: wade fear as well. I think that really, you know, is so true. You did talk about self-medicating, and then you would said that, When you're able to identify these seven points, that's a form of self-care. Lynn Lyons: That's right. Lynn Lyons: That's right. Kimberley Quinlan: Right. Do you want to share a little about that and… Kimberley Quinlan: what that looks like? Lynn Lyons: Well, so if you are reading this book, or if you're listening to me now and you're beginning to recognize that you have a few of these patterns that really take over and then and you begin to own them. Just like I was talking about with irritability and you begin to see the pattern. It takes courage to change the pattern. It takes courage to say, Oh gosh, I look catastrophizer or boy, do I get caught up in a ruminating about things, as a way to solve problems? Or you know what? I have been saying that my two or three glasses of wine. Every night is self-care and I'm really noticing that I feel worse the next day, or I don't sleep very well. So once you begin to own them and once you begin to, you know, you can talk about them openly with the people you care about. Lynn Lyons: Things start to shift the biggest thing and I'm sure you see this with your patients as well. Kimberley The biggest roadblock that I run up to run up against is when people deny that they're doing the things that I know are causing them to stress. and then, when they blame other people, You know, I I say this all the time, I have this client, The daughter was struggling with OCD, Dad had OCD, he was highly perfectionistic. Things had to be perfect in the house. He would miss his kids, recitals, or their soccer games, because he had to come home after work. And make sure that everything in the house was perfect. And I was trying to explain this to him, this rigidity and his OCD. And he said to me, What's wrong with a neat and tidy house. Lynn Lyons: Now nothing except that, that's not what was going on here. But his denial of his patterns and his inability to own them and to talk to his family about them because you can imagine what his daughter did when he said that, right? She like threw herself back on the couch and rolled her eyes got in the way of him, being able to move forward. so, When you know people talk about it, say you say, you're phobic of something, we talk about the courage to face your fears, right? So if you're afraid of bridges, you have to have the courage to go across the bridge. Or if you're afraid of germs, you have to have the courage to touch germs. I feel like the courage is much more, the courage on the inside. Lynn Lyons: To acknowledge what's going on and then to work to do the opposite and to really be to really be honest. And vulnerable with yourself. The courage comes not on the bridge or with the germs, but the courage comes from saying, I'm really struggling with this pattern, with this issue with this compulsion, and it feels scary. I'm gonna face what's going on inside of me. And that's gonna help me face. What's going on outside of me? Lynn Lyons: Yeah. Yeah. Lynn Lyons: Mmm. Yeah. Kimberley Quinlan: Awareness is the first step but that accountability. That's a hard one. Like it's it,… Lynn Lyons: It is a hard one. Yeah. Kimberley Quinlan: it's a good one, but I had one and I think Do you have like I know where we're close to being finished? I want to be respectful of your time. But do you have any thoughts on how to work towards that accountability, particularly if you're someone who's rigid and doesn't like that, Lynn Lyons: Well, I mean, one of the, one of the things that I think is really helpful is for people to recognize that these patterns and OCD and anxiety is really common, and people don't talk about it. But gosh,… 00:35:00 Kimberley Quinlan: If? Lynn Lyons: how many people have OCD in this world? How many people struggle with the things that we talk about on a daily basis? So I'm I say to people, you know, you're not unique. Your problem isn't special. It's it's, it feels big to you because it's your problem, but there are really a lot of things that we can do to help this. We know a lot about it, it's not mysterious the content of what your worried about or the content of your OCD is meaningless. This is a process. This is a thought process issue and let's just get over this idea that it's so special and that you're unique and that there's nothing anybody can do because you're worse than everybody else, right? So that's one of the things I do. Lynn Lyons: And then also really helping people. Learn about Other People's Stories. I think there are some wonderful books and resources where you read about other people's struggles. And you begin to realize gosh, This is so much of what I've experienced it is. It's a matter of being vulnerable in a matter of moving away from this idea that the perfect world that other people are presenting is not so perfect, after all. Yeah, Kimberley Quinlan: Yeah, so true. So true. Lynn, I have loved getting all your wisdom. Thank you so much. Do you want to tell us where people can learn about you and about your book and all the things? Lynn Lyons: Sure, sure. So my website is just Lynn Lyons.com. I'm on Instagram at Lynn Lyons anxiety. I'm fairly new to Instagram. My younger son is my is my Instagram helper, and then I'm on Facebook. If you go on Lynn Lyons, and just put in anxiety or psychotherapist, we've got the podcast fluster clocks with an X that comes out every Friday. Um, By the time, this comes out, by the time that people are hearing this, the audible book for the anxiety audit. Hopefully we'll be released because they told me it will be out in January. I just recorded it right before our Thanksgiving in November. So I'm excited to welcome that into the world. So yeah there's there's you know, all sorts of videos and things on my website and resources and things you can check out. Kimberley Quinlan: Fantastic and I'll link all those in the show notes. Thank you so much for coming on. Lynn Lyons: Thank you. Kimberley Quinlan: It's a delight to me meet with you. Lynn Lyons: Thank you for having me and thank you for all of your wonderful questions you made it so easy, which is nice. Kimberley Quinlan: Wonderful, thank you. Lynn Lyons: All right. Yeah, that was great. You are you are super easy to talk to so thank you. Yeah. Kimberley Quinlan: Oh, I'm so glad I didn't tell you. I beforehand, you've written a book with Read Wilson. Lynn Lyons: Yeah. He is. Kimberley Quinlan: He's a very dear friend of mine. Yeah. Yeah,… Lynn Lyons: Yeah. All right. Kimberley Quinlan: so I'm Lynn Lyons: Well, I'll tell you say hello. Yeah. We wrote two books together, I am. Kimberley Quinlan: yeah. Lynn Lyons: I was just talking to him the other day. Yeah, that's how did you, how did you meet him just through working on OCD stuff. Kimberley Quinlan: Yeah, through ICD. He's been on the show a bunch of times and… Lynn Lyons: Oh, that's awesome. Kimberley Quinlan: and I consider him such a, I know a helpful resource and and support. So I just wanted, I want to mention that at the end. Lynn Lyons: Oh yeah,… Kimberley Quinlan: Yeah. Yeah,… Lynn Lyons: that's awesome. Kimberley Quinlan: I don't often usually we don't take guess… Lynn Lyons: That's awesome. Kimberley Quinlan: unless I'm sort of developed a relationship but your name went underneath the,… Lynn Lyons: Yeah. Kimberley Quinlan: the read seal of approval. Lynn Lyons: If? Well,… Kimberley Quinlan: I was so glad to meet with you. And have you on the show? Yeah, you guys trained together. Lynn Lyons: thank you. Thanks for having me. Kimberley Quinlan: Is that what it was? Lynn Lyons: Oh no, he we wrote the books together so I'd never I'd never met him before and we were presenting it. I was we were both presenting at a brief therapy conference. I think when was it like Like, 15 years ago, maybe. And so he just,… Kimberley Quinlan: Yeah. Lynn Lyons: he just popped in and listened to my talk and then he emailed me a little while later and said, I want to write a book on kids, but I don't work with kids, and I need a co-author,… Kimberley Quinlan: Sure. Lynn Lyons: would you want to write a book with me? So I was like, Yeah. So so we wrote the two books together. It was a period of four and a half years of writing. And, you know, the two books and I think God. I mean, I talked to him every day. Probably for, you know, three and a half years. So yeah, we've become, we've become good friends. Yeah, he is a good guy. Super helpful to me,… Kimberley Quinlan: Yeah. Lynn Lyons: too. I just, I just love what he's offered me. Yeah. Kimberley Quinlan: Yeah, and and my clients and… Lynn Lyons: Mmm. Kimberley Quinlan: my stuff to be honest. Like so often when I'm consulting with my staff, they'll like bring up a read Wilson comment. Lynn Lyons: Yeah, yeah, and his new OCD program is just amazing. Yeah. Kimberley Quinlan: And it's really wonderful. Yeah. Kimberley Quinlan: Amazing. Yeah. Really amazing. That the six the six-part plan is so cool. Yeah. I love the work that you're both doing. Lynn Lyons: Yeah. 00:40:00 Kimberley Quinlan: Thank you for all your work. I'm like a learner of your work, right? I'm yeah,… Lynn Lyons: Oh thanks. Thanks thanks. Yeah. Kimberley Quinlan: it's really wonderful. Yeah, yeah, well, thank you so much. I it will be out on the 24th of February,… Lynn Lyons: Okay. Kimberley Quinlan: and we usually link to Instagram. I'm really active on Instagram and… Lynn Lyons: Okay. Kimberley Quinlan: it comes out on Friday, as well. I'll probably please come out and Friday. And so, if you want to have your assistant or a publisher, I'm not sure email me. All of the links to anything you want me to add in the show notes. That's usually an easy way to make sure I get it correct. Lynn Lyons: Okay, okay. Kimberley Quinlan: And I think that's it. Yeah. Lynn Lyons: All right. Great. Shoot. Me an email. Just to remind me before it comes out, so I can start to promote it on my stuff too. Okay. Kimberley Quinlan: Yeah, wonderful. Yeah, and it's really great to meet with you and chat. Alright. Take a have a good day.Lynn Lyons: Okay, thank you very much. Bye.

Jan 6, 2023

This is Your Anxiety Toolkit - Episode 318, and welcome 2023. Welcome back, guys. Happy 2023. Happy New Year. I want you to imagine you and I are sitting down at a table and we both have the most wonderful, warm tea or coffee or water or whatever it is that you enjoy, and we are going to have a talk. You're not getting a talking too, I'm not saying that. But I want you to imagine that I'm standing in front of you or sitting in front of you and we've got eyes locked, and I am dead serious in what I'm talking to you about because I believe it to be the most important thing you need for 2023. I really, really do. So, let's talk. Okay, you've got your tea. I've got my tea. Let's do this. Okay. So, I want you to imagine that you have a suffering in your life. We all have suffering. It's a part of being a human. Life is 50/50. It's 50% easy and 50% hard. We all are going to have suffering this year. But I want you to imagine this scenario. It could be something that's hard for you that you're already going through or could be imagined. And I want you to think about that there's a circumstance or a situation that happened that is out of your control and it's causing you suffering. Maybe it's a thought that's intrusive, maybe it's anxiety, maybe it's depression. Maybe you have a hole in your tire, maybe you-- if you hear some people walking, it's because my whole family are upstairs playing. But maybe you have some financial stresses, relationship stresses. Maybe you feel very alone. Whatever you're suffering is, I want you to acknowledge that you're having this suffering. And then I want you to think about, who could I call to help me manage this pain in my life? Is it someone who could support me and nurture me during that suffering? Is it someone who has the solution to that problem? Is it somebody who's been through it before and they can guide you on what to do? So what we do when we have suffering is we gather hopefully a list of people who we can help and we reach out to them. That's good coping, right? But what I want you to do differently, or maybe you're already doing this and I want you to do more of in 2023, is I want you to move you to the top of that list. I want you to be the first person you call to offer yourself the support and wisdom and guidance, right? I'm not here to say there's anything wrong with calling the other people. In fact, I am a huge believer in gathering your peeps when things are hard, calling your speed-dial people, right? That's cool. I want you to be doing that. But I want for this year for you to move yourself to the top of the list and ask yourself, what is it that you need while you suffer? How can I support you while you suffer? What do you need to hear as you suffer? How can I tend to this suffering in a kind, compassionate, non-abandoning way? How can we be that for ourselves? We have to be at the top of the list. And I don't mean that in any preachy way. I mean it because let's look at the problems when we're not, when we don't show up at the top of the list. We build this belief that we need other people and we don't have what it takes to get through it, right? When we put ourselves at the top of the list, we develop and grow muscles in our brain that have us start to see that we can cope really well by ourselves. That we have everything that we need, right? That is so, so beautiful. And the reason I'm sharing this with you in this hopefully not preachy way is I was journaling the other day and I was really asking myself like, what is it that I want to talk about? What is it that I'm so passionate about? What is it that lights a fire inside me? And while, yes, I love talking about anxiety and yes, I love talking about OCD and I love talking about mental health and all the things, this one thing I believe is the biggest game changer above and beyond all the tools that I give you in my toolkit. Oh, PS, I have to tell you, I was looking for-- I was doing a Google search on Your Anxiety Toolkit because I just had to pull up something and it's easier for me just to Google it. And when I wrote it in, this teeny tiny wooden kids toolkit showed up, like this little toolbox. And I couldn't help myself, but I had to buy it because I was like, that's exactly it, right? This is all about me giving you an array of tools and tools that are super effective and tools that you know when to use them. Because imagine if you had a saw but you were using it for the wrong thing, that would be very ineffective. So, that's the whole premise of this podcast. But I was thinking about, of all the tools in the toolkit, this might be the most important one, which is the one that teaches you how strong you are. That you are the most unconditional friend for yourself, the most unconditional friend. You are there non-stop, no matter what. No matter what happens, you have the capacity to sit with yourself in compassion while you suffer. So, that's it, you guys. That's all I have to say. That's the goal I have for you this year. And I would love to hear and to know what outcomes you get from that. So, as you practice it, don't be afraid to, if you signed up for our newsletter, reply and let me know. How's that going for you? How's that helping? Again, I want to really be clear here. We are not showing up for ourselves first because we don't deserve other people's help. We're still going to ask for their help, but we are moving ourselves to the front of the line. We're moving ourselves to the first person we speed dial, right? And we're showing up for ourselves as much as possible so that if the person that's second in line doesn't have the capacity for us today, that's all right because we already know that the first-speed dial person, which is us, is there ready to pick up whatever is left over. Okay? So that is my hope for 2023. That is my hope for you for the rest of the decade as well. And this is something I feel again so incredibly strong about. Sorry, that didn't make sense. It's something I feel so deeply about. Okay? All right. I am sending you the biggest love. I have got some super exciting, big things happening in the new year. Big for me, hopefully, helpful for you. Hopefully, that will, again, give you more tools, more effective tools, make you more clear on which ones to use and when. It will mean that the structure of the podcast will change just a little but hopefully for the better. Okay? All right. I'll see you guys next week and we will go from there. Have a wonderful day and it is a beautiful day to move yourself to the top of the list. Have a good one, everyone.

Dec 30, 2022

Welcome back, everybody. I am thrilled, thrilled, thrilled to have you here again, finishing out the year so strong. In this episode, we planned perfectly for this week because my guess is that you're starting to make New Year's resolutions or make New Year's goals, and we wanted to talk, myself and the amazing guests that we have this week, about how you can change your habits in the most compassionate and effective way.. We have back this week with us Monica Packer. She's been on the show before. To be honest, she's like a warm hug to me. I just feel like it's just sitting down and having a chat with a dear long friend, like an old friend. I love speaking with Monica. She's just got such deep wisdom to her. And so, today, we got together and talked about how to change your habits compassionately and effectively. Because when people set resolutions or New Year's goals, they're just talking about creating new habits, like how can I create new habits in my life? How can I make a change in my life? And sometimes, we tend to do that in a very aggressive, critical way. And so, we wanted to sit down and talk about how we can do that in a compassionate, effective way. Kimberley: Okay. Welcome, Monica. I'm so happy to have you here. Monica: Oh, it really is a joy. I just love everything you do and who you are, more importantly. So, I'm excited to be here again. HOW TO CHANGE YOUR HABITS Kimberley: Thank you. Thank you. Okay, so you and I were chatting, and I love this idea of preparing for the hard day, but particularly emphasizing how to change your habits that prepare you for your dark day or your hard day. Tell me a little about why that is so important to you or even how you've implemented this in your life. Monica: When I think back on my history with habit formation, it was clouded for a long time with these all-or-nothing models that taught me to have good habits, they needed to look this way, and it needed to be formed in this way. It needed to be consistent in this way. And a big part of that was not only were we supposed to have an ideal, we were supposed to start with the ideal. You just decide what the habit is and then you do it for 28 days, or whatever number we all have in our heads. You get to that magical number and it's a habit. And that never worked for me. And so, for a really long time-- well, it worked for me when I was the type A, very overachieving perfectionist. But that came at a big cost in my life. And we talked about that I think in our past interview we did together. And that cost was not one I was willing to make for a long time. I wasn't willing to sacrifice my mental and physical and spiritual health and my relationships anymore to be so performing. And so, because of that, I thought that was the only way to, one, progress in your life and have goals, but also trickle down to habits. I just thought I can do the habits that are required of me for my work and for my family, home management kind of things. But for myself, that was a different story because I thought, no, these are the habits I want, and they're so beautiful and amazing and would be so helpful in my life. But in order to get there, I can't do what that requires. I can't, so I just didn't. But then when I got back into habit formation a few years ago, which was not a plan of mine, but it just happened naturally as I was really working on identity and fulfillment in my life, I realized those two areas had to be supported with habits to just even give me the time and the energy to carve out what I needed to for those two areas of my life. And as part of that, I had to figure out habits in a new way. I know this is a really long answer to your question, but the nutshell version of this is that a lot of us, if not all of us, are set up to fail with habit formation in the way that we've been taught since we were little kids. I mean, even that number thing I said alone, like how many days does it take to form a habit – we all have a number because we've been taught a number. But that number is not realistic for most people, especially if you're in a caretaking role or in any kind of position or season of life where you have to be more reactive in nature to your responsibilities. Every day is different. Every season is different too. There's that kind of flexibility that makes it so you have to do habits differently. And so, what I've learned over the past few years is that, instead of starting with an ideal version of a habit, and that being "This is my habit," those are only ideal. Those are only possible for those best of days kind of days. When you get really good sleep, your routine is really set. It's more predictable. And that didn't work for me, didn't work for most of the women I work with. I work with primarily women. So, instead, what we want to do is both start with what I call a baseline habit and always have that be the foundational habit we come back to on our worst of days. The baseline habit to me is, the ideal is the highline. We definitely want to have the ideal in mind, like this is what I want ultimately. But the baseline is your foundational way to get there. It's the form of the habit that you can do on your worst of day, when you're really tired, when you're going through a depressive episode, when a kid feels really sick during the night, whatever it is. And having that baseline version isn't you lazying or-- what's the word? It's not you being lazy, it's not yourself saying, "Oh, I'm just going to get my permission to not do the habit." It's no. This is my best-of-day version today on this worst-of-day. This is the best I can do on this day. And because I have this version of it, not only am I able to create a habit faster, like I don't have to wait for a perfect 28 days, I also have something to always fall back onto on those days where I'm not having an ideal day. And that gives me the consistency I need to not only have that habit and what it's going to provide for me, but also have the foundation to build on, so it gets higher and higher. And boy, I don't even know how long I just talked HOW SOCIETY IMPACT OUR HABIT FORMATION Kimberley: No, no, no, no. I have lots of questions. So, what does this look like? I love this idea – the baseline habit first. Let's go way back. So, I think you're referring to-- and let's talk about what society tells us habits should look like. Now, I don't actually have this correct, I think, but I think there's a really famous book about habits that's like one of the top Amazon selling that says, is it 60 days? What is the book actually saying? Monica: Well, I've read every book and habit formation, so I'm trying to think of which one it is. They probably say 21, 28, or 100 days. Sometimes they say more than that. But yes. Kimberley: Okay. So, listeners have probably read one or more of those as well, which is cool. So, let's just acknowledge that that's being said as the standard, but would you agree that that's the standard for maybe people who don't have a mental illness or people who have a kid who's suffering? Would we agree that that's for those incredibly lucky people or privileged people, or what would we say? Monica: That was exactly the word I was going to use. It is a great standard and it's a privileged standard. And it doesn't even have to be about demographics. We can look at privileges that way in terms of gender, socioeconomic and race, and all of that. Those are all factors of course. But I would just even think about, if you've read those books and you learned so much like I did years ago, and then you tried to implement them and then you failed, whether it's sooner or later, then you qualify. You qualify as, that doesn't work for me Now, consistency does still matter and we can talk about that, but it's also not in the way we've been taught. So, there are seeds of truth that can apply to everyone in these methods that we've learned from and that have been so popular the past few years, but not so broadly prescribed to the general population. It's not fair. It's just, that's the biggest place I actually start when I talk about habit formation, is helping people understand you're not bad at habit formation, you're not broken, these methods are broken for you. Kimberley: Okay. So, that's really helpful. And I'll tell a story about that. I actually want to hear examples for you. I like this. I'm a pretty highly functioning person personally, but I think what's-- but I also have a chronic illness. And by default, I think I'm actually doing what you're talking about, but you can actually correct me maybe. I'm actually here to learn here. I'm definitely loving it. So, I have the things I want to get done on the days I don't feel well and that looks a whole lot different to the things that I expect myself to get done on the days where I do feel well. The base, you called it a baseline habit. It's more about expectations, I think maybe. My expectations on when the days I don't feel well are like the basics. Is that what you talk about? Is that what you're meaning when you say baseline? HABITS SHOULD BE SUPPORTIVE Monica: So, let's break this down just a little bit. One, starting with the idea that habits should be supportive. That's their purpose. They're not balls and chains to our lives. They shouldn't be about the prescriptions. Kimberley: It's not a checklist. Monica: The checklist, no. That's the shift I can see you've already made, is these habits are there to support me. They're to support me on my best of days and my worst of days. So, with that first breakdown, then baselines come in to any to-me supportive habit, personally supportive habit, whether that's exercise, meditation, journaling, even getting up early, deep breathing, stretching, whatever those are to you. These grounding stabilizing habits, having those baseline versions is what helps you have the consistency you need to show up on those days where your expectations need to match your reality better. Kimberley: Right. Well, that's the point, isn't it? Okay, so let's talk about they have to be attached to the reality. So, what does that look like? Okay. We'll call them-- well, how will we say it? "Hard days" and "easy days" or how will we-- Monica: I always say "best of days" and "worst of days," but that's really extreme language and I always preach against extremes, so maybe I shouldn't be using that. But whatever you're comfortable with. Kimberley: Hard days and not hard days. Let's do that. Monica: That sounds great. Because it doesn't have to be like, you can only do the baseline if it's the worst day ever. It's just less-than-ideal day. Kimberley: Okay. So, what does that look like? Monica: Okay. So, let me give you a real-life example of a seasonal shift where my reality shifted, had to shift my expectations and the way I was showing up to the supportive habits. And this is more of a personal example. This summer, I was really sick with morning sickness, like really, really, really sick. And it went on for four months straight. And I'm still sick, but I'm better, way better. But during that time, I was still able to keep up my supportive habits, my most important ones, of exercise, of meditation, of journaling for my children, and of reading. But those supportive habits looked way different than my spring version of them before I got pregnant and my fall version now where I'm feeling better. I'll take one of those examples. My exercise was I used to go for an hour-long walk and then do a strength training exercise video or something like that. It just turned into-- my baseline version of that was 20 minutes of slowly walking around my block. I didn't even go far in case I needed to go home sooner. But that still was supportive enough for me to have the time alone that I needed to be able to show up to other things. Another example of this is, journaling for me typically looks like I have this journal for my kids that takes just a few minutes, and then I have a journal for myself that also just usually takes about five minutes. I decided journaling for myself could wait. So, I only had the two-minute version of journaling. And that still meant I would journal throughout all that time. And now what's great about having those baselines is once the fall came around and I began to feel better, I was able to pick up my habits more in ways that match my reality. So, baselines, like I said, they are our less of ideal, less than ideal versions of the habits that can-- they give you the flexibility you need day to day, but season to season. So, as part of that, an important thing for women and men who are listening to know-- sorry, I'm used to talking to women, so I apologize for that. But an important thing to know is that your baselines can grow. Now my baselines even are different than the summer. They're just a little bit more time intense or energy intensive than they were. Your highs get higher and your lows get higher too. Your baselines even grow. So, the less-than-ideal versions can grow too, and they have. Kimberley: That's awesome. And it's funny as you're talking about that I'm thinking of my patients. If we can keep the black-and-white view of it, like you either do it perfectly or you don't do it, there's often this shift. It's like, "Oh no, Kimberley, I did really great. I did all my exposures this week," or "I didn't do any of my exposures this week. It's been a 'hard week.'" But then there can be a shift to, "Oh, I had such a hard day, so instead of doing all my exposures, I just did six minutes." And I think that's what you're saying in terms of it being a baseline habit of like, they gave themselves permission for it to not be perfect so that even on their "worst day," they were still able to get in that treatment that they know is going to help them for that supportive work. Is that what you would think of it as? Monica: Mm-hmm. And I have a daughter who has generalized anxiety disorder . She's on the spectrum as well. So, we have a lot of different things we need to keep up on in order for her to feel supported in her life. And even for her, we have baseline versions of these things. So, that way, in a day where she's really struggling, we still have a way for her to feel supported without that all-or-nothing model, just taking off the table altogether. Kimberley: Right. So, what kind of shifts would one have to make to create a baseline habit plan? Would we call it a "baseline habit plan"? Monica: Oh, yes. Kimberley: Is this an intentional plan? Tell me. SMALL, INTENTIONAL HABIT CHANGES Monica: So, first, you need to start with some small, internal habit changes, and that's something we alluded to. Just pay attention to what your own habit story is. How did you grow up thinking habits should be formed? How do you currently think they should be formed? How do you view your capacity to form habits? And how are all of those things actually connected to you being taught habits in ways that actually are not right for you and that's okay? Having that internal shift to one own, "Oh, I've been following the wrong model. So, I'm not broken and I'm capable of forming habits." And also, the second shift there is just the supportive one. That's the shift. It's not about the shoulds and prescriptions. Now the external shifts is, I mean, that's where we could break down. I could talk to you for an hour and a half about that, but you mentioned a plan, and that is what I help people do, is you do need a plan. And what that looks like is actually way simpler than maybe Pinterest would show you about a habit plan. You start with casting a vision of an ideal habit that matches a need you have. So, you can think more generally first like, what's the supportive habit I need? I need to wind down at night, so what does that look like for me? And you cast a vision of what could that entail. And then what you do is you take that version and you make sure, one, it's supportive. So, it's not about a should. You make sure it's really small. So, it needs to be-- well, we talked about the baseline version of that, but small is like broken down. So, not a full routine yet. We're just starting with the first step. Simple is your baseline version. That's like, what is the simplest version of even the small habit that I can start with? MEDITATION HABITS For an example, meditation habits, maybe you have a whole nighttime routine ideally that you would like and you know what that looks like. But you're going to start small with just the habit of meditation at night. And then from there, you're going to start by making it simple, and that means what's the baseline version of that? The easiest version of this habit is one deep breath. That's my baseline for meditation. And that actually was one of my habits during the summer. I still meditated all summer, but it was usually just a deep breath or 10 at night as I was falling asleep and just trying to clear my mind. So, we have supportive, small, simple. And the last thing here is specific, and specific means you don't just say, "I'm going to have this new habit and I'm starting it tomorrow." That's not specific. You need to have it tied to an already existing habit and form what I call a when-then pairing. So, get clear about, okay, what already happens at nighttime that I can attach this new habit to? And they might be things-- actually, not even might. Most of the time, the existing habits are things you don't know are habits because they are habits. Kimberley: Like brushing your teeth. Monica: Yes. Dress in the bathroom, brushing your teeth, getting ready for bed. Or mine at night, honestly, a lot is just starting the dishwasher. Who knew? Oh, that's a habit. I do that every night. So, it's something like identifying what's an existing habit around that time and attaching that supportive, small, simple habit to. That's your habit plan. Kimberley: Interesting. So, for those who-- let's say, I'm going to offer the listeners. Let's say, most of the people who listen, their goal is to face a fear. That's my crowd. That's my people. We face our fears. Monica: Love it. Kimberley: So, let's say we're trying to increase our ability to face a fear every day. So, what you're saying is, find a habit you already do and attach it to the time in which you do that. So, let's say if your goal is to do an exposure – that's often the biggest form of facing fear – in order to get it to be a daily thing that you're consistent with, you would find a time of the day that you would be already doing something. Often I'll say, as you drive to work, you could do it while you're driving to work. Is that what you're saying? Monica: Yeah. You're nailing this. Exactly. Kimberley: Okay. What if you don't want to do the habit, but you know you should because it's supportive? Monica: So, this is going to-- you just did the biggest disclaimer there. If you truly love the result and the result is what you need in your life, shoulds can still be chosen. We don't have to totally take shoulds off the table. And there's a lot of that kind of talk, I think, out in the personal development world like, "No shoulds." But honestly, I don't feel like doing a lot of the things I need to do most days responsibility-wise. They are shoulds. But they are chosen because of the results or because of the benefit or what I know my responsibilities need me to do. Shoulds can be chosen. So, if you've deeply truly chosen the should, which is the first step, then you have to get clear about your baseline. And ask yourself, is this actually a baseline? Because it needs to be so small and simple that you can do it even when you don't want to. That's how small and simple it needs to be. And once you do that, you get the momentum, which is a whole other topic. And you might organically be like, "Oh, I can do another deep breath, or I can spend another minute on this exposure," and ride that wave if you feel like it. Kimberley: Right. And so, what I would offer to people if I'm going off of your example is, on your baseline day, on your hottest day, you could purposely have a thought you don't want to have, and that's it. That could be your baseline. Or another would be, let's say there's something you avoid. You could just do it for one minute, be around that thing you avoid for one minute. Is that what we're looking for? Like one minute? Monica: Exactly. Kimberley: Good. Baby steps. Monica: Yes. And don't underestimate the power of these baselines. One of the biggest powers is momentum that I mentioned, but the other biggest one that honestly to me might even be more weighty than the momentum is the confidence. It's the identity shift and how you view your capacity to form habits, and your capacity to follow through with the things you say you're going to do for yourself. Kimberley: Right. Isn't that such a big piece of it? Like how many times have I-- let's say a client has panic disorder and getting on the elevator is so painful because they're so afraid of having a panic attack on an elevator, for example. And they're standing at the doors and they're saying, "I can't. I just can't do it." That's that confidence piece, right? Because we know we can. We could actually argue like, "No, you just take one foot and you put your foot on the elevator and then you put the other foot on the elevator and you're in the elevator." I think that that's an interesting piece. And I talk a lot about motivation, but what you are bringing to the table, and correct me if I'm wrong, is there are many ways in which we could get motivation and momentum and confidence, but habits is another way. Monica: Yes. And for me, these baseline versions are, go to a bigger picture concept that I teach in my community of creating momentum instead of waiting for motivation. And it's just physics. It really is just using physics here. But like you said, it's the confidence piece. It's the identity piece of being someone who can face fears, of someone who can show up for themselves, even on the hard days, on all these levels that we've talked about. It really helps. The identity piece too is really important. CHANGING HABITS WITH CHRONIC ILLNESS Kimberley: Right. Okay. So, you're having a hard day. You originally, when we were chatting, were talking about the dark days. We call them a dark day, a hard day, the worst day and all the things. On the days where that's the hardest of days, the darkest of days, we usually have a lot of thoughts about our capacity to do hard things on the dark day. I know we touched on this, but what is the mindset shift to allowing yourself to be in a baseline day? I'll give you a personal example. When I have POTS , when I've massively relapsed, the day before I could walk three miles, no problem. And on my relapse days, I am lucky if I can get around the block. Lucky. That is lucky. And so, what needs to happen there to give ourselves permission to-- because I've actually been the person who goes, "Nope, I refuse this to be a bad day. I am going for that damn three-mile walk," and then all hell gets broken. It's horrible. There's consequences to be paid for pushing myself. So, is there a piece here about the permission? That's the main last piece I want to ask. Monica: Oh yes. This alone takes a tremendous amount of courage. People, they think, "Oh, what? Habit probation takes courage?" Yeah, it does, especially if you're doing it differently than the way that you've been taught. And this is where I would go back to something about proving yourself wrong. Doing something in a different way as a way to bolster your confidence and also your know-how, but to say like, "Maybe I can just try to see, I can just prove my old self wrong here. Does this still help? Is it still a way to show myself I care about myself?" on your really bad days where you're recovering. Is this stretch still giving to your body? Is it still saying "I see you" and "I love you and I'm trying to help you and I know you're trying to help me"? Maybe you can't even do that block, but you can do a sense salutation or sorry, that's the movement I keep doing over here, like what is she doing? That's the movement I keep doing. What I would help people do who are stuck in that all-or-nothing mindset, it's so hard to let go of. Believe me, I know. Adopt the mindset of curiosity of what would it look like to try this out? Can I prove myself wrong? And I would also get a little logical and look back on your past and say, "Overall, how has this all-or-nothing model served me? Has it helped me more or hurt me?" For the high majority of people, high majority, it hurts more than helps. Pay attention to the price you have paid in the past for the all and just acknowledge it takes real strength to do this. That's one thing-- I had a client say this years ago. She said it takes the greatest of courage to do the smallest of things. And that's where I would end. Just dare to have that courage to try the smallest of things and to try them again and again and again and see over time. You've got to give yourself that time to see how it can prove yourself wrong overall. And that these small ways we invest in ourselves, not only add up, but they count in the moment too. CREATING A HABIT PLAN Kimberley: Right. So beautiful. I have one more tactical question before I let you go. So, would you have people have a breakdown of all the steps to create a habit plan? Meaning, let's say the goal is to get-- a lot of people here are working at developing a good exposure plan. Let's say we're goaling towards 30 minutes a day. Would you say, "Okay, on the dark hard days, we do two minutes. So, that's reserved for the dark hard days. And then from there, we're going to work at two minutes, three minutes, four minutes, five minutes, six minutes. And then by the end of the month, we want to be at nine minutes."? Would you break it down like that or is that actually the opposite of the plan here that you're trying to go for in terms of a supportive plan? Monica: So, the bigger question I believe you're asking is, how do we build, do it strategically or what does that look like? I would say that depends on what the habit is and the purpose of the habit. So, if this is more of like a therapy-based habit that you've been working on with clients, I would say it might be helpful to have that game plan. Perhaps not based on a certain time, but more about how consistently they're able to perform the baseline version, and from there have the foundation they need to build. In general, though, for most habits, it goes two ways. You can either maximize or add. You can do longer amounts of the habit or more intensity, that's maximizing, or you can add. That means you add another step to the bigger routine you want. And I find that can go two directions. One, strategically, you can think like, okay, this is my game plan. Maybe I don't have an exact deadline, like in two weeks. It's more organic feeling. It's more intuitive. I feel strong enough. I feel like I'm in momentum. I feel like I have the structure I need to add or to maximize. But yeah, it still can be done strategically. But most of the time, it just happens organically. You just are able to-- that baseline rises, like we talked about. And as a baseline rises, that means you tend to have more like normal days in between days where you can do a step or two above naturally and organically. So, that depends. But ultimately, I think, have trust in yourself to know what you need for a specific habit. Do I need this to be strategic or am I okay to do this more intuitively and organically? But no matter what, starting with the ideal in mind is what gives you the target that you are headed towards. Kimberley: Right. And that you can, any day, even if you're on your way up to the strategic plan, you can rely on your base plan if needed. That's your backup. Monica: Always, always. And even over time, as your baselines rise, you still have that under baseline you can always fall back to. If seasons change, your life change, circumstances change, your health changes, those are always there for you. Kimberley: Right. Love it. All right. Tell us where we can hear more about you. Monica: Well, I am a podcaster on About Progress. We're a personal development show. We don't just talk about habits there. We talk about a lot of things. And I'd love for them to come and listen. And I do have a course on habit formation and it's for women. I know there are men listening here, but it's primarily for those who identify as women because of the bigger thing I have to teach about why habits spell in particular for women. So, it's called the Sticky Habit Method, and they can go check that out at aboutprogress.com/stickyhabitmethod. And it says sticky habit because you form habits that stick. Kimberley: Nice. I love it. Oh my gosh, it's so wonderful to have you. Like I said, your episode about perfectionism that we've done is a really high-rated episode. If you want to go back and listen to that, that would be cool too. Yeah, absolutely. Monica: That's really the heart of all my work, including habit formation. Who knew I would even get into habits, but we're here. Kimberley: I love it. I love it. Thank you so much for coming on. I've loved listening. I've been the student today as well, so that was awesome. Monica: I love that. Thank you. Kimberley: My pleasure. Thank you so much. LINKS: PODCAST http://aboutprogress.com/podcast STICKY HABIT METHOD https://www.workinprogressacademy.co/sticky-habit-method FREE HABIT CLASS FOR WOMEN https://workinprogressacademy.mykajabi.com/women-habits-class

Dec 23, 2022

In this podcast: Laura Ryan tells her story of overcoming superstitious Obsessions How to manage Whack-a-mole obsessions How her family helped to support her as she overcame Superstitious OCD How to get through the hard OCD days Perfectionism and Exposure & Response Prevention Links To Things We Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION Kimberley Quinlan: Well, welcome, Laura. I am so excited to hear your story today about Overcoming Superstitious Obsessions. Thank you for coming on the show. Laura Ryan: Thank you so much for having me. I'm so excited to be here. Kimberley Quinlan: Yeah, so it's wonderful. I love the stories when I accidentally meet people online, and then we have this cool story that's together, but we're not like not together at all. So I love hearing your story for the first time today, and I love that. I've been a small small part of that journey for you. Tell me a little about you and your backstory in, you know, the area of recovery. Laura Ryan: Yeah. So I definitely would have had OCD my whole life, but it wasn't until I was about 17 or 18 years old that I just stumbled across something on the Internet where I was like Oh yeah, that sounds like me. I've got OCD, but it didn't. It wasn't stopping me from doing anything at that point. So I just ignored it and went on. I had three Uni degrees under my belt. I was working at a publisher and freelancing as a book editor, and then Laura Ryan: my family had some health issues, and my sister as well, had some relationship issues, and I don't think I knew what to do with the stress. Um, and OCD crept up. So gradually, it was undetectable, and then sudd, I found myself at age 22 with crippling compulsions. OVERCOMING SUPERSTITIOUS OBSESSIONS AND BREATH-HOLDING COMPULSIONS Laura Ryan: It was nothing short of torture. It was horrific. I was so ill with OCD that I would come home from a day at work, and I wouldn't even remember the day because I'd spent the whole day in fight or flight. And I had mental sort of thought replacement and breath-holding compulsions . So it was completely invisible to people around me, but it was able to kind of have control over me for the whole day. Like from the second, I woke up to the second. I went to sleep. When I eventually saw a doctor, the psychiatrist was like, Oh, and how often are you affected by these thoughts? And I just didn't understand the question because I was like, Well, every few seconds, I guess. Laura Ryan: Yeah, so they were weird. Compulsions, like a lot of Shame around them as well because they were all kind of magical thinking superstitious. Like there was no logical link. They were all like, I'm holding my breath because I think I will magically give someone a disease if I breathe out while looking at them, or Yeah, just weird. We had rules that made absolutely no sense. Laura Ryan: which, Also. yeah, it impacted my self-esteem because I've always thought of myself as a Logical person, but these just made no sense. Laura Ryan: yeah, I also became stick thin because if I, and it wasn't even anything to do with the food, it was just if you eat this food, the intrusive thought will come true. And I, it just wasn't worth their Stress of eating. and then, there was a point where Laura Ryan: I would have conflicting compulsions, so OCD would kind of be like if you do this thing or if you don't do this thing, the intrusive thought will come true, and then I would just stand there paralyzed Like unable to do anything. I don't like to think how long I've spent just standing still, like the pervasive slowness, I think it's called was just Yes, stopped me from. Doing anything? Some nights it would have taken more than an hour to get to bed. It was just I had to touch wood or Rearrange things for so long before I was able to get to sleep. yeah, so I'd been a really 00:05:00 Laura Ryan: Pleasant child and teenager big people pleaser perfectionist type person, and then all of a sudden I was this irritable, distracted young adult, and I didn't like who I was, and no one in my family knew what was going on with me. Um, and yeah, I was eventually unable to work, and I quit my job. And I was too anxious to Google things. So I looked up OCD on my podcast app, and that was when I found you were a guest on the mental illness happy hour, I think, and you played this game of one-up together, and it was like, It was incredible. It was like it was. Yeah, it was the first time I had Laura Ryan: heard of ERP and OCD. Laura Ryan: Yeah. Sorry, it was the first time I'd heard of ERP and Anxiety treatment that wasn't just meditation or gratitude, which are helpful. But sometimes, when you're in that dark place, the only thing that can get to you. It is something dark itself but also brings that humor as well. I think it is just the most powerful tool you can have when you're there. Then I started looking up Absolutely everything Kimberley Quinlan. I was absolutely your number one fan. You say you had a small part in my story. You had a huge, huge part in my story. Because I was way too unwell to drive. There was no way I would go to my GP and get a mental health care referral. I was not going anywhere near Medical Center. And barely making it out of the house. So, when I found your ERP schoo l to do online, it was nothing short of life-saving. I was able to get enough to go to the GP then and get a referral to see a psychologist. Laura Ryan: Yeah. Kimberley Quinlan: It makes me want to cry, it does. And when can I ask a couple of questions about that when you said There's no way you would have gone to the GP because of the obsessions that held you back or just the shame of it? What was there? Another reason that that was such a huge step for you? SUPERSTITIOUS OBSESSIONS & SYMPTOMS Laura Ryan: It was mainly the superstitious obsessions. If I go there, I'll contract a disease or give someone a disease. Not even in a contaminated way. Just like a magical way. Yeah. Kimberley Quinlan: Mmm, yeah, yeah, it's funny. I don't know when I'm helping people because you just don't know what you know. Just for those who are listening, the Mental illness happy hour is an amazing podcast, and then the host had no idea what OCD was. And so, we did play a game of one up, which is where we kind of, he said something scary. And then I went up. It was something even scarier and even more gruesome and horrible. Was that something that you started practicing on your own just from that episode? Or did you take up his school to follow the whole process? Laura Ryan: A bit of both. I kind of took the one up and… Kimberley Quinlan: Inflecting. Laura Ryan: I ran because I think it just helped me. so much immediately, and then ERP school was able to lead me through in a more systematic way. Yeah. Kimberley Quinlan: Okay. Amazing. Oh, I'm so happy that I could be there. It's not so cool. Laura Ryan: Yeah, absolutely. Kimberley Quinlan: It's so cool. Kimberley Quinlan: Especially you're my Aussie friend too. That just brings me so much joy. So as you and I emailed in preparation for this, you beautifully and eloquently shared some of the pieces. I would love to hear from you if you spoke briefly about how your OCD evolved. Would you be willing to share a little bit about what that looked like for you? Laura Ryan: Yeah. Yeah. Laura Ryan: I had every kind of OCD, so as soon as I started doing ERP, OCD came back with a vengeance with some new topic and… 00:10:00 Laura Ryan: as I think a lot of OCD sufferers know, it can be especially difficult, when a new topic shows up because you don't know what's happening you are unfamiliar with. the sorts of thoughts it's going to throw you, and you don't know how to fight back yet. I remember when it initially switched from this sort of magical thinking superstition to moral OCD. Laura Ryan: Hit and run OCD, and I've heard stories about OCD sufferers turning themselves in for crimes they didn't commit, and that was absolutely the kind of thing I felt like doing at that point. I was like Laura Ryan: Although usually, I would panic when I was driving, I would constantly be checking in my rearview mirror, recycling, back driving around, again and again, to make sure I hadn't hidden anyone and then, Laura Ryan: Yeah, I think it just Really. OCD will fight back. Laura Ryan: Yeah, absolutely. MANAGING WHACK-A-MOLE OBSESSIONS Kimberley Quinlan: that must have been pretty terrifying for you, though, or demoralizing for you for it to be sort of wack-a-moleing. Whack-a-mole obsessions are when your obsessions are changing from one obsession to another. Your obsessions will be one up and one down. Switching between obsessions each day or even hour. How did you handle that? Laura Ryan: um, Laura Ryan: I think, just I think the main thing was staying in touch with the online community and because Every thought you've had, no matter how crazy it is. Someone else has had it, and someone else has probably done a compulsion. That's Like as, or more embarrassing, is something you've done. Laura Ryan: Yeah, I always think when I have a thought I met someone else's had this, and then I'll go on like OCD Reddit and find that they have. Kimberley Quinlan: Right. Absolutely. So so, that's how it evolved. Wait, you shared. Also, Where are you now? Like what does life look like for you now? Having gone through and know, you'd said You'd moved on to getting treatment. What's life like for you Now? What does recovery look like for you? Laura Ryan: So, yeah, I spent the better part of two years just really taking the time to get better. I was doing bits of freelance work, but it shouldn't have been because it was taking me way too long. I wish I'd just given myself permission to rest properly. and I don't know whether this was a part of moral OCD or whether I like to think it's just part of who I am. Still, I didn't want to go back into publishing because I Um felt like I wanted to do a job helping other people, and I especially wanted to give back to the healthcare world. Kimberley Quinlan: It. Laura Ryan: That helped me so much. When I went, I went to the hospital to do an inpatient OCD program. And the people working in the program were obviously psychologists, psychiatrists, and occupational therapists. And so, I wanted to do a course in OT. But Laura Ryan: Then I saw speech-language, pathology, and I've been doing that course for the last two years, and I'm just about to graduate. So, Yeah. Kimberley Quinlan: Wow, that's so cool. Does OCD have something to say about you returning to school for that? Like, how did it How did your OCD handle that decision? Laura Ryan: Oh my gosh, it was so. mad at me for picking something that I needed to do hospital placements to complete. Especially being speech-language. I think they called in America speech-language therapists, in hospitals, at least in Australia, there, they see the people with the Like worst neurodegenerative or the scariest diseases, or they've just had a stroke. Like, really, the most triggering things I could have thought of at the start of my journey. And yeah, and like, you have to like to touch them and would never ever have thought that I could have done this a couple of years ago. Kimberley Quinlan: Yeah. In ERP school, we talk about your hierarchy, right? Like it would have been a 10 out of 10. I'm guessing you're like doing 10 out of 10… Laura Ryan: Yeah. Kimberley Quinlan: it's incredible of all the careers; you picked like your 10 out of 10. That's incredible. Right. Yeah. So was that like a decision? Like I'm doing it as an exposure, or is it just like your values led you there to get to that place? Laura Ryan: It was definitely my values and took me. And my therapist, a lot of coaching to get me through. Yeah. Kimberley Quinlan: Wow, it's so cool. It's so cool. It's like perfect, right? Because it's so often, I hear of people who have the career that they wanted, and their OCB gets in the way, right? You know, there he'll have health anxiety in there, and us or they have their teacher, but they have thoughts of, or pedophilia obsessions and impacts their work. Like you, you went the other direction where you moved into the career after your treatment which is just so cool. I love that you did that. So one thing you shared, Was what you find hard, and I love that you included that piece in what you find hard. So, would you be willing to share, What do you find hard? We talk about It's a beautiful day to do hard things, but What is it? It's okay that things are still hard. What do you find still hard? Laura Ryan: Yeah, I find it now that I have so much functionality back compared to where I was not leaving the house to pretty much do everything that I want and need to, I find it hard to find the motivation to do ERP to kick those last mental compulsions, and those things that kind of still follow me around all day. Yeah, I think. I think now it's less about functionality and now more about doing it to get back that quality of life. Laura Ryan: which, yeah, I think I often find really hard to it's much easier to. When you're doing ERP to reason with yourself, oh, I deserve to be able to leave the house and go to the shops. And so that's why I'm doing this thing that feels so awful. But when you're just saying, "Oh, I'm doing this now just because I want to be happy." It's a lot harder to reason with myself Kimberley Quinlan: Yeah, it's like you said at the beginning and I've heard that many times that if it's not impeding in your functioning, it is easier to sweep it under the rug and cope and not address the problem. And I've heard that many times. So I think that's a really valid point of, you know, a lot of people will say like there's a really strong. Why are they doing the exposures? There's not a strong why it's hard to do it. How are you learning or starting to practice tools to manage what's worked for you? And what hasn't Laura Ryan: 'm getting a lot better at being less of a people pleaser and getting better at not putting everyone else before myself filling up my own cup so that I have some to give to everyone else. Yeah, I'm it is hard, but I'm definitely getting better at doing things because Laura Ryan: Yeah, if I give myself that, Quality of life. I can be. Even at least I can be if not for me, I can be there better for my family and friends. Kimberley Quinlan: Yeah. Yeah. Is there you know, if you were to work? I mean, I'm assuming people listening are having similar struggles. Can you walk me through moment to moment how you muster up motivation? Or maybe it's a different experience to get yourself to do. Those exposures? Like, what do their steps involve? Or how do you get to that place? MOTIVATION FOR ERP 00:20:00 Laura Ryan: Yeah, one of my favorite tools is just before I do anything. So if I'm if I've just driven in the car to go somewhere, I will take one minute before I get out of the car, I will take one minute. and just Kind of have a word with myself and OCD, and I'll be like, right, what's OCD? You're going to throw at me. It's going to say this, and then what will I do? I'm going to do this, and then how's OCD going to push back? And then what am I going to do? Like just having a game plan before you do. Kimberley Quinlan: If? Laura Ryan: Functional things for those mental compulsions. Laura Ryan: I find it's a really Laura Ryan: it's really helpful for me because I don't have to kind of set aside time and find that motivation to do it. I can just kind of plan and make ERP tasks out of, going to the shops or seeing a friend or things like that. Kimberley Quinlan: Yeah, that's cool. It's, I think of it, like Olympians or, you know, high-performance athletes as they, they do that same thing. They're high performing, you know, the high performers there, they're rehearsing. You know the strategy to get through that really hard moment. It sounds like you're doing something similar there, which is really cool. I'm fascinated by that, sports psychology piece of it, right? I think that's so cool. All right, you had mentioned, which I thought was fascinating, what OCD gave you. Now, this is sort of a controversial topic… Kimberley Quinlan: Okay. So one of the things that you wrote as we were emailing was what OCD gave you right, which I thought was so fascinating because usually, we hear stories are like, I hate OCD, and it's the worst thing ever. And I hate everything about it, and we even know there's some controversy of some people who have sort of misused OCD. I loved what you had to say. So, would you share it? What were your thoughts regarding what OCD gave you? Laura Ryan: Yeah, I definitely don't get me wrong. I think OCD is a very unique form of torture, I don't think it's. Yeah, it's horrible. It's absolutely. Yeah, I think. When you said it was one of their Top 10 Most debilitating disorders, you can have either physical or mental. Absolutely. I think it's just Awful. But I think going through treatment gave me this really, really, Laura Ryan: I was able to see these incredible sides to my family and friends. they were just so, Incredible at every turn and so accepting of something that's really hard to understand. Laura Ryan: and, Yeah, it's also just constant reminders to follow my values. Like if, if you're having a hard day with OCD, the only thing you can use is to get yourself out of that. is to be like, okay, well, What am I doing? What am I valuing? And the treatment is kind of mindfulness and coming back to Laura Ryan: What's important? So yeah, I think I'm I'm quite lucky to have those. those treatment principles kind of under my belt because, I think everyone can use them because they're just 00:25:00 Laura Ryan: Yeah, that's how you have a better life. Yeah. Kimberley Quinlan: Yeah, that's true. It's so true. And you, you talked about your you had sort of a shift in motivation to sort of take care of your health. Was there a shift in that for you? Once you started going through OCD treatment? That was when further beyond just your mental health, Laura Ryan: yeah, it was it kind of turned into adding in. Meditation moving my body a lot. Laura Ryan: Yeah, I I remember going down this because I had access to my uni like academic journal database, and I am early on. I went into a lot of obvious research about ERP and OCD. But also SSRIs and exercise. Laura Ryan: and I think people found Or some people. And at least for me, I find Like, I'm staying on the SSRIs, but exercise is. As effective for me as those. So if I Do them both. It's like supercharges it so good. Yeah. Kimberley Quinlan: Yeah. Yeah, absolutely. The research backs that doesn't it? So that's so good. Laura Ryan: Yeah. HOW TO GET THROUGH THE HARD OCD DAYS Kimberley Quinlan: That's so good. All right, the last thing I question I have for you it's just makes me giggle and smile and feel all good. Inside is tell me a little bit about what gets you through the hard things because that's what this is all about, right? That's what our whole message is. What are some of the things that get you through the hard things and the hard days? Laura Ryan: And definitely remembering my sense of humor. And Kind of encouraging the people around you. Because I'm not as. I'm not super comfortable yet telling my family and friends to You know, help me with exposure tasks, but if you can tell them, they help me laugh about these things. They'll They can people can do that, people know how to, and they want to, and it's really good. Kimberley Quinlan: Yeah. Laura Ryan: Yeah, also, if you go on the go on Reddit and look up Reddit OCD memes , it's the best. It's so good. It's like and John Hershfield's means they're so good, and they Laura Ryan: Again they like they get into these really dark awful themes but then we're laughing at them and I think that's just the fastest way to get power over OCD. Kimberley Quinlan: Yeah. Laura Ryan: um, Yeah,… Kimberley Quinlan: Yeah. Changes the game. Laura Ryan: it's really cool. Definitely. Kimberley Quinlan: Doesn't it right when you find? Yeah, it really really does. And you did talk about the game plan Already. Laura Ryan: Yeah. Kimberley Quinlan: You mentioned something called a panic inventory. Do you want to share a little bit about what that is? Laura Ryan: Yeah, so I hope it's not a kind of reassurance knowing that I can go back and check it, but I never do. And so when I have an intrusive thought, I just write it down in the notes of my phone and it's stops me from doing things like, checking the police news or asking for reassurance, or like, if I have the thought written down, and it's there, and I can think Laura, you can come back to it like it's there. It's not going anywhere. You can come back to it tomorrow or next week, or even just if you can hold off on doing this compulsion for an hour, the thought will still be there. You can still Laura Ryan: Address it. If it still feels urgent, then and yeah, some of them only last a few minutes, some of them last a few days. But I've never come back to a thought a week later still panicking. Kimberley Quinlan: Mmm, that's cool. It's funny, it makes me think about as With young children, when we're treating young children with OCD, we talk about their OCD box, and they imagine putting their thought up in the box and they leave the box there, not to kind of make the thoughts go away. But just like it's there, you can bring it with you. The box is always with you and… Laura Ryan: Yeah. Kimberley Quinlan: we're just not going to let it be there, and we're gonna go about our lives. Anyway, so does it sound like that for you? Is that kind of mindset there? yeah, so that I love that… 00:30:00 Laura Ryan: Yeah, absolutely. Kimberley Quinlan: because what you're really doing is you're saying I'm willing to let the thought come with me. And I'm gonna be uncertain about it and sort of staying very present. Like, we'll worry about it later, kind of like not that you're planning to worry about it later but she'll deal with it when it needs to be dealt with which is sounds like never Really okay. Laura Ryan: Yeah. Kimberley Quinlan: I love that. I love that. Yeah, okay, cool. Kimberley Quinlan: Anything else that you found to be helpful in getting you to where you are today in this really cool story? PERFECTIONISM AND EXPOSURE & RESPONSE PREVENTION (ERP) Laura Ryan: Yeah, definitely. I think the Perfectionistic side of me thought that every ERP exposure had to be. 10 out of 10. Full-blown panic attack level, but it's At least for me it's only gonna work for insofar as I'm willing to actually feel what it brings up. So Laura Ryan: I think they the best exposures for me are the ones that just feel mildly uncomfortable and even to the point where I'm sitting there and I'm like, Oh, am I, Even bothered by this. Like, it's sometimes I feel like I'm lying or… Kimberley Quinlan: Mmm. Laura Ryan: Or I don't have OCD or yeah, I think those tiny. Yeah. Like a hundred. Many exposures are way way better than one, one giant one, at least for me. Kimberley Quinlan: Wow. That's cool. I'm so glad you brought that up, and because that is actually, interestingly, I'll share with you when I'm supervising my staff. That's probably one of the biggest questions that my staff come with of like, my client seems to be wanting to do these crazy high hard explosions and it feels like it's sort of compulsive in that they're doing these exposures. Laura Ryan: Yeah. Kimberley Quinlan: And I think you're speaking to this really important topic, which is the exposure should Simulate the fear and the uncertainty And so you're saying, I think. But correct me if I'm wrong Doing a small exposure actually simulates in brings on other obsessions and fears along the way. So that's how you're doing your exposures. That's so cool. Is that correct? Laura Ryan: Yeah. Yeah, absolutely. Kimberley Quinlan: Yeah, wow. And we say Any happy school. We talk about doing a b minus effort, right? Like not doing it perfectly and sometimes perfect. You know, purposely making an exposure imperfect has, was that a trigger for you? As you went through this process of trying to make the exposures perfect? Yeah. Laura Ryan: Yeah. Absolutely. I remember, I came to my first session with my psychologists, like, with a printed out, hierarchy of like this. Yeah. Everything was scored perfectly and I was ready to work from. Yeah. Number one, to number 10 in and cool. According to the research, we should be done in 12 weeks and then I'll say See you later. That was really… Kimberley Quinlan: You like my schedule,… Laura Ryan: no, it works. Kimberley Quinlan: It says right here. This is how dispersed to go. Right, right. Okay. And it didn't work out that way. No, no that would have been hard to take. Laura Ryan: Yeah. Yeah. Kimberley Quinlan: Yeah. Yeah, I have loved hearing your story. I'm so grateful that we got to meet in person and connect. You know, it's sort of a full circle moment for me and I hope you know that you should be so proud of the work you've done and how far you've come. Laura Ryan: Thank you so much. Yeah, I can't believe I'm talking to you. Kimberley Quinlan: Yeah. I know,… Laura Ryan: Yeah, it's awesome. Kimberley Quinlan: I'm so happy to have you on the show, I really? And that's again, I say it all the time, like it just to know that. That. People can make small but very mighty steps on their own. Is the whole mission here,… Laura Ryan: Yeah. Kimberley Quinlan: right? Is that just even if it's the first step, I'm so happy if that's the step that people take. So I'm so grateful for you for sharing your story.Laura Ryan: Thank you so much for having me.

Dec 16, 2022

SUMMARY: How to include family members in ocd treatment Supporting siblings during ocd treatment How to apply the "be seen" model Ocd family therapy: including siblings as "assistant coaches" Developing empathy during ocd treatment Links To Things I Talk About: ERP School https://peaceofmind.com/for-siblings/ OCD Stories (with Jessica Serber) https://theocdstories.com/episode/dr-michelle-witkin-siblings-and-ocd/ https://www.amazon.com/When-Family-Member-Has-Obsessive-Compulsive/dp/1626252467 When a Family Member has OCD https://www.anxioustoddlers.com/psp-050-explaining-ocd/#.Y2Lc2S1h2Tc Krista's webpage Instagram: @anxiouslybalanced Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION Kimberley Quinlan: Well, welcome Krista Reid. I am so excited to number one connect with you, but to talk about a topic that I don't talk a lot about which is something that I'm excited to really talk about with you today. A Peaceful Balance Wichita: Yes, thank you so much for having me. Kimberley Quinlan: So welcome. A Peaceful Balance Wichita: I'm excited. Kimberley Quinlan: Yeah. Look at you. You're all the people who don't see, you're like everything's bright and it's so happy. It makes me so joyful just to see you. A Peaceful Balance Wichita: Thank you, anybody. That has met me. Will get it. I'm a very colorful person. Thank you. Kimberley Quinlan: I love that that we need more of you in the world. Kimberley Quinlan: I really feel Yeah, good thing. I made children that sort of created more of me, right? That's the best I can do. A Peaceful Balance Wichita: I we need more of you. A Peaceful Balance Wichita: You go. There you go. Kimberley Quinlan: All right, let's talk about supportive siblings. Let's talk about… A Peaceful Balance Wichita: Yeah. SIBLINGS AND OCD Kimberley Quinlan: how the family can play a role in recovery. I kind of want you to take the lead here and tell me everything, you know. So tell me a little bit about why this subject is important to you and how you used it in clinical and in the field of OCD. A Peaceful Balance Wichita: Yeah, absolutely. And so I'll give you just a little bit of background. I always have been interested in sibling dynamics, and in fact, when I was in grad school completing my thesis, I even consulted the director of the program. I said, Are there any theories about siblings? And he's like, well, you know, there's the one by Alf or Alfred Adler on birth order. But really outside of that, no and that has just always been so entirely profound. Because when we think about family work, if you're looking at family theories, if you're looking at different types of family interventions and models, a lot of them really focus on parent child. And when you're dealing specifically with a child who has an, I'll go into the physical medical side as well, because I don't think this is exclusively just OCD or just mental illness. Kimberley Quinlan: Mmm. A Peaceful Balance Wichita: when we're seeing that a lot of times, the model is fixated on the child with the medical issue and the parent And what I was finding was that siblings. They kind of get othered In this. It's full process and the definition of other. It is essentially, you know, being excluded from meetings being excluded from family sessions being excluded in some way, shape or form. Now I could see how potential listeners will say, Well, isn't it that child with the OCD the child with the medical issues othered Yes, I'm not debating that at all, I'm saying, primarily within the family unit, that the sibling themselves can get very other and siblings struggle when their sibling has a disorder. You… Kimberley Quinlan: Mmm. A Peaceful Balance Wichita: they can struggle emotionally, they can struggle behaviorally. You know, just looking at the construct of OCD, they could struggle with the with the grief. Of their sibling having OCD, the moods that may come with the disorder. And oftentimes, this can lead to resentment within the sibling relationship, or even guilt or shame. And I I have siblings, and I think this potentially might be even where a lot of my work is very important because I am very close to my siblings. I am super close. Like I I feel like I'm very fortunate. I have, I have amazing relationships with my siblings and so it absolutely breaks my heart when you see a child. A Peaceful Balance Wichita: Who who has this? Some type of distance within their sibling relationship either because they themselves have the disorder or their sibling has the disorder. And so, I started finding different ways to incorporate siblings and to the therapeutic model. I'm really big into family work. I don't understand how special when you're working pediatrics pediatrics. And that's primarily what I'm going to focus on today is a pediatric work. I don't understand how when you're working with pediatrics? How you you can't have the family involved? To me, that doesn't make any sense because we're seeing, especially in the outpatient world, we're seeing these kids an hour a week, so tops four hours a month. Pretty sure there with their families, a lot more than just four hours a month. and then thinking about, A Peaceful Balance Wichita: The siblings. What can we do to make them feel like they're not being other? How can they also not be parentified? Because that's sometimes happens within the disorder. World is the siblings may feel that they have to have some type of responsibility for their siblings medical issues. And that is Absolutely. I don't want any sibling to have that. I want them to have a childhood. I want them to be kids, but how can we incorporate them without parentifying them and without othering them and also bringing in the family as a whole and tackling this beast together whether that's OCD or whatever? That beast might be. 00:05:00 Kimberley Quinlan: That's so interesting because as someone who treats OCD but also treats eating disorders, I have found that, you know, you'll treat the one child who has the primary disorder. We get them better. And then a year or two later, the other kid that didn't have the the diagnosis starts to suffer and all this emotion comes out and they start to really acknowledge how painful it was for them and and it all comes out later. A Peaceful Balance Wichita: Okay. Kimberley Quinlan: But I know that there are other cases where it comes out during and you've got multiple things happening at once. So, that is why I think this is so important is Kimberley Quinlan: In my early days of treating you would be like, no, that the siblings. Fine. Look at how well they're doing. They're they're doing well in school and it's quite a miracle,… A Peaceful Balance Wichita: Yeah. INCLUDING THE WHOLE FAMILY IN OCD TREATMENT Kimberley Quinlan: isn't it? But then Yeah, it all comes out, right? It all comes out. So I love that you're talking about this, right? So you you And number number one, before we move on. Is this true of not just siblings, Would we say? This is true of partners of OCD or eating disorders or depression as well. Like Does this spread to that or… A Peaceful Balance Wichita: Yeah. I I agree a hundred percent,… Kimberley Quinlan: What are your thoughts? A Peaceful Balance Wichita: you know, this, I hate to call it curriculum because that makes it sound so sterile. A Peaceful Balance Wichita: Process I guess I'll call it and I feel that this process is and as as you know aforementioned it's not just about OCD. I can see this being across the board for any medical issue. Absolutely. It could be for Let's a roommate. Let's not even like let's let's take out the family part. Kimberley Quinlan: um, And here. A Peaceful Balance Wichita: You know what, working with a college. I college student, who has a roommate that, maybe they're pretty close with. Absolutely. I if they're willing to bring that person in, How can we incorporate them? Because doesn't that client win? That's what we're wanting… Kimberley Quinlan: Yeah. A Peaceful Balance Wichita: because we know that no matter what your medical diagnosis might be relationships, struggle, and… Kimberley Quinlan: Mm-hmm. A Peaceful Balance Wichita: that absolute last thing I would wish upon anybody. Kimberley Quinlan: yeah, I'm even thinking of me as someone with a chronic illness On how I think it even like you said it stretches to medical to like that. You know, I know I look back until tell a quick story. I look back to when I was really sick and really sick. And I even remember seeing my children, Starting to play a parental role on me. Like, What do you need today? Mom, instead of like, No, I'm supposed to be asking you that Hun. Like, I think that it's,… A Peaceful Balance Wichita: Yeah. Kimberley Quinlan: it can spread. So I I think that this is that's again why? I think this is so important. So I'm gonna skip to my main sort of questions here. Now, it's like you talk about what is called a coach Like an OCD coach. I know I've watched one of your presentations like Do you want to share with us What this model may look like? BE SEEN MODEL A Peaceful Balance Wichita: Yeah. Absolutely. So before I even talk about the OCD coach, because that's not like, I'm not reinventing the wheel, this isn't something that I think a lot of your listeners are going to say, Oh like that's that's a new thing. No, it's not a new thing especially when working pediatrics. That's a pretty common term because that's what we really want these parents, or caretakers to be of these kids. As we want them, to be able to learn how to do what we are doing with their kids. So they don't have to be in therapy forever. So, I developed this process and I call it BE SEEN seen as an acronym, because why not us medical professionals. We love our acronyms. So let's make another acronym. And also it's really easy to just to remember Kimberley Quinlan: Right. A Peaceful Balance Wichita: And I chose this specific, acronym one. It fits the letters, really nicely of what I was hoping to explain throughout this process but also for a couple different reasons. One I have OCD and I struggled as a child and adolescent and one of the primary factors in my own recovery, that was so A profound was I realized I did not want to be seen. I did not want people to note because I felt I felt bad, You know that shame just smothers you like a blanket and it just it it was embarrassing. And then I was thinking about it from the other side of siblings. 00:10:00 A Peaceful Balance Wichita: When you have a child who has a chronic illness, you think about how often, are they going into doctors appointments? How often are they going into whatever type of treatment facility? They may they may be utilizing. The sibling is often and they can get hidden. They can get hidden. And if I in fact, I think it was Chris Baer who did unstuck who actually called the sibling, the forgotten child. and I,… Kimberley Quinlan: Such a crisp, man. A Peaceful Balance Wichita: I absolutely, I'm gonna, I'm gonna get to how that whole thing. Actually, kind of birthed this idea here in a bit. A Peaceful Balance Wichita: But thinking about just how profound it could be for the sibling to be seen. And as I mentioned before,… Kimberley Quinlan: Hmm. SUPPORTING SIBLINGS DURING OCD TREATMENT A Peaceful Balance Wichita: I don't want them to be responsible for their siblings treatment. That is so incredibly inappropriate. And I want them to have a childhood, but I also want them to participate and have a relationship with their sibling. So when I think of an OCD coach essentially, how I define an OCD coach, is going to be that's going to be the adult figure. So that is going to be the person that is going to take the the child to therapy to treatments. That's going to be the main one, utilizing, exposure and response prevention therapy. They're going to be kind of the one overhead and I like using the word coach. A Peaceful Balance Wichita: Because one, I really like sports and I just think that there's something kind of neat about a coach because a coach is going to be, they're gonna be tough. They're gonna be fair. And at the end of the day, all they want is for you to win. I just think that's such a cool concept and when you tell that to a parent, a parent, a lot of times can say, Okay, so I get that because I could say, I want you to be the parent to the kid but also think about a coach because when you have your child on a team, OCD FAMILY THERAPY: INCLUDING SIBLINGS AS "ASSISTANT COACHES" A Peaceful Balance Wichita: In OCD Family Therapy , that coach is going to be tough. And I'm not trying to take the emotions out at all because we know coaches can be incredibly empathetic. The coaches are probably going to push your child a little bit more than you would put child. And so putting yourself into that role and thinking about this is for a win, I know my child might be hurting, I know my child because they're doing the exposures because you're not allowing them to have the OCD accommodated, you're pushing them to grow. So, Putting yourself into the coaches role versus only solely. The parents' role can be such a powerful metaphor for parents and I just really, really love that. So when I'm looking at the siblings, I call those the assistant coaches, those are the ones that can assist and help out. The players. A Peaceful Balance Wichita: So the child that is in OCD therapy or in treatment or whatever necessarily it might be and so be seen. So each letter of scene represents something s is supportive. How can you support the child? And I've actually created Worksheets, that are age appropriate for the sibling and the child with OCD, which again, it really could be any kind of medical thing because the acronym really doesn't exclusively cover OCD. They can do this together and so s is supportive finding different ways to support and A Peaceful Balance Wichita: With the worksheets that I've developed with ages five to 10. I just love this. It's it's an art activity and the kids together get to draw them slaying. I mean I'm using quotation marks slaying the OCD monster or making a can of like OCD away spray and so it's just a really, really cute. A activity to do and again because it's ages five to ten, that's such a level of mastery and explorative and, you know, they, they like to draw in color and play at that time. So, even if their sibling with OCD, it's a lot older. Think about what an amazing bonding experience that could be, you have a five year old sibling, and a 12 year old with OCD, that's a pretty cool, a situation able to put those two together to talk about it. A Peaceful Balance Wichita: Because then that five year old. I mean, how empowering and beautiful that is is like, okay, so you know, sibling older sibling, I'm going to draw a can of a way spray, and this is what it's going to do, and it's gonna get it's gonna help get rid of this and this. And we know that children think so highly a metaphors. That, that could be such a really cool way for them to interpret that. And to be able to understand that because we also don't want little kids to well, it's not, we don't want to, it's they just simply don't have the cognitive abilities to understand OCD comprehensively So let's find age appropriate manners to be able to do that. 00:15:00 Kimberley Quinlan: Yeah. DEVELOPING EMPATHY DURING OCD TREATMENT A Peaceful Balance Wichita: And then the next one is developing empathy during OCD treatment. I'm not gonna lie doing an empathy exercise with kids can be a little bit challenging and I think I think that because the Emotions are so complex. In situations are so complex. And so I was trying to find a way to be able to put this in a manner that A five-year-old is going to comprehend and yet also like a 15 year old is not going to think is to babyish. Kimberley Quinlan: Yeah. A Peaceful Balance Wichita: Per se. So it's a it's another worksheet because they're all worksheets it's another worksheet where the siblings can work alongside each other and it really can go either way. It usually works better if the child with OCD goes first. And so the child with OCD can share a so, for instance, I feel disgusted. When I'm around a bad food, I'm just gonna say something super blanketed and then the child the sibling with who does not have OCD could say, Okay? So let's talk about disgust. When do you feel disgusted? And they might say I feel disgusted when my parents make me eat broccoli. And so that's just a really cool and simple way for them to see that this is, you know, we can we can relate on emotions. A Peaceful Balance Wichita: And we don't have to agree on your, on your emotional reaction, but we can all we can realize that we all have these emotions and this is how we can bond. And for a young young child,… Kimberley Quinlan: Hmm. A Peaceful Balance Wichita: This could also be a really cool lesson in emotional intelligence, because they may not necessarily understand or comprehend. All these different kinds of emotions I'm not gonna lie. I think this might be my favorite one because I think this really encompasses a lot of different things. I love empathy exercises, I'm sure you like being big. Kimberley Quinlan: Well, I think it builds on that common humanity, doesn't it? A Peaceful Balance Wichita: But it really does. And that's the whole point is, you know, going back to what I mentioned about being seen, we're all humans and we're flawed and we don't want anybody to feel like they have to be perfect in this process and we don't want anybody to feel like they have to be all knowing, because there's such a beautiful way to which is actually Um, I was gonna go back to support. I've already talked about supportive, but it's a really cool way to support each other. and also not feel like you have to be an expert or Creating them per say,… Kimberley Quinlan: Yeah. Yeah. Yeah. A Peaceful Balance Wichita: all right. So then the next one. The next E is encourage this one and the worksheets is make a sign. So like if you were at because again, these are assistant coaches and I'm kind of using the metaphor of sports or games or like, if you're running along a marathon, what sign would you hold for your sibling? And so, then they get to make a sign for older kids. It could be a Post-it notes, have Post-it notes, and then put it like in your siblings lunch or on the bathroom mirror, draw a picture of them, make a card for them, You know, finding different ways to encourage your sibling with out feeding and to the OCD. That could be a really big part of it. Because let's say, for instance, you have a sibling. A Peaceful Balance Wichita: Who their OCD attaches on to the color? Black black is death. Black is some. Well, you know what, we're just not going to draw with the color black because it's not the siblings responsibility to do the exposures. Unless that is something that has been discussed actually in the therapy session, because, again, I can't say it enough that I do not want the sibling, to ever be in charge of treatment, or exposures or anything along the lines of that, of course, without actually working with a therapist beforehand. Kimberley Quinlan: Right, right? Can I ask you a question really quite just to clarify Tim? A Peaceful Balance Wichita: And yeah. Absolutely. Kimberley Quinlan: So that parent is the coach. Right? And… A Peaceful Balance Wichita: Yes. Yes. Kimberley Quinlan: then the child is the assistant coach, you mentioned. Do they get assigned that or… A Peaceful Balance Wichita: Correct. Kimberley Quinlan: Do we just call them that? Do they know they're the coach? Do we use those words? Do we assign them? That? What are your thoughts? A Peaceful Balance Wichita: I think that could really be up to a parent. Those are just terms that I've used you. 00:20:00 Kimberley Quinlan: They're like,… Kimberley Quinlan: conceptualizations. Okay. A Peaceful Balance Wichita: Exactly it… A Peaceful Balance Wichita: because children work, so highly with metaphors and they can use whatever, I had a child. Once say, a lot of want to be a coach, I want to be a cheerleader. Cool. Then you could cheerlead we really kind of whatever it's like… Kimberley Quinlan: Okay. Kimberley Quinlan: Right. A Peaceful Balance Wichita: if they want to be the waterboy, I mean I don't care as long as they whatever they can conceptualize it as and we can still kind of follow this supportive method fine. Kimberley Quinlan: Yeah. Okay, thank… Kimberley Quinlan: I just want to clarify that. So okay,… A Peaceful Balance Wichita: Yep. Right. Kimberley Quinlan: we're up to we're up to N. A Peaceful Balance Wichita: That's just great. I say in is non-judgment . And this is the part that we really, really, really like to push that OCD is not your siblings fault. Absolutely did not ask to have OCD. They're not doing this on purpose to despise you or for whatever reason. And also realizing that as the sibling, the way the sibling with OCD behaves is not the siblings fault. This can be a part where you have some psycho education and learning more about what OCD is and what OCD is not. And finding different ways to be able to talk about that. Because that itself can be very difficult and… Kimberley Quinlan: Mmm. Right. A Peaceful Balance Wichita: I have, I do a lot of OCD psychoeducation when I work with families. And this is where I was going to bring unstuck back. I think that even before going through this process with families unstuck in my opinion I I'm sure other professionals you know, have their own ways of doing it but I find it to be one of the most profound psycho education methods to use for families. Because, and I'm, I do you work with kids as well. Okay, I'm sure you can, you can relate that when you're having that Psychoed session with a kid, it gets lost. They're done. They're bored. They're just like, well can I just do something else? When you have a which I love that, it's like 20 minutes, it was so made for kids the unstuck documentaries. It was beautiful. And kids talking about OCD to kids. A Peaceful Balance Wichita: I mean I I don't know how it it is more impactful than that. Because a long treatment, it's funny enough, my clients will actually refer to the kids in the movie. Like oh, okay. Well, that one boy. Um, he was able to wear Hulk mask or that one, that one girl was able to hug a tree. Oh, that one. She ripped out pages of the Bible and they'll actually refer to that and they see that as being incredibly empowering. what that also does is it lets the parents know that here are some kids… Kimberley Quinlan: You. A Peaceful Balance Wichita: who I mean, you hear their stories, you know that those were pretty severe cases These are kids who came out the other side and are in recovery. and they're talking about these challenges, they're talking about How difficult it was for them. And so when parents are learning about ERP for the first time, it's it's very scary, it's very and so I think it's not only powerful for the children with OCD and their siblings but also their parents to be able to see this documentary, I can't speak highly enough about it, but that's not why we're here. Kim, we're not here to talk about this documentary. Kimberley Quinlan: No, but I think I mean that's the beauty of the community, right? Is we all bring little pieces to what's so important. As you're talking, I'm thinking like A Peaceful Balance Wichita: That. Kimberley Quinlan: He sees that movie because that's the impact it's having. I mean I've seen it and I loved it it's so it's when we can't miss the siblings, right? Like that's some important piece. So I love that you're talking about that and I do think you're right. Question totally off topic. A Peaceful Balance Wichita: Yeah. Kimberley Quinlan: But on topic is, when you're with a client, do you? Encourage them to watch on stock. Do you bring the family in and do this training with them? What kind how do you apply these concepts in session or Are you know, for someone who doesn't have therapy, what might they do? A Peaceful Balance Wichita: Oh, okay, I'm gonna answer that. Someone who doesn't have therapy. Might what they do. I'll go. The therapeutic route to begin with, of course, after you solidify the diagnosis? Which again, for kids can be boy, that can be a challenge that can be such a challenge. So, this is after diagnosis, This is just part of the therapy. I do I, I will say, Okay, so bring in the family and I would say, I would love to have siblings here and they'll say, Well, the sibling is five or six, is that? Okay, absolutely, because you will be surprised at how aware the young sibling is going to be their older sibling. 00:25:00 A Peaceful Balance Wichita: And all time, you will also be surprised at how much accommodation the young child might be doing because they might see that as being. Well, that's just my older sibling. My only can't cut food. Kimberley Quinlan: Yeah, right. A Peaceful Balance Wichita: My older sibling doesn't walk down this one hallway. That's just how they are. Well, we also want to teach them that, you know, this is this, This has a name and here's some ways that you can be encouraging for your sibling. And so I have an entire session where I invite the entire family in and we watch the movie and then we process it together. and from there,… Kimberley Quinlan: Right. A Peaceful Balance Wichita: We go on to. A Peaceful Balance Wichita: Week, We go on to just write right away going on into the bc model and figuring out different ways how the sibling can be involved. Not other not excluded and then we'll go into more of kind of like, the clinical stuff, the Y box, exposure, higher and… Kimberley Quinlan: Yeah. A Peaceful Balance Wichita: and so forth. But you ask, how can people that don't have therapy being able to utilize this. Honestly, it's on silly. I I'm probably the. Okay, there's two ways. I'm very competitive but I'm not competitive. When it comes to This this work, I post these worksheets for free on my website because this is something that I'm not here to make a profit off of it. I'm not here to, I'm not even gonna copyright it because at the end of the day, if we can help one sibling feel heard, Cool. That's it. That's that's amazing. No, no amount of money or… Kimberley Quinlan: Right. And A Peaceful Balance Wichita: anything could ever be better than that? Kimberley Quinlan: We can link the links to these worksheets in the show notes. You're comfortable with that. That would be amazing. Yeah. Okay,… A Peaceful Balance Wichita: Absolutely. Kimberley Quinlan: that is so cool and so people can kind of work through them on their own. Okay. A Peaceful Balance Wichita: Mm-hmm. And in fact, there there was a family that I worked with whose younger sibling had had some special needs. And what I did with the parents, is I just kind of briefly explained this to them and because they know their kid better than, I know, their child and they know How how their child is going to be able to kind of understand process. This, they were able to take the information they did and that they needed to be able to help out the sibling who now helps out. That the sibling with OCD. Kimberley Quinlan: Yeah, yeah. Okay. So a couple of quick questions that I want to ask is so and it's a sort of going off of some past cases that I had. So what about the the sibling, Who's just really angry. Kimberley Quinlan: the situation at how the, you know OCD has made their family, very For treatment before they were getting resources. Do, do they There's those children who have a lot of resistance to this idea of being a coach. You work with that. Is it through the empathy? Do you have any thoughts? A Peaceful Balance Wichita: Door. And that's a fantastic question. Because we can't, we can't force. We can't force anybody to do anything. And I kind of view it like the child with OCD, If the child with OCD does not want to do the treatment. Well, then my job as a clinician is to meet that child while they're at and… Kimberley Quinlan: Yeah. A Peaceful Balance Wichita: that very much with the sibling, you know, of the child with Ocds, I'm gonna have to meet that sibling where they're at, if they don't want anything to do with this, if they want nothing to do with any of this process at all. I'll do one of a couple things one. I, I might refer the sibling on to a therapist who doesn't necessarily like they don't necessarily have to treat OCD but they can understand OCD comprehend OCD. Well enough to be able to have a conversation. And sometimes the sibling is like, Well, I'm not the one with the problem. I don't need to go into therapy, so I'll do my best. I can to coach the parents and help them to support that sibling as well. Kimberley Quinlan: Right. Right, so. Okay and just conceptually. So the parents are using the parent. Coaches are using the bc model the children. A Peaceful Balance Wichita: Yeah. Kimberley Quinlan: If they're ready and willing, they're using the bc model. And the person with the disorder or the medical condition is also using the bc model. Be seen model for the sibling and the family correct. A Peaceful Balance Wichita: Yeah, I mean this this doesn't have to just be with OCD, In fact, you know, as as I'm looking at just the the acronym of seeing, I don't know if you just has to just reach the medical stuff. Because at the end of the day, don't we generally want to be supportive and empathetic and encouraging and non-judgmental humans. I think just kind of a neat model just to teach our children in general. 00:30:00 Kimberley Quinlan: Mmm. Yeah. Kimberley Quinlan: That's what I was thinking. business sort of, like, 101 Training to be a nice. and like, A Peaceful Balance Wichita: It really is it really? Like I said, I'm not reinventing the wheel, you know, I was able to use some different strategies that I've learned with. So originally as a therapist, I was on the way to becoming a play therapist. And a lot and also dealing with Dr. Bruce Perry's neurossequential model of. Oh My Gosh. Oh my gosh. Why can't I think what it is? It's his nurse sequential model for trauma. That's what it is. Oh wow. And then just just pulling different plate therapy, text me techniques. And I kind of just establish this thick this and… Kimberley Quinlan: Yeah. A Peaceful Balance Wichita: you're right. This is basically just Yeah, I like how you said 101. Be a nice person. Kimberley Quinlan: Yeah, but the truth is and that's why I think it's so important is we all are nice people. We all want to be but when we get hit by a disorder, It's easy to go into reactivity as a parent. I know for myself or as I've seen, you know, siblings it's easy to go reactive. So these are sort of basic tools to come back to the basics and and recalibrate,… A Peaceful Balance Wichita: Exact. Kimberley Quinlan: which is why I love it. Okay. So no,… A Peaceful Balance Wichita: Ly. Yeah. Kimberley Quinlan: I love this so much is before we finish up. Is there anything that we haven't touched on that? You want to make sure we address here and we're talking about Supporting the siblings, but supporting the person with the disorder, any I've missed. A Peaceful Balance Wichita: Um, can I list some resources? Oh, okay. Kimberley Quinlan: And please. A Peaceful Balance Wichita: There's really not a ton of information out there about how can the sibling be involved with any medical treatment to be honest with you and I'll focus specifically on the OCD portion. Of course, John Hirschfield's amazing book in regards to family at the,… Kimberley Quinlan: On a family,… A Peaceful Balance Wichita: Yes at the very tail,… Kimberley Quinlan: I see. A Peaceful Balance Wichita: and he talks about different ways, family members can can be helpful. Natasha Daniels on her YouTube channel, she's so great. They're all great everybody. I'm listing is like All Stars. She specifically has a video about how to talk about OCD with young children and I think there's actually even more specific video about how to talk with siblings. Dr. Areeen Wagner on the Peace of Mind Foundation website. There is a whole slew of stuff about how to talk with siblings and I think the Bear Family is even involved in some of those presentations as well. And then this is gonna sound silly because I'm gonna shout out another podcast. Is that okay? A Peaceful Balance Wichita: Okay, there's a couple on the OCD stories that they talk about siblings. Jessica, Surber rested. Kimberley Quinlan: Yes. A Peaceful Balance Wichita: One about her own experiences being a sibling. And then, this is an older one. Maybe two, three years ago. Dr. Michelle Witkins. She does a lot of advocacy for siblings and so she has an amazing podcast on there where she talks about that work. Kimberley Quinlan: Right? No, I will link to Eyes and you know I'm a massive stew fan so don't wait. Don't worry about it. No, I he's been on our show. I've been on his show a bunch of times. We are very much in Communic. A Peaceful Balance Wichita: I figured, I don't think there was a feud going on. Kimberley Quinlan: Around food at all. No, that's that's so good that you have those and I will list those in the show notes for All as resources to use. I love. Thank you so much for sharing all those and we will have links to your sheets as well. A Peaceful Balance Wichita: ah, Kimberley Quinlan: You can An excellent resources. A Peaceful Balance Wichita: oh, you're sweet. Thank you. Kimberley Quinlan: Well, I am so grateful for you to come on and talk about this. I think it's really, really important that we talk about siblings, you know, address the whole family because it is a family condition, right? Thank you. I'm so just overjoyed to have you on the show. A Peaceful Balance Wichita: Well, thank you. I'm overjoyed to be here. Kimberley Quinlan: Where can people hear from you or get information about you? A Peaceful Balance Wichita: So my website, so my practice name is a peaceful balance, Wichita Kansas, and my website is a PB wichita.com. and really, to be honest with you, probably the easiest way to To contact me is on Instagram. I'm probably on their way more often than I'd like to admit and… Kimberley Quinlan: Yeah. 00:35:00 A Peaceful Balance Wichita: my handle is at anxiously balanced. Kimberley Quinlan: Love it and you put some amazing exposure lists and movies. It's so good. You but no it's so it's such a huge resource. A Peaceful Balance Wichita: I think I have way too much fun with those. Kimberley Quinlan: If you're looking for specific movies, documentaries songs, I think you do a great job of listing exposures. A Peaceful Balance Wichita: Thank you.Kimberley Quinlan: Thank you so much.

Dec 16, 2022

Dec 9, 2022

SUMMARY: In this podcast, Micah Howe addressed his expereince with intensive OCD treatment and the 6 most important turning points of OCD Recovery Compulsions keep OCD going, I can control my reaction to OCD Worrying is a false sense of control and is not productive Anxiety does not mean something needs solving Find an OCD community Self-compassion helps manage uncertainty Micah also addressed how to know you are ready for intensive ocd treatment and how he managed his OCD grief. Links To Things I Talk About: https://www.instagram.com/mentalhealthmhe/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online courses and resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety… If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). This is Your Anxiety Toolkit - Episode 314. Welcome back, everybody. Today, we are talking about the major turning points of OCD recovery. This episode is literally how I want to end the year, although we do have more podcasts coming this year before we finish up 2022. But literally, this is like mic drop after mic drop after mic drop. I thoroughly enjoyed interviewing this week's guest. I'm so honored to share with you this interview with Micah Howe. He's an OCD advocate and is one of the most inspirational people I know. I just have so much respect and adoration for him. And this episode is literally a bomb. I just can't, I can't shout it from the rooftop loud enough. I'm going to keep this intro very short because I really just want you to hear exactly what he's saying. And really what we're talking about here is some ideological shifts that he had, going through intensive treatment and treatment in general, specifically for OCD . But if you don't have OCD, this is still going to be a powerful punch for your recovery because the tools that he shares that he realized on the end of his recovery are ones that anybody could apply to their recovery. So, let's just do it. Before we move on, let's quickly do the review of the week. This one is from Tristramshandy1378, and they said: "I stumbled across your podcast recently. I have been through therapy with Anxiety and panic and I have a high-stress job that I love, but I needed to continue my journey to recovery and be reminded of all the skills that are available to help me along the way. Your online courses for OCD and your amazing podcast reminded me the most important part of the process is to love myself, before, during, and after my episodes of intense anxiety and that every day is a beautiful day to do hard things." Oh my gosh, Tristramshandy, this is just so exactly my mission and my model. And so, I'm so grateful for you for leaving a review. It sounds like actually Tristramshandy's review of the week should actually be the "I did a hard thing," but we have an "I did a hard thing" as well. This one is from Anonymous and they said: "Hello, Kimberley. Very glad to have this resource. I did a hard thing. I started using public transportation much more often. It helps a lot with agoraphobia. I also significantly decreased media consumption, and that helped me learn to live with my thoughts and generally slowing down to process the information." So, thank you so much for Anonymous for sharing that. To be honest with you guys, the review of the week and the "I did a hard thing" and this entire episode is like three different "I did a hard thing" segment, so I've just so overjoyed that we're all here doing the hard thing, bringing in the end of the year. This episode is going to be such an amazing resource for you. So, let's get over to the interview. Introduction To Micah Howe Kimberley: Thank you so much for being here, Micah. I am actually so excited to hear this story. So, welcome. Micah: Yeah, thanks so much. Glad to be here. Kimberley: Yeah. So, you and I had talked before we came on to record about how you are going, wanting to tell the story about your intensive OCD treatment specifically around OCD. And this is the topic that I find so interesting and something that I actually really am so excited to hear your story. So, would you be able to tell us just in brief what the backstory of your recovery looks like and get us up to date in terms of where you were, what you experienced, as much as you're willing to share? Intensive Treatment For Ocd Micah: Yeah. So, what had me in intensive treatment – I grew up in rural Iowa and so resources for OCD, particularly evidence-based treatments like ERP, particularly several years ago when I was first starting to show really debilitating symptoms, those sorts of resources were really hard to come by. And so, it took me a long time to find good help. And then once I did find good help, my OCD had gone on unrestrained for so long that I needed a really intensive setting. And so, my OCD started becoming quite debilitating around the age of 18 or 19. The college transition was really hard for me. But by the age of 25, even doing some outpatient therapy, it just wasn't really putting much of a dent in what I was dealing with. And so, I ended up in a partial hospitalization setting where we were putting full-time job hours into exposures every week. And that's what it took for me to begin to see breakthrough. Kimberley: Right. So, what was it like? What were you experiencing? Because I'm sure there are people who are going through treatment who may be feeling similarly. You are doing outpatient once-a-week therapy, were you? Micah: Yeah. How To Know You Are Ready For Intensive Ocd Treatment Kimberley: And how did or was it you who knew you were ready for in treatment or was it the clinician who advised you to take that next step? Micah: For the longest time, I had so much stigma about going to a "mental hospital." Really, I didn't know what to expect, and just naturally as people, we're afraid of the unknown. And so, I was pretty resistant. But eventually, a clinician that I was working with really had said, "If you want to get to these goals you're talking about in any reasonable amount of time, I really think I should recommend that you go to a higher level of care." And so, that really opened me to this idea of seeking a higher level of care. It was the combination of a clinician recommending it and also my just experience of realizing, this once a week, I mean, we're very well-intentioned here, but I'm just not getting very far. Kimberley: And I think so many people are there and the stigma holds them back. There is a lot of stigma attached. Besides that conversation, was there any other shifts you had to make to get your foot in that door, or it was an easy decision once you explained it? Micah: I hate to say it, but unfortunately, it's all too common in the world of OCD recovery. But I was another one of those people that I went kicking and screaming. I had to hit rock bottom. It was helpful for a clinician to tell me, "I really think this would be beneficial to you." It was eye-opening for me to realize, gosh, I'm coming back here every week and I'm just not getting very far. But I think what really pushed me the rest of the way was this very sobering realization that this OCD is going to continue to take as much of my life as I allow it to. If I continue to just do a level of therapy that, at least for me personally, is not getting me where I want to go – if I just continue doing that, hoping that something is going to change, experience was teaching me that OCD is not just going to back off if I don't do anything different. So, I think that idea of hitting rock bottom, of being tired of chasing the same goals month after month that I wasn't getting any closer to, that really pushed me to say, "Okay, I'm more afraid of losing my life and opportunities than I am of whatever stigma I might have to shoulder adding to my life's resume that I spent time in a mental hospital." Micah' Intensive Ocd Treatment Story Kimberley: Yeah. You had to weigh the pros and the cons and all directions were leading you in that direction. That's cool. That's so cool that you were able to do that, make that shift in your mind and make that decision. So, okay, you're in the door in intensive. Was it what you expected? Tell me about what you expected and how it was different. Micah: Yeah. And it's that question that I really appreciate because, for anybody listening that might be considering another level of care that is intimidated, I mean, that's right where I was. I mean, I didn't know what to expect. And when I got there, I'll never forget the biggest thing that really was surprising to me is how calm and inviting and not scary it was. I met a lot of people there and I was like, "Wow, these people are just as genuine as I am. We're all just trying to get better here." And I also think, I thought there was going to be-- the other thing that really stuck out to me was I thought there was going to be this really significant talk therapy element. I thought we're going to-- all these things that I couldn't figure out in outpatient, these treatment teams at these intensive centers, they're going to have the answers that my outpatient therapist didn't have. And it's actually like, no, they don't have the answers. They're actually more encouraging than my outpatient therapist that I live without the answers. And so, we're not really talking through the things that concern me. We're instead doing this evidence-based really rigorous exposure therapy where I'm not talking about my feelings and my past as much as I'm talking about how I reacted to something they asked me to challenge myself to do that day. And so, just the way they went about helping me get better was so different than the path I thought we were going to go down. Kimberley: Yeah. Isn't that interesting? Would you say-- and this is sometimes how I explain it to some clients, but you should actually give me feedback here. I'm as much learning from you as any. Sometimes we say intensive treatment isn't different, it's just more. It's more frequent. It's more of what you're doing in session, and that's a good thing. Was it that for you? Was it just more of what you were doing? Or was there some fundamental differences in the structure of the sessions? How was it different for you? Micah: Again, yeah. I mean, obviously, I'm not a therapist or a medical doctor, anything. Everything I say on the episode is just from my limited personal experience as a sufferer. But I would say in my experience, when I was doing outpatient therapy, only meeting with a clinician once a week, only doing so many exposures a week, I guess this idea of tolerating uncertainty, I understood it, but I don't think I bought in as deeply as I bought in when I was in intensive treatment because now, instead of we only have 50 minutes to talk through everything, now my treatment team is like, we've got two hours if you need it. And so, we've got two and a half hours if you need it. And so, if I was hung up on an exposure that I didn't want to do, it wasn't a situation of, "Ah, we'll get to that next week." It was like, "We can wait. What's the issue? What's getting in the way?" And so, I couldn't just run out at the end of 50 minutes like I would in an outpatient context. We were there full-time to deal with fears and help me gradually be willing to engage in exposures, that in an outpatient context, I didn't have to push myself that hard. And it was much harder than outpatient for me, but it also caused progress so much faster because when I ran into a bump, it was like, we're either going to try to work through it now, or we will be right here tomorrow to keep working on it. And so, there was a consistency that created breakthrough that once a week just wasn't doing. Kimberley: Right. See, that's so interesting, the mindset shift for you that you had. So, okay, I've got lots of questions, but I also want to know, you have come with four main points that I want to make sure you've got plenty of time. So, I've probably got questions there as well because I always have too many questions. Micah: Oh, no, that's great. The 6 Most Important Turning Points Of OCD Recovery Kimberley: You had said there were four ideological shifts you had to make during intensive treatment, and I want to highlight those because they're brilliant. So, would you be kind to share that with us? Micah: Yeah. Do you want me to just start with the first one or did you want me to list-- Kimberley: Yeah, just lay them on. Anxiety Does Not Mean Something Needs Solving Micah: There were so many, but for the sake of time, I think when I think about some of those paradigm shifts, some of those ideological shifts that really created a lot of breakthrough for me, the first thing that comes to mind is my treatment team challenging me to accept the notion that anxiety was tolerable and that it was an ordinary part of the human experience. When I started out in treatment, I saw anxiety as a signal that I was doing something wrong in my life, a signal that there was a problem that needed solving. And OCD didn't exactly know what that problem was, but it had rituals to offer me in the meantime. And so, I just felt like anxiety, it is a catalyst, it is an impetus, it is a sign that something is awry and I'm supposed to be doing something. The last thing I thought was, like my treatment team encouraging me, "Micah, what if anxiety is just part of being a person? And what if it doesn't necessarily mean that life is asking you to do anything to make it go away? And what if your life was actually better tolerating the distress that anxiety created rather than being a fugitive from it your whole life?" And I had never considered that in part because I again thought that it was extraordinary, but also, I had never considered the idea that anxiety could just be tolerated. It was so unique and novel to me because I just saw anxiety as anxiety is something I hate, anxiety is something I find unbearable, and either my life is miserable because it has anxiety in it, or I'm able to live the life I want because I've completely eliminated anxiety from my experience. And to be offered something in the middle, that that wasn't black and white, that was so just revolutionary for me to say, "What if I can't ever get away from this thing called anxiety? But also, what if I never come to love it either? What if I just live my life just lukewarm to this emotion? Just allowing it to be in my life?" And that was something that prior to my treatment team encouraging me to think that way. There was just nothing in my natural instinct that thought about just letting anxiety be around without reacting to it. Kimberley: Yeah. So cool. Isn't that so cool? Okay. So, what's the next one? Compulsions Keep OCD Micah: So, the next shift that was extremely meaningful to me – when I was in intensive treatment, we did a lot of ERP, we did some ACT principles, some behavioral activation because I also deal with comorbid depression and hoarding disorder, and we also did a fair amount of thought challenging. And the thought challenging was particularly insightful for me in that as I started to break down some of my rituals, I really had to come face to face with the fact that my rituals were creating very much the antithesis of what my OCD told me those rituals existed to accomplish. Compulsions keep OCD going. So, for example, scrupulosity was a big issue for me. And my OCD was telling me all of these things you are doing, all of these repeating things you are doing, this is to make you feel closer to God. This is so that you will be more engaged with your faith. This is so that you will be a better Christian. And yet, as I started breaking these things down, I was like, I have never felt so disconnected from my faith as when these rituals have become such a significant part of my experience. And even with my hoarding, it had an effect. I was collecting all of these things to relieve anxiety. And the notion was you're collecting these things so that when the day comes that you need them, you'll have them. And yet, the effect was that I had so many things accumulated that when the day came that I thought, oh, that thing would be really great. I couldn't even find the thing in my mess of things. And so, in reality, there wasn't much of a difference between not having any of these things and having a basement so full of things that I couldn't find the things I wanted anyway. And so, that thought challenging and really analyzing why am I doing this and what is the difference between how I feel about these rituals versus the reality they're actually creating in my life? And I was able to see that I am giving up long-term progress towards the person I want to become in exchange for short-term relief of anxiety. And that took me a long time to acknowledge, but once I saw it, it helped me break away from the rituals a little bit easier. OCD Grief Kimberley: I know, isn't that so true? Is that we feel in the moment the ritual is helping. It's like, this is a part of the solution. And that's a big awakening when you're like, it's not a part of the solution. At least not the long-term one. That's that. Was there any OCD grief? Was that a relief or was there some grieving you had to do about that? Micah: Yeah, I think there was some grieving only in the sense that when you spend all this time doing these things and you're believing your OCD that these are helping me, these are getting me closer to the person I want to be, there is some grieving in recognizing that there's a lot of emotional reasoning involved in why I'm doing these things. They make me feel like I'm getting closer to the person that I want to be. But it's really an illusion because people who are close to God, I don't associate those people as being people who repeat their prayers so many times because they're terrified. I associate those people as being people who enjoy the discipline of prayer, who enjoy being in religious services. And so, it was a very odd experience to have to come face to face with the reality that these rituals are making me feel a certain way, but when I look at the results I'm getting over the long term, I'm actually getting farther away from the person I'm wanting to be. Kimberley: Right. It's gold, isn't it? And I've seen that recognition and realization in my clients and it's a tough one, but it's an important one. Did that come in pretty quick in your intensive treatment or did that take time? Micah: I think in the first maybe week or two of intensive treatment, I just had my clinicians, because I was resistant to ERP at first. And so, there were a lot of nuggets being dropped that I was just like, "Whoa, I have not thought about that in my whole OCD journey." So, I would say the real change happened several weeks into intensive treatment, but definitely that first week or two, I was encouraged to think about these rituals and uncertainty and all these different elements involved in recovery from OCD very differently than I ever had before. I mean, I remember one of my first conversations with a therapist at treatment just asking me to think about what do you think a committed Christian is like, what do you think their life looks like? And I had never thought about that before and I realized that doesn't look anything like my life. And that was really eye-opening for me to be like, I don't associate being close to God with doing all these things out of fear. I associate it with actually finding meaning in these things. And so, I just had to separate that, just because these things make me feel a certain way. Another one was, I was so afraid of getting brain cancer and so I did all sorts of Google searching. And I was really challenged to think through, do you think about a healthy person as being someone that's on Google all the time? Is that what health looks like to you? And of course, the obvious answer was no, but I just had never been encouraged to think that far previously. Kimberley: Yeah. I'm loving everything you're saying, so I'm just wondering like, keep going, keep going. What's number three? I Can Control My Reaction To OCD Micah: So, the third thing was, if there was anything that I underestimated when I came into intensive treatment, it was my own capacity for change. When I came into intensive treatment, there was a lot of hopelessness, and it was rooted in this idea. My thoughts trouble me deeply. My emotions bother me deeply. I can't control either of those. And then on top of that, my life circumstances bother me. And although I might be able to change those, I can't really change them quickly. And so, what hope is there for this getting better? The blind spot I had coming into treatment was this idea that even though it's hard, and even though it doesn't feel this way often, I do hold the keys to the behaviors that I choose. And my treatment team really worked hard to say, "Micah, it's a losing battle to try to fight thoughts and emotions that you can't direct. But what if we focus on the things that you do have some ability to influence, even if it's hard to do?" And so, my life just really began to change, hope began to flood in when I began to buy into this idea that I'm not in control of many of the things I would like to be in control of, but I do have influence over my behavior. And because I'm so caught up in my rituals, I'm really not tapping into that potential at all when I'm coming into treatment. And so, once they started to say, "Micah, we're not going to sit here and talk you out of your thoughts," but they exposed me to ERP and concepts like neuroplasticity and this idea that what if we can't change your life, but we can improve your brain's ability to react to your life with more helpful behaviors? And I was just blown away because I had just never thought about it. I just thought, well, if we can't change my thoughts, we can't change my life. And they flipped that on its head and said, "Well, what if we just tolerate the distress of your thoughts and start living the way you want to live and see what happens?" And I didn't even know that there was a relationship between cognition and behavior that allowed progress to be created that way. It was unbelievable. Kimberley: There are all these light bulb moments. All I want to keep asking you, I keep feeling like myself going like, you were receptive to this? You were obviously eventually receptive to this, or did you fight them on this? I'm thinking about my clients and now the people listening, I know they may have been hearing these same things, whether it's through this podcast or through their therapists, is like OCD has a strong opinion about these concepts too, I'm sure. Was OCD throwing a massive tantrum? Micah: Yeah, no, for sure. I don't want to make it sound like I just walked in and they said these things and I was hopping down the lane just like, "Oh, perfect." It wasn't that at all. There was a tremendous amount of resistance, but I think that that resistance was weakened faster, both because we were talking every single day for hours at a time and also because, by the time I reached intensive treatment, it was like, if I'm not willing to try these concepts, if I decide I don't like this and I'm going to check myself out of this place, what am I going to go back to? Where am I going? If I'm not willing to try this, what's the next thing? And I knew it was just going to be back to more rituals, not getting anywhere. And so, I was open. And there were also specific exposures that I'll never forget. And I don't think my behavioral specialists necessarily knew the depth of impact some of these exposures would have on me. They knew it would help, but some of them were like, "Wow, that was an unbelievable exposure." One of them was, they had me watch YouTube videos of people who were explaining their experience of being diagnosed with terminal illnesses. And so, they're dying and they're on YouTube and they're telling their story. And if I could find them of brain cancer, I did brain cancer. But if it was ALS, whatever, they just find a terminal disease, find someone who's describing what it was like and watch those videos as an imaginative script. And I'll never forget watching those videos and seeing even people dying of terminal illnesses had moments of laughter and smiles. And I thought to myself, they didn't get there by sulking in their thoughts. I just realized, when these people know they're dying, somehow, they decided: I'm going to do things that matter to me even when my brain is probably telling me, "Your life is over. What's the point?" It just so inspired my confidence that, wow, I do not understand at an anatomical or at a metaphysical level what is involved in living life the way I thought I did. I had to be open to this idea that there is a way to choose behaviors, that my thoughts are not exactly supportive, and get places even when I don't necessarily feel like getting to those places. And I didn't realize I could just challenge my thoughts by choosing behaviors that mattered to me, even if it scared me to do it. And some of those exposures just really stuck with me in that sense. Kimberley: I love that. And it is true, isn't it? You're doing an exposure to purposely simulate the fear and sometimes there's a lesson in it. There's a message-- not a message, but just a lesson. So, that is incredible. And thank you so much for sharing that exposure example because that's some hard stuff you're doing. That wasn't easy. Worrying Is A False Sense Of Control And Is Not Productive Micah: No, no. It wasn't. And I think that was also part of the treatment that really was hard for me but has helped me grow so much, is just this idea that that worry doesn't have any utility to it. My OCD convinced me for so long that by worrying about things, we're doing something. And it was this magical thinking in a sense that something in the cosmos is happening because I'm here worrying. And really just being able to acknowledge, "Micah, your worrying is not doing anything productive. Your OCD can make you feel all day long, like the energy expenditure." Well, there's so much energy expenditure in my worrying. It has to be accomplishing something. Instead of just acknowledging it, it actually doesn't have to be accomplishing anything and it isn't. And as blunt and hard as that was to accept, it did help me when they started to offer me this acceptance piece of like, it sucks, but they really encourage me, my treatment team, that Micah, you do have to accept that you are a limited being and that there are answers that your OCD would love to have. And no amount of fretting about it is going to get you those answers. But it is going to chew up your life. It is going to take away opportunities. It is going to keep you out of the present moment. And I think-- sorry, I'll just add two more things real quick, but I think the one thing was this idea. When I first came into treatment and they started offering mindfulness and we did a little bit of yoga, I really didn't buy that when I got started. I just thought this is not me. But by the time I left treatment, I just found mindfulness for OCD to be the most helpful practice because the reason I didn't like mindfulness at first is because I thought it was cheesy. But once I really started to buy into what my treatment team was saying, I really recognized at a very brutal level, mindfulness is just recognizing the world for what it actually is, even if I don't like it. That what I really have as a guarantee is this moment, this breath, this blinking of my eyes. And that's really all I know for sure. And as terrifying as that statement once was for me, I became much more pro-mindfulness as I became comfortable with accepting that reality about the world. Find An OCD Community And then the last thing I would say as far as paradigm shifts that really was so impactful for me in intensive treatment was just this idea that uncertainty is a burden that is best shouldered authentically with other people. And what I mean by that is group therapy just meant the world to me when I was in intensive treatment. I grew up in rural Iowa where there's a lot of stigma and talking about what I was dealing with was really hard. And so, to finally-- instead of just bury all this stuff and pretend that the world is not as uncertain as it really is and just try to get through, it was just so unbelievable to just finally be in a circle of people and we are all just admitting we are terrified of this thing called uncertainty. And I'm terrified of uncertainty related to my health. And you are terrified of uncertainty related to religion, and you are terrified of it related to whether or not you hit somebody on the way here to treatment today or whatever. And to just openly voice our fear of uncertainty. I can't even explain it, but it just created a human bond to be able to be honest with each other in that way that I never experienced just trying to bury these things and pretend that uncertainty wasn't as scary as it really was. Self-Compassion Helps Manage Uncertainty And I think the other thing it did is it introduced me to self-compassion in a way that I hadn't really acknowledged before. There's something unbelievable about, when I talk about how much uncertainty scares me, it's so hard for me to feel empathy for myself. But as soon as I see another person across the room say it scares them, all of a sudden, it's like, where's all this empathy I have for them? When they say it affects them and, "oh, I had to drop out of college because I couldn't deal with this and I'm scared of this and that," when I have the same story, I don't feel much compassion for myself, but when I see someone else have that story, here's all this compassion. And I walked away from that thinking like, whatever it is that makes me so sympathetic to someone else's struggles with these things, I need to find more of that for myself. Kimberley: Is that something that was the switch that went on or is that something you go in and out of being able to do that self-compassion piece? Micah: I think, if I'm being honest, it really is an in-and-out thing for me. And I think it is related to the camaraderie of other sufferers. Whenever I'm at the conference, gosh, I am like at my all-time annual self-compassion highest because it's just like, "Ah, yeah." I remember we're all a community and it's like high school musical all over again. We're all in this together. But when I get back to Iowa and I'm not regularly rubbing shoulders with sufferers, I start comparing myself to non-sufferers a lot, and all of a sudden, this desire to be compassionate towards myself lessons. So, it's something I have to work on continually to remember that I'm dealing with something that is not easy and a lot of people aren't dealing with. And it's just, I work very hard to try to remember the feelings that well up inside of me when I hear somebody that's not me share their struggle and their recovery and do my best to be like, okay, whatever it is that wells up in me when it's somebody else, I need to work hard to feel the same way about my own journey. But it's definitely a process. Kimberley: Oh my gosh, you're on fire. These messages are so incredible. And I think it's exactly like what people need to hear. It's the pep talk they need. I want to be respectful of your time. Is there anything you want to say about your journey that you think would be helpful or that would be great for you to share? Micah: Yeah. I think the only other thing I would say, and I say this quite often, but I just think in my journey, I think early on in my journey and especially when I was coming to intensive treatment, I wanted everything to happen fast. I wanted a quick fix. I was hurting so badly that I wanted things to get better so quickly. And I think one of the things that has become a mantra for me personally in my recovery is that my recovery was definitely not immediate, but it has been and continues to be substantial. And I think that's a truth about my recovery that I've really tried to hang onto. Because I'm very much this person that I don't want to just-- when people are looking for hope in my story, I don't ever want to just say something that's hopeful if it isn't entirely true. And so, the thing I tried to say, at least I can't say what will be appropriate for someone else's recovery, but my recovery, it has not been as fast as I wanted it to be. I think it's so important to be transparent with people and say, I have suffered with this disorder far longer than I ever would've wanted to, but my life has become and is continuing to become far more than I once thought it was going to become. And so, there is that bittersweet hope in that, I think, is the most honest and encouraging thing I can say about my experience. Kimberley: You're such a shining bright light. Thank you for sharing that. I feel it. I've got goosebumps. I love when I get to interview people, I get goosebumps the whole time. I'm so grateful for you sharing all of these wisdoms that you've shared, and that's what they are. They're just such deep wisdom. Can we hear where people can hear more about you, learn about you? How can people get your stuff? Micah: Yeah. Right now, I don't have a ton going. I hope to have more going in the near future. But if people want to reach out to me on Instagram, they can find me at @mentalhealthmhe. Kimberley: Okay. So amazing. I'll make sure to link that in the show notes. Micah, it has been such a pleasure. Thank you for sharing all these amazing things. Thank you. Thank you. Micah: Thank you so much for having me on. This was a wonderful conversation. Kimberley: Oh, it makes me so happy. Thank you.

Dec 2, 2022

In This Episode: What causes anxiety? Is Anxiety "normal"? Genetic and environmental It is NOT your fault. You didn't ask for this You are doing the best you can with what you have Does that mean there is nothing you can do? No. What causes anxiety disorders? NIH - "Mood and anxiety disorders are characterized by a variety of neuroendocrine, neurotransmitter, and neuroanatomical disruptions. Risk factors- These factors may increase your risk of developing an anxiety disorder: Personality. People with certain personality types are more prone to anxiety disorders than others are. Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder. Having blood relatives with an anxiety disorder. Anxiety disorders can run in families. Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety. Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future. Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances. Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders. What causes anxiety in the brain? a primary alteration in brain structure or function or in neurotransmitter signaling may result from environmental experiences and underlying genetic predisposition; These alterations can increase the risk for developing anxiety disorders. Abnormalities in a brain neurotransmitter called gamma-aminobutyric acid — which are often inherited — may make a person susceptible to GAD, according to NIH Life events, both early life traumas, and current life experiences, are probably necessary to trigger episodes of anxiety. What causes anxiety and panic attacks? Same as above....but consider avoidance reassurance seeing Mental rumination other physical compulsions Self-punishment Links To Things I Talk About: Harvard research: https://www.health.harvard.edu/anxiety/generalized-anxiety-disorder#:~:text=Abnormalities%20in%20a%20brain%20neurotransmitter,trigger%20the%20episodes%20of%20anxiety . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684250/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 313. Hello friends. We are talking about what causes anxiety and why it is not your fault. So important. Okay, let's say it again. Why it is not your fault. I know you're probably beating yourself up for something related to your anxiety, that you should be handling it better, that there's something wrong with your brain. I want to really knock this concern, this belief, this thought out if I can, and try to replace it with some information that you can use in the moment to reassure yourself, not in a compulsive way, but just to remind yourself it's not your fault. Let's stop beating you up for something that's not your fault. If you saw something happen on the street and had nothing to do with you, you wouldn't probably blame yourself or beat yourself up or shame yourself. And I would like you to do the same for your anxiety. Okay? So, before we do that, let's talk about the "I did a hard thing." This is from anonymous. It's pretty cool, I have to say. Anonymous says: "I was diagnosed with relationship OCD this year after sharing my doubts and rumination patterns with a therapist. My parents have expressed concerns about a boyfriend I have been with for over a year, and I don't think these concerns are valid and my therapist doesn't think they're concerning either. My parents' comments still trigger my relationship OCD doubts big time. However, I have opened up to my parents about how I'm considering marrying my boyfriend and have responded to their criticism calmly without getting mad at them. It's been really hard to establish boundaries, but also be kind. But I feel like I'm on track. I also am trying to see my parents' criticism of him as a gift, at least I know that I can't go to them for reassurance and it's a great exposure opportunity." Anonymous, you are literally winning. The reason I am so thrilled, last week we did a whole episode on relationship OCD with Amy Mariaskin, and I really feel like you're mastering all of those skills that we talked about last week. So, that is just amazing. Congratulations on that hard thing. It's really, really cool work you're doing. And quickly, before we move on, here's the review of the week. This is from Susan in Plano. They said: "It's a life preserver! Kimberley, your podcast has been such a help to me as I pursue recovery from a particularly active and pesky flare-up of OCD. Diagnosed in 2007, I have just this year found an incredible therapist who specializes in anxiety and OCD . Your podcast encourages me to keep doing the hard things. It makes me laugh and assists me in realizing just how much company travels on this road (even when it feels lonely and isolating). I am profoundly grateful for your work, and I have personally recommended this podcast to at least ten people. Thank you so much." Susan, thank you so much. You guys, if you're able to leave a review, of all the gifts you could give me, that would be the most beneficial to me. I love your reviews. Go to wherever you listen to this podcast and leave a review if you can. It does help me to reach more people and gain their trust. So, thank you so much. WHAT CAUSES ANXIETY? All right, let's do it. What causes anxiety and why it is not your fault. Okay, so let's first look at what causes anxiety. The first thing to remember here is, anxiety is actually not a problem. And what I mean by that is it is normal and healthy and an important part of our functioning and survival. What we're talking about here is, normal anxiety has its roots in fear and what it really does is it helps us to respond to dangerous situations. So, if you were there facing some kind of dangerous, stressful situation, a bus was coming your way or your house was on fire, or your car broke down on the highway with tons of cars beating past you, you would naturally get anxiety. And that anxiety would show up to alert you that you must be careful and take care of this somewhat dangerous situation. When that happens, you'll notice your heart beating faster, your chest might get tired, you might need to pee, you might need to poop. You might feel like you need to throw up. You might feel an overall irritability or jitteriness. So many different symptoms. You might get dizzy, you might have a headache. So many symptoms of anxiety show up, not because there's anything wrong with you, but because that is your brain's way of preparing you for fight, flight, or freeze. It's very, very important. And so, it is a normal function of the body. However, some of us experience extreme degrees of this and our brain sends this "normal anxiety" out when there's not danger. Your brain is perceived there to be danger when in fact there isn't any danger. And this becomes a problem and it becomes a cycle, particularly if we respond to it. So, what are we talking about when we're talking about excessive degrees of anxiety, or in the case, we may be an anxiety disorder, which I'll get to here in a minute, is we understand that problematic degrees of anxiety or high levels of anxiety are caused by genetics, which is your generations above you. It's hereditary, but it's also caused by environment. We don't yet really understand what specifically causes it, but we know so far that it is a combination of genetics and environment. What that means is, you were probably genetically set up to have anxiety. It's in your DNA the day you were born, which is why I'm going to emphasize to you that it is not your fault that you have anxiety. A lot of this could be passed down multiple generations. So, you might be thinking, "What? My parents aren't anxious, my parents aren't depressed, can't be my family. Can't be genetic for me. Must be just something wrong with me innately." And I'm going to say, no, it could be paternal grandparents, maternal grandparents, or even further up the chain of genetics. Now we also know it could be environmental, it could be what you've been exposed to. We know that if you've been exposed to multiple stresses throughout your life, you may be more predisposed to anxiety. But we'll get to that here in a little bit. The thing to remember as we move through is this going to keep reaffirming to you that it's not your fault. You never asked for this. In fact, my guess is you're asked to not have this many, many times. You've asked your brain, why are you this way? So, you really didn't want this, you didn't ask for it, and you're doing the best you can with what you have. Meaning, even if it's environmental, you would make-- some people might go, "Yeah, if I didn't make this one decision, I wouldn't have been exposed to this one thing." We're all doing the best we can with the information we have. It's easier to look back with 20/20 vision, but in the moment, we're all just doing the best we can. Now, the thing to remember here as we go through is, please don't get hopeless. Just because it's environmental and genetic, it doesn't mean that you are stuck with this problem now and that there's nothing you can do. I'm going to outline here in a little bit close to the end exactly what you can do to have a toolkit to help you work through this situation that you've got this brain that's responding. So, let's really focus on that piece at the end. Okay? WHAT CAUSES ANXIETY DISORDERS? So, let's move on now. What specifically causes anxiety disorders? Now, I'm going to leave you some links here in the show notes. If you want to do more in-depth, I am not going to go into great depth here because it'll go over your head, most likely it goes over my head completely. They're using some very scientific words. Unless you have some kind of really great science, you have great knowledge in this area, I'm not going to go into that because I don't think it's beneficial to fill your brain with all these words. That doesn't mean anything. But basically, the National Institute of Health have said that mood and anxiety disorders – I'm actually reading directly from their website here – are characterized by a variety of neuroendocrine, neurotransmitter, and neuroanatomical disruptions. That is what they have said. And what they're really talking about is a bunch of functions that happen in the brain that can get disrupted, causing us to have a brain that sets off the fire alarm or the danger alarm too often, too many times. Now, what we also know, and this is actually coming from a Harvard Journal article, what we know is that they considered them to be risk factors for getting anxiety disorders. So, as we talked about above, anxiety is genetic and environmental, but what we do understand is that there are these particular risk factors that may make you more likely to develop an anxiety disorder. Again, not your fault, because we're set up with this genetically or we're exposed to these things environmentally. So, let's go through them just briefly. Number one is personality. So, this is, again, a genetic thing. People with certain personality types are more likely to have anxiety such as anxiety disorder like OCD, PTSD, panic disorder, generalized anxiety, health anxiety, phobias, and so forth. There are certain personality types or personality factors. We know people who are more hyper-responsible are more likely to have anxiety. People who are perfectionistic are more likely to have anxiety. People who like to have more control tend to have more anxiety because we can't control much in our lives like most of the people in our lives are. A lot of the times, we can't control environmental factors. And so, that can create a lot of anxiety. Another risk factor is if you have another mental health disorder. So, if you have depression, you're so much more likely to have generalized anxiety or panic disorder. If you have an eating disorder, you're so much more likely to have OCD, generalized anxiety, phobias. These are really important factors to consider. And again, those disorders are more likely to be genetic as well. We know and we've already discussed, you are much more likely and you have a greater risk if you have a blood relative with an anxiety disorder. They do run in families. We also know that there are some risk factors related to drugs and alcohol. So, misuse or withdrawal of drugs and alcohol can cause anxiety. And this is not even just hardcore drugs. It could be caffeine, alcohol, marijuana, even some medical drugs. So, talk with your doctor about if any of these drugs you're taking are causing anxiety. I have had clients report to me that they have several drinks or a couple of drinks every day, and they didn't really see that to be a problem. Or maybe a little bit of marijuana every day, they didn't see it to be a problem. But then once they took a break, they realized how much the alcohol and drugs were actually causing their anxiety. Same goes for caffeine. Again, I'm not giving you medical advice here. Please speak with your doctor about these things, but we do know that they are considered risk factors based on science. Another one, and you know I've done episodes on this recently, is stress due to an illness can be a risk factor for having an anxiety disorder. Health conditions can cause significant stress on you and your family and can be something that can also impact your ability to succeed in treatment because you're managing another illness, which I want to make sure, again, you recognize it is not your fault. You're doing the best you can at juggling multiple things at the same time. Another one is stress buildup. A buildup of stress over time can increase your chances of having an anxiety and an anxiety disorder. This could be worry about work, school, finances, children, your medical health. It could be the pandemic. We have a massive increase in mental health issues right now because of the pandemic and the effects of the isolation of the pandemic. Again, please give yourself a break for what you've been going through. And then the last one, again, this is according to a Harvard research review, is trauma. Children who do endure abuse or trauma or witness, this is for adults too, have witnessed traumatic events are at higher risk of developing an anxiety throughout their life. This is true for adults. And I think it's important that we acknowledge that. It doesn't mean it's always caused by trauma. Unfortunately, on social media, particularly Instagram, I feel like everything is caused by trauma these days. And I don't want to discount that for people who have been through a traumatic event. But please don't jump to that because then it confuses people who have anxiety and they didn't have a trauma, and it makes everybody question everything. So, it can be trauma, but we don't want to over-label that either. And I bring that up just because I do see everything being labeled as trauma these days, and that can be problematic and stigmatizing in and of itself. Okay. How are we doing, everybody? Are we hanging in? We're getting through this. I know it's a bigger, heftier session this time, but I think it's so important. WHAT CAUSES ANXIETY IN THE BRAIN? Alright, so let's now talk about what causes anxiety in your brain . Again, we're not going to go into too much depth here, but I'm going to throw some words at you, and we're just going to do the best we can. Again, this is from the National Institute of Health , and they said a primary alteration in brain structure or function or in neurotransmitter signaling may result from environmental experiences or underlying genetic predisposition. Again, what they're saying is environmental experiences and genetic predisposition can both create alterations in the brain structure or function of your brain. So, we are really getting clear on that. And these alterations increase the risk. Now, what they're saying here is abnormalities in a brain neurotransmitter called gamma-aminobutyric acid are all often inherited. So, don't worry about that big word. It's just saying these abnormalities are often inherited and do make us more susceptible to, specifically here they were talking about generalized anxiety, but we do have information about that also being for OCD and panic disorder and so forth as well. Link is in the show notes if you want to read more about this. They're also saying life events can trigger these. And what we know is our brain is what we call "neuroplastic." Meaning, events can change our brain to having these alterations causing anxiety. But if we change our behaviors, we can actually reverse that in your brain. So, this is where we start talking about solutions to the problem. We can reverse the alterations made to our brain, particularly the neurotransmitters that were caused by genetics and environmental, when we change our behaviors. WHAT CAUSES ANXIETY AND PANIC ATTACKS? So, let's talk about it. If we were to just overview what causes anxiety and panic attacks in general, we could say we've clearly outlined as genetics and environmental factors. That is completely out of our control. When we have these environmental factors or genetic predispositions, often, as I talked about, when our brain perceives anxiety, our natural instinct is to run away or do something or fight it. That's your natural reaction. Anybody would do it. Anybody in your situation would do it. Again, I'm going to reinforce, this is not your fault. But what we do is when we have that faulty system in our brain that sets off an alarm that tells you there's danger, what we end up doing is a bunch of what we call safety behaviors to try and reduce our discomfort and reduce our anxiety. Safety behaviors such as avoidance, reassurance-seeking, mental rumination, physical compulsions, or self-punishment. So, when we do that, our brain then goes, "Oh, they're interpreting this as a danger. They're responding to it as a danger. So, next time I have that thought or that situation, I'm going to send all the anxiety again." And so, when it comes out again, if you respond with avoidance and reassurance-seeking and mental rumination and physical compulsions and self-punishment, you're now stuck in a cycle where we reinforce the fear, the perceived danger. So, here is again where I'm going to offer to you, we have some options of intervening into this cycle. We talk about this in ERP School, the online course for OCD. We talk about it in overcoming anxiety and panic in our course for anxiety and panic on breaking the cycle by reducing our reaction to this stressful event or this brain danger alert. And when we do that, we can actually reverse that alteration in the brain. We have scientific proof of this, so I'm so excited that we get to do this together. It's not like we end the episode by going, "Yeah, this is the problem and there's no solution." There's multiple solutions. And it's about really, again, intervening at the reaction we have to that anxiety. If you have a therapist, I want you to be talking with them about how you can intervene and break the cycle. If you don't have a therapist, consider going to CBTschool.com and looking at some of the courses that we have that may help you understand this process and help you intervene where and when you're ready. Those courses are self-led. They're not therapy, but they may help you look at the cycle and see where you're getting stuck. And so, that is where I'm going to leave you guys, which is with so much hope that, number one, we know what causes anxiety. We know very clearly, it's not your fault. And then we can all come together and work at reducing the cycle that happens and changing our brain. It's so cool. So, so cool. Thank you, guys, so much for being here with me. That was a hefty episode, but I hope you found it helpful. I'm so happy to get through that. Actually, I feel like that was super productive. And for me even, it's like, oh, it's so good to know that we can do so much about this. So, as you guys know, I'm always going to say it's a beautiful day to do hard things. Go and do some hard things today. They could be small hard things, big hard things, it doesn't matter. Just baby steps lead to medium size steps, which lead to life-changing steps. Alright, my loves, have a wonderful day. I will see you next week. Please do go and leave a review. It should take you no more than a couple of minutes and it will help me so much. Thank you so much.

Nov 25, 2022

In This Episode: Amy Mariaskin, PhD shares her new book, Thriving in relationships when you have ocd What is Family accommodation and how does it apply to ocd Ocd family accommodation vs family support, What is OCD reassurance and how it can creep into one's relationship Relationship ocd, also known as rOCD Relationship issues with ocd and how to manage them Sexual orientation OCD, Gender related OCD, and Harm OCD and the impact this has on relationships Attachment styles in ocd and how to understand them to help you navigate communication. Links To Things I Talk About: Thriving in Relationships When You Have OCD: How to Keep Obsessions and Compulsions from Sabotaging Love, Friendship, and Family Connections Amy's Instagram https://www.instagram.com/ocdnashville/?hl=en ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This Your Anxiety Toolkit - Episode 312. Welcome back, everybody. This is going to be a really important episode for you to listen to. Today, we have the amazing Dr. Amy Mariaskin, who is what I consider to be a very dear friend, someone I very much respect. She has written a book about relationships and OCD, and we talk all about it. We go deep into some of the core skills and discussions she has in her upcoming book. And this is just going to be an episode I really feel like you could take away and put some skills together right away. I'm so thrilled. So, thank you, Amy, for coming on this show. But before we do that, I would like to do the review of the week, and I really hope you listen carefully to this. Not because it's reviewing the podcast, but because I actually think the person who wrote this, who put in this review, is following some key points that I want you to consider. And this is what I encourage a lot of people to do. So, let's go. This is from Detroitreview and they said: "Thank you, I just started listening today after having a few weeks of anxiety and irregular thoughts that I never experienced. I randomly chose your podcast and am thankful for your experience, knowledge and personal and situations. As a 46-year-old father of two boys and loving wife, your podcast gives me a sense of calming. I'm taking notes on each cast." Guys, I encourage you to do this. This is a free resource. It is jam packed full of skills. I encourage you to take notes. So, I love that you're doing that Detroitreview. "While I started with the most recent, I have listened to #301/302/303." And then they went on to say: "And they've already given me strategies that I'm using. I decided to start from your first podcast in 2016." And that is what I encourage you all to do, mainly because those first 11 episodes are core content. I want you to take the content I talk with my patients about all the time. He went on to say, "I have been so impressed. I've listened to 1-2 daily. I'm up to 10 and 11. There's so many things to listen to and I'm so grateful for you. The meditations are amazing. Keep up the great work." Thank you so much for that review, Detroitreview. That is exactly my intention. This is a free resource, you guys. I want you to take advantage of the skills and tools so that you can have a toolkit for yourself. And so, I'm so thrilled for that review. It just makes me feel like, yes, that's exactly what I want you guys to take from this podcast. Okay, before we get over to the show, let's talk about the "I did a hard thing" segment. This one is from Kelly, and they said: "I recently faced one of my biggest fears – general anesthesia." Holy moly, Kelly, I feel you on so many levels with this. "I started struggling with some gallbladder issues and was told I needed to have it removed. I was terrified, and I didn't think I could go through with it. Thoughts were racing out of control. I sought help with therapy and your podcast. Thoughts are thoughts and not facts was huge for me. It was calm the day of the surgery, and I did it. Thank you." That is amazing. You guys, listen, thoughts are thoughts. Just because you have them doesn't mean they're facts. I love that they're bringing in that key concept as well. Alright, let's go over to the show. This is the amazing Dr. Amy Mariaskin. She's an OCD therapist. She's an advocate. She's an author of an upcoming book. You must go and check it out. I'll leave the link in the show notes. I am so, so honored to have you on the show, Amy. Let's get over to the episode. Kimberley: Welcome, Amy Mariaskin. I am so excited for this episode today. Can you do a little introduction of who you are and all the good things about you? Amy: Yes. Thank you so much. I'm excited to be here. I'm Dr. Amy Mariaskin. I'm a licensed clinical psychologist and owner and director of the Nashville OCD and Anxiety Treatment Center in Brentwood, Tennessee. I've been working with OCD and anxiety for over 15 years now, and I just absolutely love it. Kimberley: And you wrote a book? Amy: And I wrote a book. I know I need to get better about that. I was like, "Oh, do I say it now or do I say it later?" Kimberley: You say it all the way. Amy: All the time. I wrote a book. It was fun and not fun and everything in between. And I think we'll be talking quite a bit about it. It's called Thriving in Relationships When You Have OCD . Kimberley: Right. Now, when you told me that you were going to write this book, I was so excited because I feel like at the crux of everything we do, a lot of the time, the reason people with OCD want to get better or the thing that propels them is how much their OCD impacts relationships. Not always, but I feel like that's such a huge piece of the work. So, I am so grateful for you for writing this book, and it is an amazing book. I've read it myself. You did a beautiful job. And I want to cover some of the main pieces that you cover in your book today and go from there. So, first of all, congratulations. I know writing a book is not easy. Amy: Thank you. Yeah, it's been a dream for a long time. So, I'm excited about the accomplishment and I'm ready to figure out the next topic. When Ocd Is The Third Wheel Kimberley: Yeah. I love it. I love it. Okay. So, Chapter 1, I think it's funny. I'll have to tell you how, when I was reading your book, I was lucky enough to get an early manuscript. I remember sitting, it was with my kids at track and they were running. And I opened the book and the first chapter said, "The Third Wheel: Understanding OCD's Role in Relationships." And I was like, "That's exactly it." So, I was excited right off the bat. Tell me, what do you mean by the third wheel? Tell me a little bit about that. Amy: Yeah. First, I should also thank you for writing the wonderful foreword for the book. So, if anybody is a fan of Kimberley, yet another reason that you might be interested in this book. Well, let me think. So, yeah, the third wheel analogy, it felt very apt because when I work with couples, I often imagine, and sometimes I'll have couples imagine that the OCD is like this other presence in the room sitting there with us. Not physically, but in all the things that are important for relationships, all the ways that we develop intimacy, and that we even structure our time or the activities we choose to do together that OCD can wiggle right in there and can be this like third presence. And the thing is, it's really easy, I think, for somebody without OCD if they don't have good education or they don't understand it, to get that third wheel confused with the person with OCD itself. So, like, "Well, you never want to go out," as opposed to saying, "We both want to go out." And here's this other guy, OCD, really bossy, really pushy, really oppressive, who's also coming along with us. And even when you do the things that you love, OCD can come along. So, it felt to me like this sense of something in the relationship that makes it both unbalanced and is this separate component and that both people, in coming together, have to find creative ways to connect around it or eventually connect and evict it more and more. And so, that's why I chose that metaphor. Kimberley: Yeah, I love that. And it's funny because I remember when I was an intern and I was seeing a family or perhaps the wife who had OCD, what was interesting is I'm sitting in my chair and I noticed that the family members always sat across from her as if it was like her versus them, like who's on which side of the team. And a big part of it was like, all you guys need to be over on that side of the room. You're the team. I'll be over here with OCD and we'll work this out. But I think that that, even metaphorically, is such an important part of how OCD can turn everyone against each other. Is that how you've experienced it? Amy: Yeah, I think at times there are a lot of conversations about how everybody has a common goal to figure out how to live with one another, develop intimacy, connections, be they friendships, parenting relationships, romantic relationships, even work relationships, and things like that, how to form those and how to come together around common goals. And sometimes OCD can be, again, confused as a goal that one person in the relationship has. And the truth is, everybody's suffering in a way, and that everybody can be a part of that process of, again, reducing symptoms or evicting it, things like that. I do the thing as well when I have people in my office to just look at where are they sitting or when OCD comes up, what is the body language? Are both people really like arms crossed? Is the person with OCD hanging their head in shame, which we know could be such a powerful emotion and such an inhibitor of connection and vulnerability. So, I look for some of those and I remind them, "Head up, we're all talking to OCD right now, and we're all working with that, and we're all on the same team." Family Accommodation & Ocd Kimberley: Such an important message. Thank you for that. I think that's beautiful. So, let's say the third wheel, I always think of like you go on a date and the third wheel shows up. And we know that definitely happens with OCD. You addressed a lot in your book about family accommodation. Can you share what that means and how that can impact a relationship? Amy: Yeah, absolutely. Accommodation is this thing where we're extending this metaphor. You're on a date, you're with somebody, and the third wheel rolls on up. It's, "Hey, my buddy from college is here, what's up?" Essentially, accommodation is like, "Hey, why don't you have a seat right here? Here's the menu, here's a place mat." It is anything that the person in the relationship without OCD is doing to make OCD have a comfortable place at the table. So, that's the metaphorical way. That's abstract, but bringing it down to practically what it looks like, it means doing things generally in the service of what feels comfortable in the moment for the person with OCD. We're going on a trip and I have concerns about contamination and I really want you to check all the hotels, do all this research to make sure that none of these places have ever had bedbugs or things like that. Then when we get there, we're dirty from traveling, so I'm going to need you to take a shower. And so, the person, the spouse is taking showers and doing research and perhaps taking over responsibilities from the person with the OCD in order to provide that short-term relief. But it ends up, again, making a place for OCD in the relationship. And it reduces that motivation for the person with OCD to change. Family Accommodation is tricky. There are a lot of ways that it can happen. I think reassurance-seeking is certainly one that I think we'll talk about, but providing excessive reassurance about things to the person with OCD in a way to keep them comfortable but keep them caught up in compulsions. And I think it's important to note that a lot of times, partners will hear about accommodation. And just as much as we think being apprised of accommodation and looking out for it is important, it's also, I think, really important that partners understand that that's nuanced and that they don't take it to like, "Well, I'm not going to do that for you. That might be accommodation," or, "I'm not going to reassure you about anything," or "Is that your OCD?" I guess I say that to say that it's a little tricky, but it's really anything that is preventing the person with OCD from experiencing discomfort and thereby strengthening the cycle. Kimberley: Right. No, I'm grateful that you bring that up actually, because probably the one that I get asked the most from parents, and this not in every relationship, but with parents, is like, okay, my child is having a really hard time getting homework done, their OCD is impacting them. So, if I don't help accommodate them, if I don't do some compulsions for them, read for them or so forth, they won't do their homework. And then there's an additional consequence. So, they'll say like, "I feel like that's too risky. I could actually be letting my kid fall behind, so I can't stop doing this accommodation." What are your thoughts on that? Again, how would you approach that type of situation? I mean, there's many examples. Amy: Sure. I think with a situation like that, first, I would validate the parents' love and desire for their child to do as well as possible. Most accommodation is coming from a place of love and not a deliberate enabling or anything like that. Of course not. So, I really provide a lot of validation there. And then I help them reframe it as, "One way to be loving and supportive in the long run is to really cheer your child on in taking over, taking on more and more ownership of that." So, does that mean, "I know that I've been reading. Right now, I've been reading for you, and that makes it easier to do your homework. We also know that you have OCD and we know that your brain tells you, you've got to reread and reread and reread. So, can we be on the same team together, fight that rereading? I'm not going to read it for you because I love you, because I know you can do this. Boy, is it going to be hard at first and I'm going to be there to cheer you on and motivate you." I sit with kids, I'm always about gamifying it. "Do we want to just race through this? We don't have to be perfect." Again, it depends on the symptoms, if it's perfectionism or what's getting in the way. And then what I say is, if a parent says, "Well, then they're really just not going to get their schoolwork done," sometimes then I'll say, "Well, if it gets to the point where it is interfering with things like that, then it may be that they need a little bit more support." Because it's like, with kids, your job is school and with the adults, your job can be a job or it can be care taking. It can be a lot of different things. But if one of those major domains of living is affected, then it may just mean that you need more support. So, we might up the number of sessions per week or refer out to another program or things like that. But those kinds of things would be the same things I would say in any kind of relationship where there's an accommodator, which is, wow, you love your friend or partner or coworker so much that you're willing to do this stuff for them so that they're not suffering or so that they can demonstrate their potential as in the case of the kid with homework. But here's why that's not the loving response in the long run. Ocd Family Accommodation Vs Ocd Support Kimberley: Right. You're right. I mean, you mentioned like, then we have the complete other end of the spectrum where people are going, "No, I'm cutting you off completely." And I think too, I think it's important, as you said. Some accommodation happens in every relationship. I don't particularly like cleaning hair out of the sink drain. That's not my favorite. So, I'm going to ask my husband to do it, knowing that I take the trash out or whatever. We trade-off. So, how might people identify accommodation through the lens of OCD compared to loving exchanges of acts of service? Amy: Right. Oh, I love that question, because essentially, what we call compromise in relationships could be called accommodation – accommodation by a gentler name. And I think part of that has to do with, what's the motivation there? You do such a wonderful job in your podcasts and online and everything of talking about how doing the hard things are important, and how if you're not doing the hard things and you're avoiding difficult things that can really shrink your world over time and put anxiety or OCD in the driver's seat. So, if the motivation, if a child or a spouse or a friend is asking-- well, if you are asking a child or a friend or a spouse, if you're saying, "Hey, can you do this for me," or "I'd feel a lot more comfortable if you did this," thinking about, is it a compulsion or a preference to me? There are so many different ways that we can look into that, but is it in the service of just like, I could, but I prefer not to? Or is it, I feel like if I do that, I'm going to be too anxious or I'm going to do too many compulsions, or something bad is going to happen? So, I think if the motivation there is more avoidance due to anxiety as opposed to just preferences, I think that's helpful. Sometimes I'll say to people when they'll say to me like, "Well--" and I think division of labor in the house is such a good example. When people say, "Well, I don't ever take the trash out," I will often ask, "Well, what happens when your roommates are out of town?" Let's say they're living in a roommate situation. And if they say, "Well, it just piles up and I can't deal with it," then I say, "Aha, this might be a place that we need to work on and chip away." And again, reducing accommodations doesn't mean like all of a sudden, I'm a garbage master and I'm the only one doing it. It might mean that I'm doing some exposures to get up to the point where I can have that role in the household. So, I love that question of like, well, what if you had to do it? What would that be like? And if it's really hard, then hey, let's help break down some of those barriers and reduce accommodation. OCD Reassurance Kimberley: Yeah. I usually tell clients like, "Okay, let's just do it so that we know you can, and then you can move on to the next exposure." Tell us about reassurance. You talked about it a little bit. And in your book, actually, the thing I highlighted, because I read it in Kindle, that I love the most is your reassurance tracking. Tell us a little about that. Amy: Yes. Because again, I love that you're highlighting this because reassurance is something that is okay. Reassurance happens in all relationships. Again, we might call it by different names. It might just be checking in. It might be clarification. It might be getting information from one another. So, I developed a worksheet that's also available with the book that allows for people to track when they're asking for reassurance from loved ones, and to answer a series of questions that aren't going to give you a 100% certain answer of whether or not it's compulsive, but are going to give you some clues. So, on the worksheet, it says, people write down the situation. So, for example, I was asking my friend if she was mad at me. That might be the situation. And then there's a column that says, what were your emotions? Again, if we're seeing anxiety, guilt, shame, some of those words might be a clue that our OCD is at play, but not always. And then people track, did you ask only once? Because we also know if it's truly the type of reassurance, "Oh, I just need to know. I'm having a vulnerable moment. I just need to know, is this okay with you? Are you upset?" Then asking once and accepting the answer is generally how it goes. So, if you're asking more than once, if you answer no to that, it's a clue that it could be compulsive reassurance. And then also, was the source credible? I feel like I talk about this example a lot, but I just love it so much, which is that I worked with a little girl who was really worried about getting strep throat. She would ask everybody for reassurance about her tonsils. I mean, anybody and everyone. At one point, she took a picture and she was just old enough that she got social media. She put it on her Instagram and she was like, "Do you guys think I have a strep throat?" That was the caption. That was the little caption, which is like, she was laughing about it afterwards, but that's not a credible source. I mean, she wasn't even friends with all the docs in town or anything, or ear, nose, and throat specialist. So, was the source credible? Now, often if it's social reassurance, it is a credible source. If I ask you, if I say, "Kimberley, was I too long-winded," you're going to be able to tell me. So, you would be a credible source. If I leave this room right now after doing this podcast and I ask somebody, "Do you think I was long-winded? Do you think I was?" and they're like, "Well, we weren't there," that's that answer. That's that question about credibility. And then the last one is, did you accept the answer? Anxiety and OCD have this way of undermining. Well, pretty much everything, but undermining any answer we get and countering with it. 'What if,' or 'Are you sure?' 'But I think...' So, if it's starting with a 'but,' a 'maybe,' a 'what-if,' then again, it may not be that helpful reassurance-seeking. Relationship Ocd (Rocd) Vs Relationship Issues With Ocd Kimberley: Yeah, I love that. And thank you for adding that because I just love that template so much. That is just like gold. I love it so much. Alright. So, as you move into Chapter 4, I believe it is, you talk about specific subtypes of OCD that are commonly impacted in relationships. Can you share just briefly what your thoughts are around that? Amy: Yeah. I love this question too because as I've been talking about the book, a lot of people are like, "Oh, great, a book about ROCD, or relationship OCD." And my answer to that, or my response to that is, "Yes, and..." Just a step back, any subtype of OCD can affect and often does affect relationships. Why? Because OCD goes after what's important to us. And for many of us, our connectedness with one another is just so important. That being said, there are subtypes of OCD that are relational in nature. And so, I do have a chapter that is more devoted to these types, and one of which is relationship OCD. This is a passion of mine. I've done now a few iterations of an ROCD treatment group at my clinic, and I have other plans to expand that group and do some cool programming around that. But relationship OCD, it's basically when OCD symptoms are about the relationship itself or about the person with whom you're in relationship. So, it could be about-- we think about it a lot of times with romantic relationships, but it could be any relationship. To use a different one, it could be, am I a loving enough parent? Do I love my kids enough? How do I know? Do other parents have these thoughts? So, it could be about the relationship or it can be about the individual. Like, my spouse doesn't like the same music that I do, and are we ever going to get past this? And so, something that might be seen as, yes, it's an actual difference, but then there's all this story making around the difference and how the difference is going to be the demise of the relationship. Those are the two flavors of ROCD, relationship and partner-focused. I also want to pause here and say that oftentimes when people talk about ROCD, I feel like there's this pull to say, "Well, if you know you have ROCD, if relationship issues come up in your relationship, it's probably your ROCD." And that's just like another backdoor to the certainty that we all want. I think all relationships have some crunchy bits and some edges that chafe. And so, I want the people with ROCD to feel empowered to also develop the relationships that they want and then notice that maybe the ROCD turns up the volume on some of their concerns, if that makes sense. Kimberley: It's hard, isn't it? Because so many times a patient will say, "But I don't know if I really love-- is he the one?" And we're like, "Well, we'll never know." There's no way to objectively define that. And then someone, a friend is like, "Well, if you don't know, it must be a problem." It's so hard for those people because people without OCD also don't know all the time either, so it's a common concern. Sexual Orientation Ocd & Gender Related Ocd Amy: Right. No, that's a great point. So, I have some stuff about relationship OCD in there and then the identity subtypes of OCD as well. So, sexual orientation OCD and gender-related OCD . I put those in there because oftentimes our identity is the foundation from which we interact with others and create relationships and things like that. So, I talk a little bit about sexual orientation OCD, not just even in dating, but in finding a community and friendship and things like that. SOOCD can rear up and lead to lots of social comparisons or it can just really try to sabotage certain relationships, and with gender-related OCD as well, be it somebody who is cisgender and wondering if they are transgender or vice versa. I've worked with people in the transgender community who have OCD and have these unwanted thoughts about like, "Well, what if this is not who I am? What if I've been doing this for attention?" And then, therefore, are wanting to compulsively disengage from their community because of the feeling of like, "Well, I don't feel authentic enough." So, that's a way in which that can root in relationally. Kimberley: Right. So, we've got relationship OCD and identity. What are the other ones? Harm Ocd & Its Impact On Relationships Amy: Yeah. And then the last one that I highlighted in here in that section is harm OCD. And I put that in there because harm OCD , which again is a huge category, which I would say under that are anything that's violent. That could be sexual as well. So, sexual violence toward others or sexual intrusive-- obviously, all intrusive thoughts, but intrusive thoughts about being sexual with children. I would roll all that into the harm OCD category. And this one is just, it's always so striking to me the ways in which OCD can take something that's really important. Like, I want to be a good person, I want to be a kind person and then undermine it. So, the amount of people I've worked with harm OCD who are experiencing isolation and really the self-imposed isolation, the irony of which is "I'm isolating myself because I don't want to harm others," but then they're withholding themselves as this fantastic person to be out in the world. And so, that's what I always say, is you're doing more harm isolating, but sort of. Get out there. You have so much to offer and in fact, your OCD has attacked this area because it's important for you generally to have relations with others. Kimberley: Yeah, I love that. So, I love how you've given us a way, and as you said, it can impact any relationship outside of those subtypes as well. What I'd love to do is give you the mic and tell us just now, in general, give us your best relationship ideas, advice, tips, tools, whatever you want to call them, for the person with OCD and the loved ones of people with OCD. Amy: Yeah. Thank you. I feel like that's a dangerous thing to be giving me the mic. Kimberley: It's all yours. Go for it. What's the main thing you want people to know? Amy: I think I want for people to be able to-- number one, there's no right or wrong way to have a relationship provided that everything is consensual and respectful. And so, taking a step back-- and actually Russ Harris just put out this. I don't know if you saw this, but this incredible list of relational values words. So, there's an activity where-- or I don't know if it's new, it's new to me. That's clarifying what are your relational values and what are they with different relationships? Is it playfulness? Is it intimacy? And so, figuring out what you want and having your spouse do the same. In our relationship OCD group, most recently, we had people and their significant others, I shouldn't say spouse, do this and figuring out ways to connect around those things. I think it comes down to connection and to supporting each person, like supporting each other's goals. I think I'm bringing this up in part because I think sometimes there are these narratives out there about like, we have to have all the same interests or opposites attract. And again, to that, I say yes, and... For some people, they want people with really similar interests and for others, they want somebody who's going to be different. But I think what we can do is support each other and try to see the world through your loved one's eyes and try to celebrate when they're celebrating. I think part of this is like, I'm married to somebody who's a huge thrill seeker. He's paragliding. He just got his private pilot's license. He does things that are not in my nature. If he's gone out and he's done some sort of paragliding trip in a different country, and he'll come back and he'll say, "I found a lift here and there were thermals," in my head, I'm like, "You didn't die. You didn't die. Yeah, you didn't die." And I have to stop my own anxious story about it or my own interpretation of "I wouldn't like that" and just be there with him in that moment of sharing his joy. It's finding joy in others' joy. It's being there with other people's emotions about whatever they are. Because I think with anxiety and OCD, it can always be this upper-level analytical process of like, "Oof, I don't like that. Is that okay?" or things like that. I know a lot of the Gottman's research will talk as well about how very important it is to just support one another, be cheerleaders, et cetera. Attachment Style & Ocd I think too, knowing your attachment style. And this is a whole topic that we could spend forever on, but knowing if you're somebody who-- when you get close to others, do you feel more resistance in getting closer or do you feel worries about like, "Ugh, I don't want to lose myself by merging with someone else"? Or do you have more resistance around, "I'm worried they'll abandon me, I'm worried they won't love me enough?" And that's a very, very, very rudimentary look at two of the concepts of attachment, that more avoidant attachment where it's, "I'm worried I'll be subsumed by the other person and I value independence," or more anxious attachment, which is, "I'm worried they won't love me enough or I'll be abandoned." Knowing that and knowing when those thoughts come up, take a pause, take a step back and check in with yourself and your body and the facts and things like that, instead of reacting in that moment. When anxiety is there, it wants us to just react to every alarming or provocative thought that we have. So, yeah, those are some things. I know that I had them scrolling through because I know I had more in the book from the Gottman. They're top of mind. Kimberley: I think back to when I was first married, I was so young. So, if someone had explained to me attachment styles, it would've made the first five years so much easier. You know what I mean? My husband would go away. He's actually away right now. He would go away because he loves to fly fish. And for me, I would feel anxiety because he would leave and I would interpret, because I'm anxious, and I was like, "No, this isn't hard for me to be alone." It would quickly turn to anger towards him for having a hobby. I'm totally fine to say this too. I'm feeling anxious here by myself. He's off doing something fun for him. So then I got angry that he's doing fun things and leaving me to have my anxiety. He would come home not to a happy wife. He would come home to wife with her hands on her hips. You know what I mean? And I think that that is so common for people with anxiety. When you're feeling anxious, you feel like they're doing it to you like, "Why are you doing this to me?" And then that can create a whole narrative that can interfere in relationship. So, that's just a personal example of how, if I had have known my anxious attachment early in our marriage, I think that would've saved us a lot of fights. Amy: Yeah. Oh, I love that example. And I feel like for me, as somebody who tends toward the other side, I tend to feel more worried about being stifled by relationships. I want to be fully seen and encouraged. And so, sometimes, in particular with friendships, if I've had people who are like, "I've felt exactly the same way," or "I had the same experience," or "We should do this all together. Let's get matching jackets," I'm like, "I am an individual." I get really threatened because my feeling is-- my brain's automatic interpretation is they don't see you because they think that you are just-- they assume like we're all the same, whereas they're just like, "We want to affiliate." So, I've had to do some work there as well, even with friendships, to know like it's not-- people aren't trying to kidnap my identity and merge it with theirs. They're actually just being loving. Kimberley: Right. But it feels threatening. Yeah, absolutely. I think the last question I have for you is, it goes back to that accommodation reassurance piece, particularly related to these dynamics. And maybe this is just my experience, I'd actually love to hear yours. What I do find is, when the person with OCD is coming from an anxious place, like often overanalyzing things, hyper-attending hyperawareness of things, their need for reassurance or their need for everyone to follow what OCD tells the family to do, I have found that the partner, because it's so overwhelming for them, tends to flip to the other end of the spectrum where they don't worry about anything or they're like, "It's fine." Or maybe even they're frustrated of like, "It's fine, it's fine." Have you noticed that as a trend in dynamics of a relationship? Amy: Yeah. Sometimes almost like there's a dismissiveness. Yes, I have noticed that and I think that there are so many reasons why that can happen. And I think for the partner and their experience, getting at what that is and what's motivating that is so interesting because, to the person with anxiety or OCD, it can feel really invalidating, or it can feel very comforting. But I think a lot of the times, it can feel invalidating and the partner might be doing it because they might be having their own feelings come up about, "I don't know what to say." I've tried to use facts and sometimes facts can bounce right off of OCD if you're not in the mindset to accept them. OCD is skeptical about everything. So, I've tried everything and I'm really now at this place of like, "I am so tired." And it'll come out. "I'm so tired of hearing you talk about this." And that's when, as a clinician, I see time out. I think you're both really tired of this cycle that OCD has you both in. So, yeah, I will see that. And I think sometimes when that's the pattern as opposed to a lot of overly accommodating, I think when that's the pattern, the element for me in working with couples to inject back in there is the validation of, "This is really hard." And also for them to take a step back and realize, well, not everything is going to be OCD either. Sometimes if there is reassurance-- I mean, again, the irony is sometimes this pattern can lead to more reassurance because then it's like, "Well, you just dismissed me. You said that there's nothing wrong in our relationship that you did it in a manner that felt dismissive. And so, now I'm going to ask again." So, yeah, deconstructing that pattern. Does the partner feel angry? If so, you're angry at this pattern, not your partner. Does the partner feel helpless, hopeless? Did they feel scared? Are they grasping at straws? So, yeah, that would be how I would look at that when I see it come up. Kimberley: Oh, thank you. I'm so grateful that you shared all that because I think they are all great questions that need to be addressed within the relationship. Thank you. So good. Okay, tell us about your book. I want to be respectful of your time. Tell us about your amazing book, which I think every family that has members should read. Tell us about it. Amy: It's called Thriving in Relationships When You Have OCD: How to Keep Obsessions and Compulsions from Sabotaging Love, Friendship, and Family Connections . It's available for pre-order as of the recording of this, which is in October, but I think this is going to come out later. It will be hot off the presses December 1st from New Harbinger Publications, available on Amazon, available through New Harbinger, I think available on other websites. People keep sending me links and I'm like, "Wow, that's really cool." So, yeah, I tried to cover all different kinds of relationships. We talk about family relationships, parenting, romantic relationships, sex and intimacy and those kinds of relationships, friendships, work, and really just a relational lens to what can be a very isolating and security disorder. And I don't want anyone to feel like they have to go at it alone. Kimberley: Thank you. Again, hats off to you. Much respect. You did a beautiful job writing the book. It's an honor. I was so honored to write the foreword. And I think, again, it's like a handbook I think everybody needs to have on the onset of being diagnosed. Here's the book to make sure you can protect your relationship and nurture the relationship outside of OCD. So, thank you. Amy: Well, thank you for having me.

Nov 18, 2022

In This Episode: What if people notice I am anxious? How to handle the fear that people ill judge you Tools to manage anxiety Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 311. Welcome back, everybody. I am so happy to have you with me today. Today, we're talking about what to do if people notice how anxious you are. This is something that I've even thought about myself. When you're having anxiety, it's like, "Are people noticing how anxious I am?" And when you worry about that or you think about that, sometimes it can actually create more anxiety for you. Quite a few of you have asked this question to me in the past, specifically around when doing exposures. As you go to do your exposures, then you have this secondary thought of like, "Oh my goodness, are people actually seeing how anxious I am?" So, I wanted to do a podcast just about this topic. Before we get into the episode, let's quickly run through the "I did a hard thing" for the week. This one is from Anonymous and they said: "My son just started preschool this month. For context, my OCD and anxiety has me housebound for the last two years, and never in a million years did I think I was going to be able to handle this. I still feel discomfort and struggle with intrusive thoughts, but the sparkle in his eye when I pick him up makes it all worth it. This has reinforced the importance of pushing through even when it's hard." Anonymous, this is so good. Look at you go. And I think we can all resonate with being so overwhelmed with anxiety, but we make decisions based on our values, not our fear. And then we get to see people sparkle in people's eyes or our own eyes. And I'm so excited to have you share that with me. So, thank you so much. All right, quickly, review of the week. This is from Sybil Cross and they said: "Compassionate and competent care. My ERP therapist recommended this podcast to me and I love it! It is both educational and supportive. It helps me learn more about my OCD and feel comforted, all while retaining its therapeutic value. Thank you for all your hard work and love, Kimberley!" It is my pleasure. Thank you, Sybil, for sharing that amazing review. Please do go and leave a review. I know I say it every week, but you do not understand how helpful it is to me. I am really doubling down in 2022 and next year on really making sure this podcast reaches as many people and makes a massive impact. So, your reviews mean so much to me. All right, let's get over to the show. Have you ever been out and about doing your thing socially and then all of a sudden, you have anxiety and then you start to worry, what if people start to notice that I'm anxious? If this is you, you're going to want to listen up because today we're going to go through what to do if people do notice or what to do if you're afraid of people noticing that you have anxiety. So, thank you so much for joining me again today. I love spending time with you, talking about all things anxiety. Let's talk about what to do if people do notice that you have anxiety. So, the first thing to ask yourself, and I love asking questions because I think it really helps us to really understand the actual problem, but what I'm going to ask you is, what's your actual fear? If you're afraid of someone noticing that you are anxious, what are you actually saying there? Are you afraid that maybe they're going to judge you for having anxiety? Or are you afraid that there may be some consequence for having anxiety? Sometimes people are afraid in certain work environments or school environments. Or is it that you're afraid that if they notice you have anxiety, that then you'll then have even more anxiety and then that creates a perpetual cycle? Let's take a look at these outcomes depending on which one you struggle with. So, let's talk about first the fear that they might judge you. Now, if this is you, there is a pretty good chance you may have social anxiety. Social anxiety is a specific anxiety disorder around the fear of being judged by others socially or feeling humiliation or embarrassment around others socially. And often what we understand about social anxiety is it's actually not so much an anxiety disorder. Well, yes, you will feel a lot of anxiety, but we actually understand it to also be a shame disorder. Often people go out and then enter the social environment and they're afraid that if someone notices an adequacy or a floor, that they'll be judged and that will create a lot of shame for them. Remember, fear and shame is often associated together. They often go together. And shame is really about us having a thought that there's something wrong with us, that we are inherently bad. So, if your fear is that you're going to be noticed and they'll catch you, and then you're going to feel shame, what you'll want to do here is work at being able to navigate your shame. Stay here and we'll talk about that a little bit later. It could be also that you're afraid of humiliation or embarrassment. Some people don't want to be judged because then they know they'll get stuck in a cycle of regret. "Why did I do that? Should I have done that? What could I have done different?" which looks a lot like mental rumination, which we know is a mental compulsion, a common behavior we do to try and reduce or remove anxiety. So, we can talk a little bit more in a second about how to manage that. First, let's talk about another concern people have, which is that you're afraid that if you get noticed for having anxiety, that you might have more. The thing to remember here, and you probably know this from me already, is the more you try to make fear go away, the more likely you are to have a strong wave of fear. So, remember, what you resist persists. So, if you're saying, "What if someone notices that I'm anxious and then that makes me more anxious," if you're paying a lot of tension to their facial expression, trying to figure out what they're thinking about you, chances are, you will have more anxiety because of how much attention you've put on their opinion of you. The last piece here is, will there be consequences? So, let's really talk about that. Some people are concerned that if they are visibly anxious, let's say you're giving a presentation at work or school or you're meeting your boss for your yearly meeting or your teacher for a check-in and so forth, that there will be consequences if you're visibly jittery, nervous, stuttering, shaky. Some people are afraid that they'll get noticed for sweating. And sometimes there can be consequences. Maybe a part of your job or your schooling is to be able to perform. And if you're engaging in avoidant behaviors, yes, there may be some consequences that go along with that. But what I'm going to encourage you to do to manage this is talk to your boss, talk to your teacher, talk to your coach, whoever it may be that you're concerned will employ these consequences. Ask them what we can do and what they can do and how you can get supported as you manage your anxiety. Hopefully, it's an environment that supports mental health struggles and supports mental health in general. And usually, I have found, if you go to your boss or your teacher or your dean or your parent or your coach or whoever it may be, and you let them know that you're struggling, they may have some really helpful tools or they may actually be able to help you to manage that in that environment. So, 100%, while I know bringing it to their attention is actually your fear, that can often very much help. Now, if you're in a situation where you don't feel comfortable going to them and sharing that-- it could even be with a friend, or a partner, a boyfriend, girlfriend, someone you're interested in. If you're really afraid of that and you don't want to share, that is entirely okay. But what it does mean is, and this is where we get to the tools, you're going to have to give yourself permission to have anxiety. So, number one, the main thing I'm going to tell you if you have this fear in any certain way is, if you are going into this circumstance or this event saying you shouldn't have anxiety, you're going to have more anxiety. We know that to be true. So, what do you do instead? You can practice allowing your anxiety to be there and actually saying, "This is a good thing." And I know it doesn't feel good, it doesn't feel fun, but what you're saying is, "Here is an opportunity for me to have the anxiety and show up anyway." Number two, here is an opportunity for me to have the anxiety and show up and really see who are the true friends, who are the unconditional friends, who can be caring and compassionate in this environment, and can I face this fear, and baby steps, make small wins, and have small achievements where you're able to increase your willingness to have the anxiety, increase your tolerance of discomfort and sensations that you don't like. The next thing I want you to do is, number three, the most important, you will be shocked how important and how helpful it can be if you practice self-compassion. If you are using the tool of self-criticism to manage this, chances are, you're going to make your anxiety a whole bunch worse. So, instead, try validating yourself. "It makes complete sense that this is hard for me. It makes complete sense that this would create anxiety for me." Maybe you would say, "Anyone else in this situation would have anxiety." And I know your brain is going to say, "No, no. Jack, John, and Jennifer could do this without anxiety." The thing to remember is, they might be a few steps ahead of you and you can get there too. Our brains are neuroplastic. We can actually get there too with practice, small wins and self-compassion. The self-criticism is only going to make you more anxious. Really, I think you probably already know this, but I think it's important for you to understand, self-criticism only makes it worse, and we want you to do great, and we know you can do great. Number four is, be an observer to what's going on. So, let's say you're about to do this event or this social experience with somebody, or you're about to have a conversation, and you're shaking or you're sweating or you're stuttering, or whatever it may be. Your job is to be an observer of your thoughts about that. Now, here is an example. I am often with anxious people. It's a normal part of my day. I'm an anxiety specialist, but I go into a lot of exposures with my patients. We go to Costco, we go to the supermarket, we go to the outdoor park, and my patients practice exposing themselves to the exact thing they're afraid of. And what you'll find here is the average human that they interact with are incredibly forgiving. Humans want to like you. They don't want to not like you. They want to be in connection with you. They don't want to be out of connection with you. And when you're struggling, if that is the case, 99% of the time, they have enough empathy and compassion to help you along. And so, a part of this work is you increasing your ability to see the good of the human race. Now, I know you may have had a few experiences where people weren't so kind, but the good people are out there. It's just a matter of practicing. And when I go on exposures with my patients, they're actually pleasantly surprised. We might go to the supermarket and we might say, "Okay, I want you to go and ask 10 people for the time, or I want you to look 15 people in the eye and say good morning to them. Or I want you to ask five people a question, where is the local bank, or can you tell me where such and such street is?" And 99% of the time, they walk away going, "Wow, people are actually kinder than I thought." There are people who don't want to talk to them, and that's usually because they're anxious too. And so, it's important for us to understand and have an understanding of the human race here, and give ourselves permission to show up imperfectly when we're around other people. Now, another thing I want you to think about here is, how can I practice on purpose facing this fear. I know what you're thinking. You're like, "Let me just shut this down. Where's the pause button?" But I really want you to understand that there are hundreds of opportunities in your day where you can practice showing up anxious on purpose and how many of those can you put in a day. Put them in your calendar, plan for them, leave work, or leave for school a little early so you could get an extra couple of practice runs in with this. If someone had, let's say, a fear of being shaky, I actually encourage them to be shaky. Sometimes we even induce shakiness for them. We might have them have a cup of coffee before they do the exposure so that they're on purpose feeling this feeling and they've got a lot of practice doing it. And then the last thing I want you to remember is, once you've done all these steps and you've done the hard thing, because I always say it's a beautiful day to do hard things, I want you to then practice what we call response prevention. Response prevention is, now that you've done the hard thing, you're to practice not engaging in rumination and self-criticism, the things that actually you used to do, which only make you feel worse and actually reinforce the fear. You're going to practice not doing those things and instead engage back into the world and just practice moving on, practice engaging in what you are showing up to do, practice engaging in the things that you love and that you value. Instead of sitting there looping about how it went and what they thought and what they think about you and how did they perceive you and you should have said this and you shouldn't have said that, your job is actually to catch the urge to engage in that rumination and then bring yourself back to the present. Now, if you can do those things, you are leaps and bounds ahead of where you would be if you weren't engaging in those things. And we know that small steps lead to medium size steps, which lead to massive steps forward. Now, what is the one thing I want you to take away? Because I really love giving you a takeaway here. Number one, the more you try and avoid the fear, the more you're probably going to have it. And then the last thing here I'm going to say is, go gentle. Go easy. Catch how you're engaging in self-criticism. The truth is, we have a lot of research to show that people aren't thinking about you nearly as much as you think they are. Most of the time, they're thinking about them. They're thinking about what they're going to have for lunch and their meeting that they have coming up and, "Whoops, I forgot to get milk at the grocery store." They're not hyper-attending to every little mistake that you make as much as you think they are. And if they are in fact judging you that heavily, that is a strong relation and reaction of what's going on in their mind. It actually shows us a lot. It's a reflection of what they value and what they're judging about themselves. And so, really other people's judgment is often just a reflection of their judgment about themselves and the way that they think. And our work is actually to focus on actually being the person you want to be or who do you want to be? How do you want to show up? What are your values? What kind of person do you want to be? So, I hope that's been helpful. At the end of the day, you will be judged. This is something I have had to learn the hard way. I have had to learn that not everyone is going to like me, and that is okay. I am a messy human being. I am not perfect. I was never supposed to be perfect. And my job is to give myself some grace and some compassion for the fact that I'm just a human, messy person, just like you're a human, messy person. And that's true for every human. Okay? Have a wonderful day. Do remember it's a beautiful day to do hard things and I look forward to talking to you again next week.

Nov 11, 2022

Nov 11, 2022

SUMMARY: What if you don't identify with the concept of an obsession being a FEAR? It's a repetitive thought or feeling, but you're not scared of a specific outcome. What is the UNCERTAINTY when it comes to these obsessions? Guilt Obsessions: WHAT IS OCD GUILT? OCD Guilt over past mistakes "I shouldn't have done that" "That was a mistake" OCD Guilt as a simple intrusive thought- no known mistake "Is it bad that I did that" "Did I make a mistake?" "What could be the consequences" REGRET obsessions. I've heard a lot about how guilt is a common intrusive feeling in OCD but not much about regret. "I wish I didn't do that" "I wish I had done it another way" Guilt and Regret accompanied with sadness?? How to stop OCD guilt? How to treat OCD guilt and regret Links To Things I Talk About: Feeling guilty doesn't mean you have done something wrong https://kimberleyquinlan-lmft.com/ep-161-feeling-guilty-doesnt-mean-you-have-done-something-wrong/ How to let go of the past https://kimberleyquinlan-lmft.com/ep-70-how-to-let-go-of-the-past/ I screwed up. Now what? https://kimberleyquinlan-lmft.com/ep-293-i-screwed-up-what-now/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 310 Welcome back, everybody. We are at Episode 310. I just recorded it as 210 and I'm still in shock that we have hit 310 episodes. I recorded it and I was like, "Hang on a second. That doesn't sound right." And it wasn't, and that still shocks me to this day. All right. Today, we are talking about a very important topic, which is guilt and regret. And I've called this episode Guilt and Regret: The Most Misunderstood Obsession, and I believe that to be true because a whole bunch of you are walking around wondering whether you have OCD or not because a lot of what you hear is that OCD is all about anxiety and uncertainty. But what about the folks who don't have a lot of anxiety and a lot of uncertainty, but they're having obsessive guilt and obsessive regret in the form of OCD guilt and OCD regret? So, I wanted to talk about that today. Before we do so, let's quickly do the "I did a hard thing" segment. For those of you who are new, this is where listeners and followers share the hard thing that they've done. Why do I do this? Because so often, you guys forget that just because your hard thing is hard for you doesn't mean there's anything wrong with that. I want you to see that hard things are hard things and we should celebrate them and we should share them, and this is a platform I want to do that with. So, this one is from Mars, and Mars said: "After many weeks and years of hard work, I finally managed to reach an important stage of my career, and I ended up with two job offers." Amazing. "Both were great really for different reasons, and I couldn't choose. I went back and forth and tortured myself four months trying to get certainty about which one is the right choice. I'd never been so anxious in my life. Finally, today, I sent the final email, even though I wasn't certain about the choice, it was the hardest thing I've ever done, but I finally feel like I can move forward with my life again." Mars, number one, congratulations. Sounds like you've worked really hard. And number two, you're also doing this hard thing where you're allowing the discomfort into your day, into your life, and you're moving forward anyway. Thank you for sharing that. That is such an amazing accomplishment. Interesting, isn't it, how you've shared here too like it was around the certainty, but it sounds like that was similar to what we're talking about today, and let's talk about that. So, let's start from scratch. Start from the beginning. So, often people will come into therapy and say, "I didn't seek treatment for the longest time, because all I'm hearing is OCD is the uncertainty disorder, and I don't feel a ton of uncertainty in the way that I've heard other people do with OCD." What do I do if I don't identify with this concept of the obsession being around fear and uncertainty? What about if you have a repetitive thought or a feeling, but you're not scared of the specific outcome? And this is so important, guys, because we do hyper-focus on uncertainty and I really do believe that uncertainty is the root of lots of OCD obsessions and a lot of our suffering if we don't accept that uncertainty. But what about those who have obsessive guilt and obsessive regret? So, let's talk about it. Guilt OCD - Guilt Obsessions Let's first talk about guilt obsessions. So, what is guilt obsessions, or what is OCD guilt? Ultimately, it's a thought or an action that occurs. That's the trigger. So, you had a thought or you did some behavior, and then you are having this onset of guilt. Remember, an obsession is an intrusive thought, feeling, sensation, urge, or image. And so, in this case, we're talking about intrusive feelings. And so, what's happening here is you've had a thought or you've done something and then you feel this very, very real feeling of guilt, very real feeling of guilt. Most of my patients who struggle with OCD guilt or obsessive guilt will say, "I genuinely feel like I've done the equivalent of killing a person. That's how much guilt I feel." Even though you might be very clearly able to identify like, I didn't kill a person, or it doesn't make total sense on why I'm feeling this high level of guilt, that's so disproportionate. and that can be really confusing. And so, they're really confused as to what's going on. So, they might show up in-- the guilt may be accompanied by intrusive thoughts like, "I shouldn't have done that. That was a huge mistake. I wish I didn't do that. How can I avoid that in the future?" And then you can easily see why we then move into compulsions, like avoidance, rumination, tons of reassurance seeking. In therapy, a lot of people go to therapy, not even OCD therapy because they don't even know they have OCD yet, and they spend all this time doing EMDR and biofeedback and hypnosis and all of this deep therapy work, exploring the deep meaning of the guilt, only then to realize like, "Wait a second, this is OCD. I'm doing all these compulsions and I'm even doing them in session." Now, as I mentioned, OCD could be as simple as an intrusive thought of you're walking down the street and you just get the onset of guilt after some kind of trigger where there's no known mistake. Or it could be that you did something that didn't completely line up with your values, but again, then you have disproportionate degrees of guilt. Disproportionate. If it's just a simple intrusive thought that has no known trigger or no known mistake, maybe your thoughts are related like, "Is it bad that I did that? Did I make a mistake? Was that right? Did that line up with my values? What could be the consequence of this?" And it can be incredibly painful. Regret OCD- Regret Obsessions So, now let's move over to regret obsessions and compulsion. So, with regret obsessions or regret ocd, they usually are presented more as, "I wish I didn't do that. I wish I hadn't done it that way. I wish I had done it in a different way." It's often accompanied with a deep feeling of sadness, like regret this deep feeling. Again, it can be an intrusive thought, but it often is just an intrusive feeling. This deep sense of, "I wish I didn't do that." Sometimes it's accompanied with dread. "Oh, I hope I never do that, have this emotion, or do that thing again." It can be incredibly painful. And again, people can get stuck in really the wrong kind of therapy, ruminating, ruminating, trying to solve what it was. Sometimes I've had patients even come to me and say, "Oh, I saw you because you do self-compassion and I want to be able to forgive myself," and they're doing compulsive forgiveness. I believe in forgiveness. I'm not saying there's anything compulsive about forgiveness in the day-to-day. But if they're doing it to get rid of an obsessive degree of regret, an OCD degree of regret, and that involves obsessions and compulsions, well then, that forgiveness practice can become impulsive. OCD Guilt Over Past Mistakes I always laugh because I'm doing this breathing training, this meditation training right now. And some of them, the trainers who obviously are not OCD informed will say, "Breathe in your discomfort and breathe it out and let go of it and release it." And I think that's a beautiful practice. But for a person with OCD, that can become compulsive. And so, it's important when you have OCD to catch these little nuances and these little behaviors and activities that can end up becoming a problem. So, let's talk about how to stop this obsessive guilt or this OCD guilt, and let's think about this a little bit in terms of how you might master this sensation and this feeling that you're having. So, a couple of things before we move on is I have done quite a few episodes on guilt or letting go of things in the past in other episodes. So, I wanted to let you know, you can also go over, I did one episode about feeling guilty. It's Episode 161. I did another episode, which was highly requested, Episode 70, which is called How to Let Go of the Past. And I did another episode, which was actually me talking about my own sense of getting through something that I felt regret and guilt for, which was Episode 293 and it was called I Screwed Up, Now What? So, we'd actually have tons of sources here on the podcast about that, and I wanted to share those in case you wanted to really delve a little deeper. But let's talk about how to stop this OCD guilt. How To Treat OCD Guilt And Regret All right? So, as you know, trying to stop an emotion usually doesn't work. So, we don't want to try that. That's not going to work. Same with regret. How to treat OCD regret, I don't encourage it. What we want to do instead is we want to be able to acknowledge it and observe it and do nothing about it. Now, I am a big believer in this. Truly I am. Whether you have OCD or not, when it comes to guilt, when it comes to regret, when it comes to shame, I'm going to encourage this very mindful approach. Number one, are you able to catch it in its tracks? That is number one. That is a tactical skill, is awareness, to be able to catch, "Oh, I am stuck in this guilt bubble or this regret bubble or this shame bubble." Just like you would when you're stuck in OCD. You're able to catch, "Oh, I'm engaging in a pattern of behaviors that looks a lot like OCD." Same goes for this situation. So, I'm observing and being aware of it. And then number two, catching where I'm wrestling with it. What safety behaviors do you have in relation to this feeling? Again, when it comes to OCD, it doesn't matter what the obsession is, it doesn't matter whether it's associated to uncertainty or not, it doesn't matter if it's real or feels real or not. What we want to do is take a look at the safety behaviors we're engaging in and first ask ourselves, are these helpful and effective? So, if you have guilt or regret, and your way of coping with that is to beat yourself up in hope that you never do it again, how effective is that? Is that working for you? Is it actually preventing you from doing things in the future that may trigger off regret and guilt? No. Are you avoiding certain things so that you don't have to have this guilt and regret in the future? Do a quick assessment on those safety behaviors and ask yourself, does this help me in the grand scheme of things, knowing that OCD may pull guilt and regret on me for the most minor thing again tomorrow? Is it effective for me to try to make my life really small and avoid things because of an emotion that I may have to experience? Remember, the emotion will not hurt you. You'll allow it to rise and fall. It is painful. I'm not going to lie, it is painful, but it won't destroy you, especially if you have a relationship with guilt and regret and with this discomfort where you're not resisting it. Remember, what you resist persists. So, you want to take a look at, do a functional analysis, do a review on how effective is my safety behaviors. Are you engaging in reassurance-seeking compulsions saying, "Do you think I did something wrong?" Going to your partner, "Do you think I did something wrong?" Maybe you're confessing. "I feel guilty that I did this thing. I want to tell you what I did so that I can let it off my conscience." Now again, within a normal degree, we do this to some degree. I always laugh. Several years ago, my son, who was four at the time, came home and blurted out to my husband that mom had run through a red light, just out of the blue. He'd figured out that red lights were bad and you can't drive through them and he's like, "Mom went through a red light," the minute he saw him. Of course, he was like, "No, you didn't." And I had to admit to it. But after that, I felt this urge to admit to things so that I could absorb myself of that guilt and regret that I had. And we all do it. I want to normalize that. I don't want to pathologize those kinds of behavior. But if you're doing that repetitively and it's interfering with your relationships and it's creating more and more stress for you, and you do it once and you don't completely feel absolved and you feel like you need to confess again, this is a safety behavior that isn't effective and that's causing long term problems and is feeding the cycle of OCD. We want to break that, guys. We want to break that. So, what I want you to look at here is, again, awareness. Are you able to acknowledge what's going on? Are you able to identify the compulsions that are problematic? And then are you able to let it be there? Let it be there. Do nothing about it. Now, if you're a real badass, which I know that you are, you will then, if you're really ready, you might even do something fun and pleasurable while you feel guilt. Now that is doubling down. While you feel the obsessive guilt, while you feel the obsessive regret, you're actually going to go have some fun and enjoy yourself. So important. This is a super important piece of the work that we do. How To Stop Relationship OCD Guilt Now, for those of you who have relationship guilt or relationship OCD guilt in relation to your OCD, this is so important. It's so important that you catch the safety behaviors that you're doing and then you reengage with your loved one, because often what we do is we either do a whole bunch of compulsions or we shut down completely. We stop hanging out with them, we stop opening our heart with them, we stop engaging in intimacy with them. And that can become a big problem. For those of you who have real-event OCD and guilt associated with real-event OCD, the same thing is applicable, which is we want to go through those steps, and then we want to practice opening up our life being fully engaged in our life, in the things that you value, whether the real event happened or not. I often get emails and DMs from people saying, "I feel like my real event is worse than other people's real event, and so therefore I should suffer, or I should figure this out." And I want to say, "That's a very tactical trick that OCD plays on you to get you back into doing compulsions." And so, I want you to be aware specifically to harm obsessions, relationship obsessions, real event obsessions, sexual obsessions. This is such an important piece because that's often where it shows up. But again, it doesn't have to be fear and uncertainty related. Sometimes the guilt and the regret can be the actual obsession that people experience. Okay? So, as always, we want to throw a massive dose of self-compassion onto this. Self-compassion in and of itself is an exposure for many people. and often people with specifically this OCD guilt and OCD regret when they practice self-compassion, it is like the ultimate exposure. The ultimate exposure. And I really want to encourage you guys to surround yourself with kindness, encourage yourself with kindness, motivate yourself with kindness, nurture yourself with kindness when you're struggling and you're experiencing a high level of discomfort. It doesn't have to be fear. It can be around these other emotions that you experience, and shame. Shame often comes along with this. So, we want to make sure that we are doing everything we can to engage in self-compassion as much as we can. Okay? All right. That's it for now. Let's quickly do the review of the week. This is from Triphonik and he or she said: "Love this podcast. Kimberley's podcast is so inspirational, relatable, and helpful. I have been dealing with OCD since my early 20s. I went through extensive therapy, medications, and lots of prayer! I got to the point where my OCD was not taking over my life anymore & hardly noticeable. I'm now 43 & I've recently gone through some lapses with it after these years. It really shook me to the core. Following Kimberley's anxiety toolkit podcast was helpful in getting me back on track with the tools I've learned from my past along with some new ones! Her spirit and her level of sincerity with the knowledge and experience she has helped me so much! I'm so incredibly grateful to have found this podcast. Thank you, Kimberley!" Thank you so much, Triphonik. Your reviews mean the world to me. Really, they do. And I'm just so happy to be on this journey with you. All right, folks, I'm going to see you next week and I'll talk to you soon.

Nov 11, 2022

SUMMARY: What if you don't identify with the concept of an obsession being a FEAR? It's a repetitive thought or feeling, but you're not scared of a specific outcome. What is the UNCERTAINTY when it comes to these obsessions? Guilt Obsessions: WHAT IS OCD GUILT? OCD Guilt over past mistakes "I shouldn't have done that" "That was a mistake" OCD Guilt as a simple intrusive thought- no known mistake "Is it bad that I did that" "Did I make a mistake?" "What could be the consequences" REGRET obsessions. I've heard a lot about how guilt is a common intrusive feeling in OCD but not much about regret. "I wish I didn't do that" "I wish I had done it another way" Guilt and Regret accompanied with sadness?? How to stop OCD guilt? How to treat OCD guilt and regret Links To Things I Talk About: Feeling guilty doesn't mean you have done something wrong https://kimberleyquinlan-lmft.com/ep-161-feeling-guilty-doesnt-mean-you-have-done-something-wrong/ How to let go of the past https://kimberleyquinlan-lmft.com/ep-70-how-to-let-go-of-the-past/ I screwed up. Now what? https://kimberleyquinlan-lmft.com/ep-293-i-screwed-up-what-now/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 310 Welcome back, everybody. We are at Episode 310. I just recorded it as 210 and I'm still in shock that we have hit 310 episodes. I recorded it and I was like, "Hang on a second. That doesn't sound right." And it wasn't, and that still shocks me to this day. All right. Today, we are talking about a very important topic, which is guilt and regret. And I've called this episode Guilt and Regret: The Most Misunderstood Obsession, and I believe that to be true because a whole bunch of you are walking around wondering whether you have OCD or not because a lot of what you hear is that OCD is all about anxiety and uncertainty. But what about the folks who don't have a lot of anxiety and a lot of uncertainty, but they're having obsessive guilt and obsessive regret in the form of OCD guilt and OCD regret? So, I wanted to talk about that today. Before we do so, let's quickly do the "I did a hard thing" segment. For those of you who are new, this is where listeners and followers share the hard thing that they've done. Why do I do this? Because so often, you guys forget that just because your hard thing is hard for you doesn't mean there's anything wrong with that. I want you to see that hard things are hard things and we should celebrate them and we should share them, and this is a platform I want to do that with. So, this one is from Mars, and Mars said: "After many weeks and years of hard work, I finally managed to reach an important stage of my career, and I ended up with two job offers." Amazing. "Both were great really for different reasons, and I couldn't choose. I went back and forth and tortured myself four months trying to get certainty about which one is the right choice. I'd never been so anxious in my life. Finally, today, I sent the final email, even though I wasn't certain about the choice, it was the hardest thing I've ever done, but I finally feel like I can move forward with my life again." Mars, number one, congratulations. Sounds like you've worked really hard. And number two, you're also doing this hard thing where you're allowing the discomfort into your day, into your life, and you're moving forward anyway. Thank you for sharing that. That is such an amazing accomplishment. Interesting, isn't it, how you've shared here too like it was around the certainty, but it sounds like that was similar to what we're talking about today, and let's talk about that. So, let's start from scratch. Start from the beginning. So, often people will come into therapy and say, "I didn't seek treatment for the longest time, because all I'm hearing is OCD is the uncertainty disorder, and I don't feel a ton of uncertainty in the way that I've heard other people do with OCD." What do I do if I don't identify with this concept of the obsession being around fear and uncertainty? What about if you have a repetitive thought or a feeling, but you're not scared of the specific outcome? And this is so important, guys, because we do hyper-focus on uncertainty and I really do believe that uncertainty is the root of lots of OCD obsessions and a lot of our suffering if we don't accept that uncertainty. But what about those who have obsessive guilt and obsessive regret? So, let's talk about it. Guilt OCD - Guilt Obsessions Let's first talk about guilt obsessions. So, what is guilt obsessions, or what is OCD guilt? Ultimately, it's a thought or an action that occurs. That's the trigger. So, you had a thought or you did some behavior, and then you are having this onset of guilt. Remember, an obsession is an intrusive thought, feeling, sensation, urge, or image. And so, in this case, we're talking about intrusive feelings. And so, what's happening here is you've had a thought or you've done something and then you feel this very, very real feeling of guilt, very real feeling of guilt. Most of my patients who struggle with OCD guilt or obsessive guilt will say, "I genuinely feel like I've done the equivalent of killing a person. That's how much guilt I feel." Even though you might be very clearly able to identify like, I didn't kill a person, or it doesn't make total sense on why I'm feeling this high level of guilt, that's so disproportionate. and that can be really confusing. And so, they're really confused as to what's going on. So, they might show up in-- the guilt may be accompanied by intrusive thoughts like, "I shouldn't have done that. That was a huge mistake. I wish I didn't do that. How can I avoid that in the future?" And then you can easily see why we then move into compulsions, like avoidance, rumination, tons of reassurance seeking. In therapy, a lot of people go to therapy, not even OCD therapy because they don't even know they have OCD yet, and they spend all this time doing EMDR and biofeedback and hypnosis and all of this deep therapy work, exploring the deep meaning of the guilt, only then to realize like, "Wait a second, this is OCD. I'm doing all these compulsions and I'm even doing them in session." Now, as I mentioned, OCD could be as simple as an intrusive thought of you're walking down the street and you just get the onset of guilt after some kind of trigger where there's no known mistake. Or it could be that you did something that didn't completely line up with your values, but again, then you have disproportionate degrees of guilt. Disproportionate. If it's just a simple intrusive thought that has no known trigger or no known mistake, maybe your thoughts are related like, "Is it bad that I did that? Did I make a mistake? Was that right? Did that line up with my values? What could be the consequence of this?" And it can be incredibly painful. Regret OCD- Regret Obsessions So, now let's move over to regret obsessions and compulsion. So, with regret obsessions or regret ocd, they usually are presented more as, "I wish I didn't do that. I wish I hadn't done it that way. I wish I had done it in a different way." It's often accompanied with a deep feeling of sadness, like regret this deep feeling. Again, it can be an intrusive thought, but it often is just an intrusive feeling. This deep sense of, "I wish I didn't do that." Sometimes it's accompanied with dread. "Oh, I hope I never do that, have this emotion, or do that thing again." It can be incredibly painful. And again, people can get stuck in really the wrong kind of therapy, ruminating, ruminating, trying to solve what it was. Sometimes I've had patients even come to me and say, "Oh, I saw you because you do self-compassion and I want to be able to forgive myself," and they're doing compulsive forgiveness. I believe in forgiveness. I'm not saying there's anything compulsive about forgiveness in the day-to-day. But if they're doing it to get rid of an obsessive degree of regret, an OCD degree of regret, and that involves obsessions and compulsions, well then, that forgiveness practice can become impulsive. OCD Guilt Over Past Mistakes I always laugh because I'm doing this breathing training, this meditation training right now. And some of them, the trainers who obviously are not OCD informed will say, "Breathe in your discomfort and breathe it out and let go of it and release it." And I think that's a beautiful practice. But for a person with OCD, that can become compulsive. And so, it's important when you have OCD to catch these little nuances and these little behaviors and activities that can end up becoming a problem. So, let's talk about how to stop this obsessive guilt or this OCD guilt, and let's think about this a little bit in terms of how you might master this sensation and this feeling that you're having. So, a couple of things before we move on is I have done quite a few episodes on guilt or letting go of things in the past in other episodes. So, I wanted to let you know, you can also go over, I did one episode about feeling guilty. It's Episode 161. I did another episode, which was highly requested, Episode 70, which is called How to Let Go of the Past. And I did another episode, which was actually me talking about my own sense of getting through something that I felt regret and guilt for, which was Episode 293 and it was called I Screwed Up, Now What? So, we'd actually have tons of sources here on the podcast about that, and I wanted to share those in case you wanted to really delve a little deeper. But let's talk about how to stop this OCD guilt. How To Treat OCD Guilt And Regret All right? So, as you know, trying to stop an emotion usually doesn't work. So, we don't want to try that. That's not going to work. Same with regret. How to treat OCD regret, I don't encourage it. What we want to do instead is we want to be able to acknowledge it and observe it and do nothing about it. Now, I am a big believer in this. Truly I am. Whether you have OCD or not, when it comes to guilt, when it comes to regret, when it comes to shame, I'm going to encourage this very mindful approach. Number one, are you able to catch it in its tracks? That is number one. That is a tactical skill, is awareness, to be able to catch, "Oh, I am stuck in this guilt bubble or this regret bubble or this shame bubble." Just like you would when you're stuck in OCD. You're able to catch, "Oh, I'm engaging in a pattern of behaviors that looks a lot like OCD." Same goes for this situation. So, I'm observing and being aware of it. And then number two, catching where I'm wrestling with it. What safety behaviors do you have in relation to this feeling? Again, when it comes to OCD, it doesn't matter what the obsession is, it doesn't matter whether it's associated to uncertainty or not, it doesn't matter if it's real or feels real or not. What we want to do is take a look at the safety behaviors we're engaging in and first ask ourselves, are these helpful and effective? So, if you have guilt or regret, and your way of coping with that is to beat yourself up in hope that you never do it again, how effective is that? Is that working for you? Is it actually preventing you from doing things in the future that may trigger off regret and guilt? No. Are you avoiding certain things so that you don't have to have this guilt and regret in the future? Do a quick assessment on those safety behaviors and ask yourself, does this help me in the grand scheme of things, knowing that OCD may pull guilt and regret on me for the most minor thing again tomorrow? Is it effective for me to try to make my life really small and avoid things because of an emotion that I may have to experience? Remember, the emotion will not hurt you. You'll allow it to rise and fall. It is painful. I'm not going to lie, it is painful, but it won't destroy you, especially if you have a relationship with guilt and regret and with this discomfort where you're not resisting it. Remember, what you resist persists. So, you want to take a look at, do a functional analysis, do a review on how effective is my safety behaviors. Are you engaging in reassurance-seeking compulsions saying, "Do you think I did something wrong?" Going to your partner, "Do you think I did something wrong?" Maybe you're confessing. "I feel guilty that I did this thing. I want to tell you what I did so that I can let it off my conscience." Now again, within a normal degree, we do this to some degree. I always laugh. Several years ago, my son, who was four at the time, came home and blurted out to my husband that mom had run through a red light, just out of the blue. He'd figured out that red lights were bad and you can't drive through them and he's like, "Mom went through a red light," the minute he saw him. Of course, he was like, "No, you didn't." And I had to admit to it. But after that, I felt this urge to admit to things so that I could absorb myself of that guilt and regret that I had. And we all do it. I want to normalize that. I don't want to pathologize those kinds of behavior. But if you're doing that repetitively and it's interfering with your relationships and it's creating more and more stress for you, and you do it once and you don't completely feel absolved and you feel like you need to confess again, this is a safety behavior that isn't effective and that's causing long term problems and is feeding the cycle of OCD. We want to break that, guys. We want to break that. So, what I want you to look at here is, again, awareness. Are you able to acknowledge what's going on? Are you able to identify the compulsions that are problematic? And then are you able to let it be there? Let it be there. Do nothing about it. Now, if you're a real badass, which I know that you are, you will then, if you're really ready, you might even do something fun and pleasurable while you feel guilt. Now that is doubling down. While you feel the obsessive guilt, while you feel the obsessive regret, you're actually going to go have some fun and enjoy yourself. So important. This is a super important piece of the work that we do. How To Stop Relationship OCD Guilt Now, for those of you who have relationship guilt or relationship OCD guilt in relation to your OCD, this is so important. It's so important that you catch the safety behaviors that you're doing and then you reengage with your loved one, because often what we do is we either do a whole bunch of compulsions or we shut down completely. We stop hanging out with them, we stop opening our heart with them, we stop engaging in intimacy with them. And that can become a big problem. For those of you who have real-event OCD and guilt associated with real-event OCD, the same thing is applicable, which is we want to go through those steps, and then we want to practice opening up our life being fully engaged in our life, in the things that you value, whether the real event happened or not. I often get emails and DMs from people saying, "I feel like my real event is worse than other people's real event, and so therefore I should suffer, or I should figure this out." And I want to say, "That's a very tactical trick that OCD plays on you to get you back into doing compulsions." And so, I want you to be aware specifically to harm obsessions, relationship obsessions, real event obsessions, sexual obsessions. This is such an important piece because that's often where it shows up. But again, it doesn't have to be fear and uncertainty related. Sometimes the guilt and the regret can be the actual obsession that people experience. Okay? So, as always, we want to throw a massive dose of self-compassion onto this. Self-compassion in and of itself is an exposure for many people. and often people with specifically this OCD guilt and OCD regret when they practice self-compassion, it is like the ultimate exposure. The ultimate exposure. And I really want to encourage you guys to surround yourself with kindness, encourage yourself with kindness, motivate yourself with kindness, nurture yourself with kindness when you're struggling and you're experiencing a high level of discomfort. It doesn't have to be fear. It can be around these other emotions that you experience, and shame. Shame often comes along with this. So, we want to make sure that we are doing everything we can to engage in self-compassion as much as we can. Okay? All right. That's it for now. Let's quickly do the review of the week. This is from Triphonik and he or she said: "Love this podcast. Kimberley's podcast is so inspirational, relatable, and helpful. I have been dealing with OCD since my early 20s. I went through extensive therapy, medications, and lots of prayer! I got to the point where my OCD was not taking over my life anymore & hardly noticeable. I'm now 43 & I've recently gone through some lapses with it after these years. It really shook me to the core. Following Kimberley's anxiety toolkit podcast was helpful in getting me back on track with the tools I've learned from my past along with some new ones! Her spirit and her level of sincerity with the knowledge and experience she has helped me so much! I'm so incredibly grateful to have found this podcast. Thank you, Kimberley!" Thank you so much, Triphonik. Your reviews mean the world to me. Really, they do. And I'm just so happy to be on this journey with you. All right, folks, I'm going to see you next week and I'll talk to you soon.

Nov 4, 2022

SUMMARY: Not having a subtype makes it hard to get diagnosed with OCD Not fitting into a subtype can make you doubt having OCD. When you don't see other examples, you can feel like an outsider in the OCD community. All the subtypes seem to have their "people." The doubt can make you feel that it really is about the content, not OCD. What if I don't fit into a typical OCD Subtype Examples: What if I picked the wrong name for my baby? Obsessions about the weather and whether you will enjoy the weather? This nail color makes me feel strange. What if I don't remember this the way it was? What if my partner cheats on me? What if my child suffers? What if my taxes were not correct? How will I know when it is time to stop therapy? General Anxiety Vs Ocd? Dimensional Obsessive COmpulsive Scale (Jon Abramowitz) Concerns about germs and contamination Concerns about being responsible for the harm. Injury, Bad luck Unacceptable thoughts Concerns about symmetry, completeness, and the need for things to be "Just right." Does ERP work for these obsessions? Does the process of treatment work any differently than it would with a "subtype"? Ideal Treatments for OCD ERP ACT SC MINDFULNESS Links To Things I Talk About: ERP School (An online course for OCD) https://www.cbtschool.com/erp-school-lp Dimensional Obsessive COmpulsive Scale (Jon Abramowitz) http://www.jabramowitz.com/uploads/1/0/4/8/10489300/docs.pdf Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION What If I Don't Fit Into The Typical Ocd Subtypes? Welcome back, everybody. Thank you so much for joining me. I know your time is so valuable, and so I am so honored to spend this time with you to talk to you about today common question that I get asked. Well, actually, no, it's not a common question, but it has been a question that I have been asked over the years by clients and followers, and listeners. And I was proposed with this idea as something that we really need to address. And so, here I am. And my goal is to always address the things that maybe aren't getting addressed if possible. And so, today we are going to talk about, what if I don't fit into the typical OCD subtype? So, what if my obsessions don't line up with the typical classifications and categories that we have for OCD? Ocd Subtypes So, for those of you who maybe are new to this idea, we have OCD as a general diagnosis. And then under that umbrella of the diagnosis, we have-- over the years, the clinical and OCD community have created subtypes of OCD to help us, number one, categorize different groups of obsessions so that we can then direct the treatment to being very specific. We also do that to build a sense of community so that you feel less alone. Let's say you have a harm obsession that can be very stigmatizing and feel very, very overwhelming, and you can have a lot of guilt and judgment about that for yourself. So, knowing you're in a category, in a group with other people can actually soften the blow of the stigma and the judgment around that obsession. Same goes for sexual obsessions, pedophilia obsessions, and so forth. Again, as a clinician, as I'm training my therapist, these subtypes are actually helpful so that we can help the newer therapists have a treatment plan specific to that person's obsession. However, what about the group of people who don't line up perfectly in those groups? And so, in today's episode, we're going to talk about what to do if that is you, what to do if you're a therapist and you're dealing with this, some skills that you might use, and maybe a few shifts and reframes here, I'll use some clinical research that may help you shift the way you look at this problem. And maybe we can even stop calling it a problem. We could actually not address it as a problem and actually move through that together. Okay? Before we do that, let's get straight to the "I did a hard thing." I haven't even read this hard thing you guys, so I'm as excited as can be. This one is from Hannah, and this is what Hannah had to say: "Earlier this year, I suffered a debilitating OCD episode that focused on harm OCD," so, there we are, we have a subtype already explained, "Specifically the fear of sleepwalking or going crazy and harming my family. At the time, I had no idea I had OCD as I had always been told I was just an anxious person. So, this well and truly threw me to the point that I couldn't get off the couch, take my daughter to and from school or be alone. I wanted to admit myself into a mental health facility for fear that I was a real danger to my family and my daughter in particular. Long story short, after weekly ERP with a therapist and starting an SSRI, I did a very hard thing by being at home alone with my daughter for a whole weekend while my husband went away for work. I don't think I'd be able to do it and I had been feeling anxious for months prior to knowing it was coming. But I did it and I actually ended up enjoying our time together despite some fairly consistent rumination." Hannah, oh my gosh, this is so good. You are such a walking billboard for how effective ERP and medication can be. I love that you did this. This is so good. And so, congratulations. I am so honored that you shared that with us. And look at you go. Look at you go. All right. Again, quickly, let's do the review of the week. This one is from Austin-mang, and they said: "I finally did it and signed up for therapy. My session is this Friday. I've been doing my best to prepare and was uncertain about what to expect my first session. This show helped me to know exactly what to expect and gave me some great mindset tools going in. Thank you!" Austin-mang, it sounds like you did a hard thing too. This is so wonderful. So, thank you guys for sharing your hard thing, and thank you so much for leaving a review. It does help me immensely build trust for those who are new to the show. All right, let's get to it. A Common Question: "I Dont Fit Into A Typical Ocd Subtype?" So, let's backtrack to the main concern here, which is what if I don't fit into a typical OCD subtype. Now, this is a hard thing for people, because not falling into that subtype can make it hard to be diagnosed. I was just thinking about this yesterday. Ten years ago or longer when I first started treating OCD – it's been nearly 15 years now – if you typed into Google "What if I harm my baby," maybe one or two articles would come up, but you would find an article about OCD and then you would slowly, if you're able, get to treatment. Remember, our mission here is to reduce the amount of time it takes someone with OCD to get diagnosed and treated. Right now, it's seven to 14 years, which is absolutely horrendous, but we're getting better. We're getting better. So, if you typed in "What if I harm my baby" or "What if I sinned," you would probably come to an article that may lead you to, you may have OCD. What if I get sick and die? If you typed your what-if thought into Google, you'd probably find an article somewhere. But there are a group of people who if they typed their fear in, OCD would never come up. It would never show up on a Google search. If you told your doctor, they might not be able to identify this as OCD, because as far as we've come with educating, these subtypes have actually helped us educate doctors, nurses, teachers, and caregivers so that they can be more likely to pick up on children's and young adult's OCD. As much as we've done this, if you don't have those specific subtypes, it can make it very difficult to get diagnosed. The next piece here is a lot of people, and this is what I really hear a lot in my community online, on Instagram – if you follow me on Instagram, it's @YourAnxietyToolkit – is some people will say, "Because I don't fit into this subtype, I have a lot of doubt that I have OCD at all." We know OCD is a doubting disorder, but often people with OCD even doubt, even if they fit into a subtype, they doubt that they have OCD. But if you don't fit into one of these categories that we've put, these loose categories that we've put, that can make it even harder to really double down with your treatment and feel confident in your provider and feel confident in your diagnosis and so forth. There is a lot of times when people don't talk about their specific obsession, when it doesn't fall into that subtype in fear that someone would say, "You don't have OCD. You don't follow any of the subtypes." And I'm sure maybe even some uneducated clinicians have shared that with their clients like, "No, you don't meet criteria because you don't meet a subtype." And hopefully today we can actually get rid of that and hopefully resolve that issue. And what really comes and becomes apparent is, as we were talking before, let's go to the "I did a hard thing." They said they had harm OCD. And as I said before, it can feel really validating to know you have your community like, "Oh, I have perinatal OCD." So, you have your little-- you can find a group of people who have the same obsessions, and that can be really validating. It can be very, very comforting to feel like you have that community. But for those who don't feel like they fall into a subtype, they may actually feel quite isolated and alone, like unseen. And that doubt can really make it really difficult. And what I thought was really interesting is somebody said to me, the doubt can make you feel that it really is about the content, not the OCD. So, remember, we're always talking about like, it's not about the content. The content doesn't matter. And in this case, they were saying, no, it really does feel like the content matters because if your content is within a category, well then you get that community, you get that reassurance. Not compulsive reassurance, but you get a little reassurance like, "This is OCD, you're on the right track, keep going." So, I have such compassion. If you are somebody or your client is somebody who has an obsession that doesn't fall into these categories, let's really make sure we validate them. Let's really make sure we slow down to understand what that is like for them. Examples Of Ocd That Do Not Fit Into Traditional Subtypes Let's talk about some examples of what this might look like. So, examples of what it might look like if you don't fit into a typical OCD subtype might be: What if I picked the wrong name for my baby? Some people could go, "Oh, that's just a normal concern. Let's come up with a solution." You know what I mean? That would be probably, "Let's work at making the right choice." And I have had clients in the past who've gone as far as changing their baby's name multiple times. I've seen this case multiple times, trying to just figure out the solution. But you can see here, it's not a general fear. It's something that is repetitive and they can't seem to get rid of that uncertainty. And even if they do change it, the uncertainty still returns and it's very urgent. Again, we can really see that's OCD. Clear and clean OCD. It's got the obsession, it's got an urgent compulsion that is repetitive, that causes distress. It doesn't line up with their values. So typically OCD. Some people have obsessions about the weather and whether they'll enjoy the weather. And you might immediately think, well, again, that doesn't sound like OCD. But again, let's look, it doesn't matter about the content, it matters on the process. Is this person ruminating about this a lot? Are they stuck on trying to find the correct answer or the answer that resolves their uncertainty? Is there an incredible amount of distress? Are they trying to solve this with urgency? If that is the case, we have a very clean and clear case of OCD. I've had clients who've spent a lot of time obsessing and compulsing over the nail color that they picked or whether nail-- simple things like things they've chosen for their body – tattoos and so forth. And again, we could say that's a generalized anxiety or that's a common concern, but if it's done repetitively and urgently and it's causing them an extreme amount of distress, and it's often targeted around uncertainty or anxiety or disgust, clean and clear OCD. Some clients I've had have said, "What if I don't remember something the way that it actually was? What if I can't remember it the exact way that it was? What if I lose a part of the memory?" Now, this might show up around, let's say the loss of a loved one. What if I don't remember them? And we might say that is a total normal stage of grief, except this person is trying to solve this memory issue repetitively, urgently over and over again, struggling in massive amounts of distress. The uncertainty of this is really destroying them. And again, clean and clear case of meeting criteria for OCD, but they don't seem to make these into these categories. They don't seem to slide into a category. I've had patients have obsessions about whether their partner cheats on them, and we could say, "Oh, well, they were probably--" in some cases, they have been cheated on before and we go, "That makes complete sense that they would worry about that. That's not OCD." But we look at the presentation and it goes far beyond generalized anxiety. It goes far beyond daily normal anxiety concerns for that situation. Again, it could become massive amounts of reassurance-seeking, rumination, avoidance, compulsions, self-criticism, self-punishment. And we can see that the way these compulsions are playing out meet criteria for OCD. And you might even say there, "Well, that's kind of relationship OCD." But that fits into the category. And we could argue that maybe you're right, but I really wanted to highlight how often. Let's say, if the partner had cheated on them and they're having this obsession, usually, people would not put it in the category of relationship OCD because the partner had cheated on them or because a family member had cheated on their partner and they were somewhat traumatized by that event. We can sometimes miss cases because it doesn't fall into a category. I've had people and clients who've worried obsessively and compulsively about their thought, what if my child suffers? What if my child goes through hard times? And again, we would go, "Oh, that makes complete sense. Every parent feels that. Every parent worries about that." But then again, it crosses a line into massive amounts of rumination, massive amounts of checking, massive amounts of reactivity. It might not even be that it's the typical compulsions. It might be just a great deal of reactivity done because the uncertainty of this is so overwhelming. I've had patients have obsessions about their taxes. What if they weren't done correctly? They go back and they check them and then they go back and have a second opinion, and then they-- and again, we could say, "Well, isn't that kind of like a bit of a moral obsession?" But when we ask the patient, they might say, "No, it's not about that. It's just about the fact that it's uncertain." Again, doesn't fit into a typical subtype. One other example I have is a lot of patients I've had have had the obsession, how will I know when it's time to stop therapy? Now that's a common rational concern. That's actually a really good question to ask. Well, how will I know? But again, the obsession is excessive and causing them great distress. They spend a lot of time trying to figure it out. They can't figure it out. There is no solution. The uncertainty is so overwhelming and overbearing and painful, they end up doing a lot of compulsions. And so, there we have all of these examples, and I'm sure you probably have more of where your obsession doesn't fit into a typical subtype but is so clearly OCD. So, here is what I want to offer you. In this case, I'm going to give you the answer up front, and then we're going to work through it together. The truth is, the subtypes really don't matter. The only reason they matter is they help with treatment and they help with validation in helping people to feel not alone. But we must remember that nowhere in the criteria for OCD does it say you have to have a subtype. The only criteria you need to have is to have an obsession, a repetitive thought, feeling, sensation, urge, or image. And that obsession has to create a lot of distress in your life and can impact your functioning. Not always, but it can. And then must contain compulsions. And the compulsions are either covert or overt, meaning they're behavioral, they're physical, or they're mental. They must cause a lot of distress in your life. They must take a certain amount of time. And if you meet that criteria, that's all we really need for you to move forward with your recovery, and I want to encourage you to move forward as fast as you can. Try not to get caught up. Remember the subtypes. Just think about me being a therapist who trains staff. I have ERP School , which is our online course. That is for people who don't have face-to-face therapy, who don't have access to therapy, who want to learn how to structure ERP for themselves. I talk a lot about subtypes there, but only because it's an education tool to help people get direction for their treatment. But if you don't meet that criteria, that means nothing about whether you can recover or not. So, that's the main point, and now we're going to talk about how we can do this. Now, first, before we do this, I actually want to introduce to you something that is a science-based measurement tool we use for OCD that may be very validating to you folks if you don't have a specific subtype that you fall into that category. Dimensional Obsessive Compulsive Scale (Jon Abramowitz) Now, Jon Abramowitz and his team has created what he calls the Dimensional Obsessive-Compulsive Scale. If you Google it, it should come up. I will do my best to link it in the show notes. And this ultimately doesn't have anything about subtypes. It really just has four categories of concerns that people with OCD have. And what I found so wonderful about that is if we throw out all the subtypes and we just look at the symptoms, we look at the process that someone with OCD goes through, you'll probably find you fall into one of these categories. If you don't, still don't worry because-- but I think that this is-- I love the way that they've really put this together because it simplifies everything. It makes it a whole lot less confusing. So, let's go through them together. Number one, category 1 is concerns about germs and contamination, and they go through to explain that. If you download it, you'll get more information about this. Category 2 - concerns about being responsible for the harm, injury, or bad luck. And so, for that one, that includes harm OCD, it includes religious obsessions, self-harm OCD, moral obsessions. A lot of those subtypes can fall into these little categories, but I like that these are really basic. The third is simple, unacceptable thoughts. And in these cases of people with OCD that don't fit into the subtypes, we could easily just say, "You fall into the unacceptable thoughts category, that these thoughts are unacceptable to you. The uncertainty is unacceptable to you." And then the fourth category is concerns about symmetry, completeness, and the needs for things to be just right. And what I think is so helpful about that is so often these cases where they don't fall into these more typical subtypes, I find often they do fall into somewhere around this idea of the need for things to be completed or just right or resolved. Hopefully, this Dimensional Obsessive-Compulsive Scale helps catch a net underneath all of these subtypes that can validate you, that you still fall under the category of having OCD, that you can still move forward with your treatment. You go full fledged into your ERP and move forward ultimately. Ocd Vs General Anxiety Disorder (Gad) Now, that being said, we also need to look at the overlap, or maybe we should actually say the spectrum of where generalized anxiety can meet OCD. Some of these, as we said, some of these obsessions fall under maybe that's more generalized anxiety, but we know that you could have generalized anxiety fears. But if they're presenting with obsessions and compulsions, we're actually going to treat it like OCD. And some people – I've actually really loved the OCD community – are now arguing that general anxiety and OCD are the same thing, just on a spectrum, from not so severe to very, very severe. And they're doing that. People with generalized anxiety are doing obsessions, having obsessions, and doing compulsions. The biggest one being mental rumination and avoidance. So, let's round this out by talking about what to do now. So, if this is you, here is what I want you to remember. At the end of the day, and this is what I say to my clients, at the end of the day, it doesn't matter what we call this. We could call your set of symptoms bibbidi-bobbidi-boo, and we would still use the same tools to get you effective results because what do we know? It doesn't matter. Whatever the content is, what do we know is the problem that you're struggling to manage the uncertainty that you're having, that you're having a great deal of distress and discomfort, and we need tools to be able to manage and ride that out. So, again, if we call it this specific subtype, we call it OCD, we call it generalized anxiety, we call it bibbidi-bobbidi-boo, at the end of the day, they all require us to stop trying to suppress the thought because we know suppressing the thoughts make it worse. And then we can practice exposing ourselves to the situations where those thoughts come up without doing those compulsions. So, if you've taken ERP School or you're interested in taking ERP School, we go thoroughly through what ERP is, which is exposure and response prevention. What it is, is that we expose you to the thought and fear and the obsession that you're having. And then we practice, slowly but surely, reducing – this is called response prevention – reducing the compulsive behaviors that you do that reinforce that fear and obsession. That's ERP. It's actually pretty structured. We walk you through it in ERP School, but if you have an ERP therapist, they're going to walk you through identifying your obsession, even if it doesn't meet those categories, identifying what is your fear, and then practicing, exposing you to the life that you want to live, whether that fear shows up or not, and then practicing reducing those compulsions. The process of treatment is the same, disregarding the subtype, whether you have a subtype that you fall into or not. It is effective either way. Ideal Treatments For Ocd And so, what I'm going to encourage you to do, and I'm just going to think of this as me finishing out the podcast, but giving you some direction, is if you meet criteria for OCD, and that involves doubting your disorder-- I remember once John Hirschfeld when I was training to become an OCD therapist. He said to me, if he had his way, he would add to the criteria for OCD that you must doubt your disorder because it's so common for people with OCD to doubt whether they have the disorder. So, here we want to do is we want to have a plan where ERP is the meat and cheese of your treatment. And what you can do then is supplement treatment with either acceptance and commitment therapy, self-compassion, mindfulness. Sometimes people use DBT. There are new supplements coming to treatment all the time, which is wonderful, but the meat and cheese is to make sure you're doubling down on that exposure and then the reduction of those compulsions. Okay? My message to you is you can still 100% recover from this disorder. Look at the "I did a hard thing" today and look at the review even, talking about the benefits of practicing ERP. So, that's what I want you to focus on. If you don't have access to an ERP therapist, we have a course available to you. It's $197, which is actually less than one session with any of my staff or most ERP therapists. That is about seven hours long and will walk you through this process. So, if you're interested, head over to CBTSchool.com. The course is called ERP School and hopefully, it will give you the tools and the education you need to feel like you can get the ball going here, even if you don't fit these typical subtypes. Okay, that's all I have to say about that. I hope that this has been absolutely jam-packed with helpful skills for you to learn. I hope it absolutely validated your concern if, in fact, this is a concern that you have, and it is my honor to be on this journey with you. So, as I always say at the end of almost every episode, it is a beautiful day to do hard things. Thank you so much again for supporting me. I just adore sending out these free resources for you and hopefully filling up your cup if your cup is feeling very empty. Please also, one thing I should have said, be gentle guys. OCD and anxiety in general can be a mean beast in our minds. And one of the best antidotes to that can be kindness, gentle self-care, loving, nurturing presence. And so, I hope that's what I am for you and I hope that is what you are for you as well. Have a wonderful day, everybody.

Oct 28, 2022

In This Episode: Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. addresses the benefits of ERP and how ERP is for Everyone How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety Links To Things I Talk About: Andrew's Instagram @justrught ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 308. Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you're going to love it. But the main point we're making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don't technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I'm so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. Before we head into the show, let's quickly do the "I did a hard thing" for the week. This one is from Christina, and they went on to say: "Thought of you today, and you're saying, 'It's a beautiful day to do hard things,' as I went down a water slide, terrified, as I'm well out of my comfort zone." This is such great. They're saying that's on their holiday, the first time they've taken a holiday in quite a while. "It's difficult, but I'm doing it. I'm trying to lean into the discomfort." This is so good. I love when people share their "I did a hard thing," mainly, as I say before, because it doesn't have to be what's hard for everybody. It can be what's hard for you. Isn't it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I'm totally with you on that. But some of the people find it thrill-seeking. And then I'm sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don't miss that point, guys. It is such an important thing that we don't compare. If it's terrifying, it's terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew's amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said: "Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you're truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)" So, for those of you who don't know, I wrote a book called The Self-Compassion Workbook for OCD . If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. All right, let's get over to the show. Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here. Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit. Kimberley: Yeah. How fun. I'm so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about. Andrew: I might bring some of them up because I think, anyway, it's related to our big topic. Erp Is For Everyone Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you. Andrew: Yeah. So, there's a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn't know what it was and really didn't know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it's probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn't want to talk about it then, I think. Andrew's Story About Having Obsessive Compulsive Disorder A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we're South Midwest, East Coast, whatever. But still there, there's a culture that mental health is for "crazy people." Of course, we don't believe that. So, my tiptoe around it was saying, "I'm having trouble focusing in class. Maybe I have ADHD." And that's what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, "Hey, you have a problem." And so, ended up talking more. So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn't know about it. I didn't know about it. I didn't have the language to talk about it at the time because I didn't have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that's a common story. So, I entered therapy in 2009, and I've been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I'm very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. So, let's keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There's a long-term outpatient stay, Skyline Trail. I'm thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. So, finally, gosh, I can't quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I'm not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I'd have an excuse until I finally was like, "I'm going to get found out that I'm not working full-time. I'm going to jump the gun, I'll voluntarily go down in part-time." So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, "I've failed. I've quit so many things – college, AmeriCorps." I was a summer camp counselor and I left early. "Now this job. I need something." So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, "Well, one problem is you have OCD." I was like, "What? No, I don't have that. I don't wash my hands. I'm not a messy person. I'm not organized." Gosh, I'm so thankful for her. Kimberley: Yeah, I want to kiss this person. Andrew: Yeah. But here's the duality of it. She diagnosed me with it. I am forever grateful. And she didn't do ERP. She didn't know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn't feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, "Oh, this isn't working for me. I've been doing the same type of therapy for a decade and I'm not making progress." Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. Kimberley: No, I've got goosebumps. Andrew: I'm unemployed, I have my diagnosis, but I'm not making any progress. So, I go, "Throw this in as well. Not really that important." But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, "I need you to commit to this." And I said, "But I don't think this is helping me either," because the conversation was about relationships, my relationship was great. It was about work, I wasn't working. It was about parents, my parents were great. They were supporting me financially. They're super helpful and loving and kind. It's like, "None of this is external." I kept saying, "This is internal. I have something going on inside of me." And she said, "Well, I want you to commit to it." I said, "I'm sorry, I found a local OCD clinic. I'm going to try them out." So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we'll talk about this in a bit, what ERP is. So, built the hierarchy, I'm afraid of cutting my veins and bleeding out. So, let's start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, "Okay, you need to find the juiciest, bumpiest vein, and that's where you put it in." And my therapist, pause the video. She said, "Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins." Oh my gosh. Can you imagine? Kimberley: The imagery and the wording together is so triggering, isn't it? Andrew: Right. She's amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it's doing all three of these things. So, I went around. And of course, it's an OCD clinic, so nobody's against it. They're like, "Sure, here you go. This one looks big. Here, let me pump it up for you." And I'm like, "No, I don't like this." Kimberley: Well, it's such a shift from what you had been doing. Andrew: It's totally different. I'll speak to the rest because that's really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I'm an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP. Kimberley: Right. Oh, my heart is so exploding for you. Andrew: Oh, thank you. Kimberley: My goodness. I mean, it's not a wonderful story. It's actually an incredibly painful story. Andrew: You can laugh at it. I told it humorously. How Andrew Applied Erp For His Ocd Kimberley: No. But that's what I'm saying. That's what's so interesting about this, is that it's such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you're obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you'd been put through the wringer. Andrew: Yeah. There's a lot to talk about, but there are a couple of key moments when you mention it. So, one, we're going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don't do the compulsion? "Oh, never. I've never stopped. But you can do that?" It was just this moment of, "What do you mean?" If it's hot, I'm going to make it colder. If it's cold, I'm going to make it warmer. If I'm uncomfortable, I'm going to fidget. I'm a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and "just right" OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. Am I Doing Erp "Just Right"? But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, "I don't know. Who knows? Maybe, maybe not." So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, "I know there is a right way to do it. There is. I know there is." But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you're doing it wrong, maybe you're not. I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don't know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It's good I'm doing the exposure. I'm preventing the response by staying there. I didn't get out. But in my head, I'm doing, "Just get through this. Just get through this. I hate this. It's going to be over soon. You'll get through it and then you'll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh." And then you get to the end and you go, "Okay, I made it through." And of course, that didn't really prevent the response. That reinforced my dread of it. And so, I would say that's definitely a lesson as we get into that. Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who'll say early in treatment, "You'd be so proud I did the exposure." And I'd be like, "And the RP, did that get included?" So, let's talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from? Andrew: I would say it's been slow going over the years where-- I don't know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they're not clinical level OCD and maybe it's just anxiety or I think, as I emailed you, just stress. But it's this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, "Oh, I cannot try to solve this." And so, I see people that I really care about and I joked with my wife, I said, "Why is it that all of our best friends are anxious people?" And I think that comes with this care and attention and that I've suffered and I don't want anyone else to suffer. And so, I see that anxiety in others. But getting back to what I see in them, maybe someone is socially anxious so they're avoiding a party or they're leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don't know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It's worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it's a little too loud or it's too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it's helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I'm not cured, I think. I'm still listening to your six-part rumination series because I think that's really what I'm working on now. So, I think those physical things, I've made tremendous improvement on blood and veins and all that. But that's also not why I quit work. I didn't quit working. I didn't quit AmeriCorps because there's so much blood everywhere. No, it's nonprofits, it's cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I'm going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn't have that response prevention piece, all I had was the exposure piece, then it's-- I can't remember who said it, but like, ERP without the RP is just torture. You're just exposing yourself to all these miserable things. Kimberley: You're white-knuckling. Andrew: Yeah. And it's-- I love research. I am a scientist by heart. I'm a Physics major and Environmental Studies master's. I love research and all this. And so, I've looked into neuroplasticity, but I also am not an expert. Correct me if I'm wrong, but from what I hear, you're just reinforcing that neural pathway. So, I'm going into work and I dread it. I'm saying, "I hate this. I can't wait to go home. I hate this." So, that's reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let's see how we can do ERP with the things you don't like and so you're not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that's meaningful. But I'm watching you get more and more deteriorated at work. And that's hard to do that in others. ERP Is For Everyone Kimberley: Yeah. I resonate so much from a personal level and I'll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I'm watching how anxiety is forming them. They're being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there's so many times-- I've used the example before of both my kids separately were absolutely petrified of dogs. And they don't have OCD, but we used a hierarchy of exposure and now they can play with the neighbor's dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, "You're fine. Let's never be around dogs." And so, it's so interesting to watch these teeny tiny little humans being formed by like, "Oh, I'm not a dog person." You are a dog person. You're just afraid of dogs. It's two different things. Andrew: Yeah. So, it's funny that my next-door neighbor, when I was young, had a big dog. And when we're moving into the house for the very first time, very young, I don't know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the "Stay off my lawn, don't let your soccer ball come over." So, for years, I had this like, "I'm not going to root for Germany in sports. I don't like Germany." And then here I am living in Germany now. Kimberley: Like an association. Andrew: Yeah. So, I think fear association, anxiety association. And then I'm also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don't know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, "That's how a girl sits. You have to sit with your foot up on your leg." So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, "Oh, you can't wear that, guys don't wear that." So, I didn't. I stopped wearing that and all these things, whether it's about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. I don't know if you agree, but I see this under the umbrella of ERP. So, you're exposing yourself to this potential situation where there's shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, "What are you doing with painted nails?" And I'm going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can't wear pink, or you can't be that when you grow up, or just these associations where I think you can, I think you can do that. Kimberley: I love this so much because I think you're so right in why ERP is for everyone. It's funny, I'll tell you a story and then I don't want to talk about me anymore, but-- Andrew: No, I want to hear it. That's fine. Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, "It's a beautiful day to do hard things." I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it's so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn't realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don't have to wear your bathing suit right into the thing. So, I'm like, "Cool, that's fine. I'm comfortable with my body." But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it's still learned avoidance from something I don't even suffer from anymore. And I think that, to speak to what you're saying, if we're really aware we can-- and I don't have OCD, I'm open about that. If all humans were really aware, they could catch avoidant behaviors we're doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, "Oh, no, no. I don't even have anxiety." But it's funny what you can catch in yourself that how you're running actually literally running. Andrew: Literally running. Yeah. Kimberley: Away. So, that's why I think you've mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that's why I think that's so cool. It's such a cool concept. Andrew: Yeah. And so, help me since I do consider you the expert here, but I've heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let's say that's what ERP is proposed for. But then we also have generalized anxiety and I think we're seeing that. I've heard Jenna Overbaugh talk about that as well. It's this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I'll find a way to skip it. Or I have this stressful family event, I'll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone. Kimberley: Yeah. No, I mean, clinically, I will say we understand it's helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren't OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody's self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that's why I think like, again, even if you're not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they're in an environment that's safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it's also-- this is my opinion, but I'm actually more interested in your opinion, is I think ERP is also a mindset. Andrew: Yeah. Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That's what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn't handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP? Andrew: Yeah. That's a good question. I've had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don't want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, "You'll be the mayor of this town someday, Andrew." And I watched this slip away and I had to change that identity. And not to say that you can't ever get that back with recovery, but what I will say is through recovery, I don't have that desire to anymore. I don't have that desire to be a hundred percent. I'm a big fan of giving 80%. And mayor is too much responsibility. I don't know, maybe someday. So, that changed. And then definitely, through that down downturn, I thought, I can't handle this. I can't handle anxiety, I can't handle stress. People are going to find out that this image I've built of myself is someone who can't handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don't have to fix it. You don't have to solve the problem. I think that was me. And that's not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain "Dolores" after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we're nine hours apart right now. "Oh, did I get the time difference right?" I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn't eat right before we talked, so I didn't burp on camera, made sure I had my water, and it was just all these-- and if I wasn't about to meet with an OCD expert, I wouldn't have even noticed these. I wouldn't have even noticed all of these checking, fidgeting, optimizing, best practicing. But it's exhausting. And so, I'm going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, "Oh, I'm doing an avoidant behavior," or "I'm fixing something to fix my anxiety that gives me temporary relief"? Because I didn't notice them for 10 years. Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It's knowledge that that-- but it's a lot to do with awareness. It's so much to do with awareness. I'll give you an example, and I've spoken about this before. As soon as I'm anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there's no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It's like this thick, and I look at it and I go, "Okay, be aware as you go into the day." And then I can work at catching as I start to speed up and speed type. So, I think for the person who doesn't have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it's being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don't have to change it. I'm not doing any harm by typing fast. In fact, some might say I'm getting more done, but I don't like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question. Andrew: So, I think you bring up a good point though that I'm curious if you've heard this as well. So, you said you're typing fast and you're feeling anxious and you don't like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don't realize those are connected. I didn't realize that was connected. In college, I'm wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I'm very, very anxious and miserable and I don't know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I'm going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It's still something I'm trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn't realize that was giving me that anxiety. So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I'm not a therapist, I can't diagnose and I'm not going to go up, I think you have this. But seeing that they're coming to me and saying, "I'm exhausted. I just have so much going on," I think in their head, it's "I have a lot of work." Kimberley: External problems. Andrew: Yeah. I may be seeing-- yeah, but there's all this tension. You're holding it in your shoulders, you're holding it here, you're typing fast and not realizing that, oh, these are connected. Kimberley: And that's that awareness piece. It's an awareness piece so much. And it is true. I mean, I think that's the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren't previously aware of. I go to therapy and sometimes even my therapist will be like, "I got a question for you." And I'm like, "Ah, I missed that." So, I think that that's the beauty of this. Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there's a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, "Well, can I read some self-help books, and then if those don't work, go to therapy?" "No, I think go to therapy right away. Big fan of therapists. I'm not a therapist. You need to talk to a therapist." "Okay. But what if I did some podcasts and then if that didn't work, then I go to therapy?" "Nope. Therapy is great. Go to therapy now." "Should I wait till my life gets more stressful?" "Nope. Go now." Kimberley: Yeah, because it's that reflection and questioning. Everyone who knows me knows I love questions. They're my favorite. So, I think you're on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion? Andrew: How do we put this with a nice bow on it? Kimberley: It doesn't have to be perfect. Let's make it purposely imperfect. Andrew: Let's make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, "Hey, actually, ERP is an evidence-based gold standard. We know it works, we've seen it work. It's helped us. Let it help you because we care about you and we want you to do it." And then moving down stress from work, from life. You have a big trip coming up. There's a fun scale, home's rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, "Oh, that's a stressful thing?" "Yeah, It can be." And so, noticing the stressful things in your life and saying, "Well, because of these stressful things are the things I'm avoiding, things I'm getting anxious about, can I learn to sit with that?" And I think that mindfulness piece is so important. So, whether you're clinical, whether you're subclinical, whether you have stress in your life, whether you're just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don't know if people roll their eyes at people like us, "Follow your values, talk about your values." Do you value spending time with your friends, but you're avoiding the social gathering? Sounds like ERP could help you out with that. Or you're avoiding this, you want to get a certification, but you don't think you'll get it and you don't want to spend the time? Sounds like ERP could help with that. We're in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you're embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I've become almost evangelical about it. Look at this thing, it works so well. It's done so much for me. Kimberley: Love it. Okay, tell me where-- I'm going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work. Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It's JustRught but with right spelled wrong. So, it's R-U-G-H-T. Kimberley: That is perfect. Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, "You know what, Andrew, leave it. This works. This works just fine." Kimberley: Oh, it is so good. It is so good. Andrew: Yeah. So, I'm also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I've learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I'm currently an OCD advocate as well. You can find me on IOCDF's website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, "Guys, Kimberley Quinlan is at the same level as me." I was so excited. Kimberley: You're so many levels above me. Just look at your story. That's the work. Andrew: The imposter syndrome, we talked about that earlier. Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It's so beautiful. So, thank you so much. Andrew: I will add in, if you allow me a little more time, that it's not magic. We're not saying, "Oh, go do ERP for two days and you'll be great." It's hard work. It's a good day to do hard things. I think if it was easy, we wouldn't be talking about it so much. We wouldn't talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It's given me my life back, it's saved my relationships, it's helped me move overseas, given me this opportunity, and I'm just so thankful for it. Kimberley: Yeah. Oh, mic drop. Andrew: Yeah. Kimberley: Thank you again.

Oct 28, 2022

In This Episode: Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. addresses the benefits of ERP and how ERP is for Everyone How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety Links To Things I Talk About: Andrew's Instagram @justrught ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 308. Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you're going to love it. But the main point we're making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don't technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I'm so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. Before we head into the show, let's quickly do the "I did a hard thing" for the week. This one is from Christina, and they went on to say: "Thought of you today, and you're saying, 'It's a beautiful day to do hard things,' as I went down a water slide, terrified, as I'm well out of my comfort zone." This is such great. They're saying that's on their holiday, the first time they've taken a holiday in quite a while. "It's difficult, but I'm doing it. I'm trying to lean into the discomfort." This is so good. I love when people share their "I did a hard thing," mainly, as I say before, because it doesn't have to be what's hard for everybody. It can be what's hard for you. Isn't it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I'm totally with you on that. But some of the people find it thrill-seeking. And then I'm sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don't miss that point, guys. It is such an important thing that we don't compare. If it's terrifying, it's terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew's amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said: "Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you're truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)" So, for those of you who don't know, I wrote a book called The Self-Compassion Workbook for OCD . If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. All right, let's get over to the show. Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here. Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit. Kimberley: Yeah. How fun. I'm so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about. Andrew: I might bring some of them up because I think, anyway, it's related to our big topic. Erp Is For Everyone Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you. Andrew: Yeah. So, there's a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn't know what it was and really didn't know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it's probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn't want to talk about it then, I think. Andrew's Story About Having Obsessive Compulsive Disorder A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we're South Midwest, East Coast, whatever. But still there, there's a culture that mental health is for "crazy people." Of course, we don't believe that. So, my tiptoe around it was saying, "I'm having trouble focusing in class. Maybe I have ADHD." And that's what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, "Hey, you have a problem." And so, ended up talking more. So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn't know about it. I didn't know about it. I didn't have the language to talk about it at the time because I didn't have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that's a common story. So, I entered therapy in 2009, and I've been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I'm very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. So, let's keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There's a long-term outpatient stay, Skyline Trail. I'm thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. So, finally, gosh, I can't quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I'm not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I'd have an excuse until I finally was like, "I'm going to get found out that I'm not working full-time. I'm going to jump the gun, I'll voluntarily go down in part-time." So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, "I've failed. I've quit so many things – college, AmeriCorps." I was a summer camp counselor and I left early. "Now this job. I need something." So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, "Well, one problem is you have OCD." I was like, "What? No, I don't have that. I don't wash my hands. I'm not a messy person. I'm not organized." Gosh, I'm so thankful for her. Kimberley: Yeah, I want to kiss this person. Andrew: Yeah. But here's the duality of it. She diagnosed me with it. I am forever grateful. And she didn't do ERP. She didn't know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn't feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, "Oh, this isn't working for me. I've been doing the same type of therapy for a decade and I'm not making progress." Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. Kimberley: No, I've got goosebumps. Andrew: I'm unemployed, I have my diagnosis, but I'm not making any progress. So, I go, "Throw this in as well. Not really that important." But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, "I need you to commit to this." And I said, "But I don't think this is helping me either," because the conversation was about relationships, my relationship was great. It was about work, I wasn't working. It was about parents, my parents were great. They were supporting me financially. They're super helpful and loving and kind. It's like, "None of this is external." I kept saying, "This is internal. I have something going on inside of me." And she said, "Well, I want you to commit to it." I said, "I'm sorry, I found a local OCD clinic. I'm going to try them out." So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we'll talk about this in a bit, what ERP is. So, built the hierarchy, I'm afraid of cutting my veins and bleeding out. So, let's start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, "Okay, you need to find the juiciest, bumpiest vein, and that's where you put it in." And my therapist, pause the video. She said, "Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins." Oh my gosh. Can you imagine? Kimberley: The imagery and the wording together is so triggering, isn't it? Andrew: Right. She's amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it's doing all three of these things. So, I went around. And of course, it's an OCD clinic, so nobody's against it. They're like, "Sure, here you go. This one looks big. Here, let me pump it up for you." And I'm like, "No, I don't like this." Kimberley: Well, it's such a shift from what you had been doing. Andrew: It's totally different. I'll speak to the rest because that's really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I'm an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP. Kimberley: Right. Oh, my heart is so exploding for you. Andrew: Oh, thank you. Kimberley: My goodness. I mean, it's not a wonderful story. It's actually an incredibly painful story. Andrew: You can laugh at it. I told it humorously. How Andrew Applied Erp For His Ocd Kimberley: No. But that's what I'm saying. That's what's so interesting about this, is that it's such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you're obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you'd been put through the wringer. Andrew: Yeah. There's a lot to talk about, but there are a couple of key moments when you mention it. So, one, we're going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don't do the compulsion? "Oh, never. I've never stopped. But you can do that?" It was just this moment of, "What do you mean?" If it's hot, I'm going to make it colder. If it's cold, I'm going to make it warmer. If I'm uncomfortable, I'm going to fidget. I'm a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and "just right" OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. Am I Doing Erp "Just Right"? But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, "I don't know. Who knows? Maybe, maybe not." So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, "I know there is a right way to do it. There is. I know there is." But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you're doing it wrong, maybe you're not. I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don't know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It's good I'm doing the exposure. I'm preventing the response by staying there. I didn't get out. But in my head, I'm doing, "Just get through this. Just get through this. I hate this. It's going to be over soon. You'll get through it and then you'll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh." And then you get to the end and you go, "Okay, I made it through." And of course, that didn't really prevent the response. That reinforced my dread of it. And so, I would say that's definitely a lesson as we get into that. Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who'll say early in treatment, "You'd be so proud I did the exposure." And I'd be like, "And the RP, did that get included?" So, let's talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from? Andrew: I would say it's been slow going over the years where-- I don't know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they're not clinical level OCD and maybe it's just anxiety or I think, as I emailed you, just stress. But it's this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, "Oh, I cannot try to solve this." And so, I see people that I really care about and I joked with my wife, I said, "Why is it that all of our best friends are anxious people?" And I think that comes with this care and attention and that I've suffered and I don't want anyone else to suffer. And so, I see that anxiety in others. But getting back to what I see in them, maybe someone is socially anxious so they're avoiding a party or they're leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don't know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It's worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it's a little too loud or it's too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it's helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I'm not cured, I think. I'm still listening to your six-part rumination series because I think that's really what I'm working on now. So, I think those physical things, I've made tremendous improvement on blood and veins and all that. But that's also not why I quit work. I didn't quit working. I didn't quit AmeriCorps because there's so much blood everywhere. No, it's nonprofits, it's cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I'm going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn't have that response prevention piece, all I had was the exposure piece, then it's-- I can't remember who said it, but like, ERP without the RP is just torture. You're just exposing yourself to all these miserable things. Kimberley: You're white-knuckling. Andrew: Yeah. And it's-- I love research. I am a scientist by heart. I'm a Physics major and Environmental Studies master's. I love research and all this. And so, I've looked into neuroplasticity, but I also am not an expert. Correct me if I'm wrong, but from what I hear, you're just reinforcing that neural pathway. So, I'm going into work and I dread it. I'm saying, "I hate this. I can't wait to go home. I hate this." So, that's reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let's see how we can do ERP with the things you don't like and so you're not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that's meaningful. But I'm watching you get more and more deteriorated at work. And that's hard to do that in others. ERP Is For Everyone Kimberley: Yeah. I resonate so much from a personal level and I'll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I'm watching how anxiety is forming them. They're being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there's so many times-- I've used the example before of both my kids separately were absolutely petrified of dogs. And they don't have OCD, but we used a hierarchy of exposure and now they can play with the neighbor's dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, "You're fine. Let's never be around dogs." And so, it's so interesting to watch these teeny tiny little humans being formed by like, "Oh, I'm not a dog person." You are a dog person. You're just afraid of dogs. It's two different things. Andrew: Yeah. So, it's funny that my next-door neighbor, when I was young, had a big dog. And when we're moving into the house for the very first time, very young, I don't know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the "Stay off my lawn, don't let your soccer ball come over." So, for years, I had this like, "I'm not going to root for Germany in sports. I don't like Germany." And then here I am living in Germany now. Kimberley: Like an association. Andrew: Yeah. So, I think fear association, anxiety association. And then I'm also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don't know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, "That's how a girl sits. You have to sit with your foot up on your leg." So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, "Oh, you can't wear that, guys don't wear that." So, I didn't. I stopped wearing that and all these things, whether it's about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. I don't know if you agree, but I see this under the umbrella of ERP. So, you're exposing yourself to this potential situation where there's shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, "What are you doing with painted nails?" And I'm going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can't wear pink, or you can't be that when you grow up, or just these associations where I think you can, I think you can do that. Kimberley: I love this so much because I think you're so right in why ERP is for everyone. It's funny, I'll tell you a story and then I don't want to talk about me anymore, but-- Andrew: No, I want to hear it. That's fine. Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, "It's a beautiful day to do hard things." I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it's so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn't realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don't have to wear your bathing suit right into the thing. So, I'm like, "Cool, that's fine. I'm comfortable with my body." But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it's still learned avoidance from something I don't even suffer from anymore. And I think that, to speak to what you're saying, if we're really aware we can-- and I don't have OCD, I'm open about that. If all humans were really aware, they could catch avoidant behaviors we're doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, "Oh, no, no. I don't even have anxiety." But it's funny what you can catch in yourself that how you're running actually literally running. Andrew: Literally running. Yeah. Kimberley: Away. So, that's why I think you've mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that's why I think that's so cool. It's such a cool concept. Andrew: Yeah. And so, help me since I do consider you the expert here, but I've heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let's say that's what ERP is proposed for. But then we also have generalized anxiety and I think we're seeing that. I've heard Jenna Overbaugh talk about that as well. It's this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I'll find a way to skip it. Or I have this stressful family event, I'll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone. Kimberley: Yeah. No, I mean, clinically, I will say we understand it's helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren't OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody's self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that's why I think like, again, even if you're not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they're in an environment that's safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it's also-- this is my opinion, but I'm actually more interested in your opinion, is I think ERP is also a mindset. Andrew: Yeah. Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That's what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn't handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP? Andrew: Yeah. That's a good question. I've had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don't want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, "You'll be the mayor of this town someday, Andrew." And I watched this slip away and I had to change that identity. And not to say that you can't ever get that back with recovery, but what I will say is through recovery, I don't have that desire to anymore. I don't have that desire to be a hundred percent. I'm a big fan of giving 80%. And mayor is too much responsibility. I don't know, maybe someday. So, that changed. And then definitely, through that down downturn, I thought, I can't handle this. I can't handle anxiety, I can't handle stress. People are going to find out that this image I've built of myself is someone who can't handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don't have to fix it. You don't have to solve the problem. I think that was me. And that's not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain "Dolores" after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we're nine hours apart right now. "Oh, did I get the time difference right?" I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn't eat right before we talked, so I didn't burp on camera, made sure I had my water, and it was just all these-- and if I wasn't about to meet with an OCD expert, I wouldn't have even noticed these. I wouldn't have even noticed all of these checking, fidgeting, optimizing, best practicing. But it's exhausting. And so, I'm going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, "Oh, I'm doing an avoidant behavior," or "I'm fixing something to fix my anxiety that gives me temporary relief"? Because I didn't notice them for 10 years. Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It's knowledge that that-- but it's a lot to do with awareness. It's so much to do with awareness. I'll give you an example, and I've spoken about this before. As soon as I'm anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there's no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It's like this thick, and I look at it and I go, "Okay, be aware as you go into the day." And then I can work at catching as I start to speed up and speed type. So, I think for the person who doesn't have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it's being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don't have to change it. I'm not doing any harm by typing fast. In fact, some might say I'm getting more done, but I don't like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question. Andrew: So, I think you bring up a good point though that I'm curious if you've heard this as well. So, you said you're typing fast and you're feeling anxious and you don't like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don't realize those are connected. I didn't realize that was connected. In college, I'm wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I'm very, very anxious and miserable and I don't know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I'm going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It's still something I'm trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn't realize that was giving me that anxiety. So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I'm not a therapist, I can't diagnose and I'm not going to go up, I think you have this. But seeing that they're coming to me and saying, "I'm exhausted. I just have so much going on," I think in their head, it's "I have a lot of work." Kimberley: External problems. Andrew: Yeah. I may be seeing-- yeah, but there's all this tension. You're holding it in your shoulders, you're holding it here, you're typing fast and not realizing that, oh, these are connected. Kimberley: And that's that awareness piece. It's an awareness piece so much. And it is true. I mean, I think that's the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren't previously aware of. I go to therapy and sometimes even my therapist will be like, "I got a question for you." And I'm like, "Ah, I missed that." So, I think that that's the beauty of this. Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there's a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, "Well, can I read some self-help books, and then if those don't work, go to therapy?" "No, I think go to therapy right away. Big fan of therapists. I'm not a therapist. You need to talk to a therapist." "Okay. But what if I did some podcasts and then if that didn't work, then I go to therapy?" "Nope. Therapy is great. Go to therapy now." "Should I wait till my life gets more stressful?" "Nope. Go now." Kimberley: Yeah, because it's that reflection and questioning. Everyone who knows me knows I love questions. They're my favorite. So, I think you're on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion? Andrew: How do we put this with a nice bow on it? Kimberley: It doesn't have to be perfect. Let's make it purposely imperfect. Andrew: Let's make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, "Hey, actually, ERP is an evidence-based gold standard. We know it works, we've seen it work. It's helped us. Let it help you because we care about you and we want you to do it." And then moving down stress from work, from life. You have a big trip coming up. There's a fun scale, home's rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, "Oh, that's a stressful thing?" "Yeah, It can be." And so, noticing the stressful things in your life and saying, "Well, because of these stressful things are the things I'm avoiding, things I'm getting anxious about, can I learn to sit with that?" And I think that mindfulness piece is so important. So, whether you're clinical, whether you're subclinical, whether you have stress in your life, whether you're just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don't know if people roll their eyes at people like us, "Follow your values, talk about your values." Do you value spending time with your friends, but you're avoiding the social gathering? Sounds like ERP could help you out with that. Or you're avoiding this, you want to get a certification, but you don't think you'll get it and you don't want to spend the time? Sounds like ERP could help with that. We're in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you're embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I've become almost evangelical about it. Look at this thing, it works so well. It's done so much for me. Kimberley: Love it. Okay, tell me where-- I'm going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work. Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It's JustRught but with right spelled wrong. So, it's R-U-G-H-T. Kimberley: That is perfect. Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, "You know what, Andrew, leave it. This works. This works just fine." Kimberley: Oh, it is so good. It is so good. Andrew: Yeah. So, I'm also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I've learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I'm currently an OCD advocate as well. You can find me on IOCDF's website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, "Guys, Kimberley Quinlan is at the same level as me." I was so excited. Kimberley: You're so many levels above me. Just look at your story. That's the work. Andrew: The imposter syndrome, we talked about that earlier. Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It's so beautiful. So, thank you so much. Andrew: I will add in, if you allow me a little more time, that it's not magic. We're not saying, "Oh, go do ERP for two days and you'll be great." It's hard work. It's a good day to do hard things. I think if it was easy, we wouldn't be talking about it so much. We wouldn't talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It's given me my life back, it's saved my relationships, it's helped me move overseas, given me this opportunity, and I'm just so thankful for it. Kimberley: Yeah. Oh, mic drop. Andrew: Yeah. Kimberley: Thank you again.

Oct 28, 2022

In This Episode: Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. addresses the benefits of ERP and how ERP is for Everyone How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety Links To Things I Talk About: Andrew's Instagram @justrught ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 308. Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you're going to love it. But the main point we're making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don't technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I'm so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. Before we head into the show, let's quickly do the "I did a hard thing" for the week. This one is from Christina, and they went on to say: "Thought of you today, and you're saying, 'It's a beautiful day to do hard things,' as I went down a water slide, terrified, as I'm well out of my comfort zone." This is such great. They're saying that's on their holiday, the first time they've taken a holiday in quite a while. "It's difficult, but I'm doing it. I'm trying to lean into the discomfort." This is so good. I love when people share their "I did a hard thing," mainly, as I say before, because it doesn't have to be what's hard for everybody. It can be what's hard for you. Isn't it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I'm totally with you on that. But some of the people find it thrill-seeking. And then I'm sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don't miss that point, guys. It is such an important thing that we don't compare. If it's terrifying, it's terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew's amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said: "Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you're truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)" So, for those of you who don't know, I wrote a book called The Self-Compassion Workbook for OCD . If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. All right, let's get over to the show. Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here. Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit. Kimberley: Yeah. How fun. I'm so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about. Andrew: I might bring some of them up because I think, anyway, it's related to our big topic. Erp Is For Everyone Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you. Andrew: Yeah. So, there's a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn't know what it was and really didn't know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it's probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn't want to talk about it then, I think. Andrew's Story About Having Obsessive Compulsive Disorder A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we're South Midwest, East Coast, whatever. But still there, there's a culture that mental health is for "crazy people." Of course, we don't believe that. So, my tiptoe around it was saying, "I'm having trouble focusing in class. Maybe I have ADHD." And that's what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, "Hey, you have a problem." And so, ended up talking more. So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn't know about it. I didn't know about it. I didn't have the language to talk about it at the time because I didn't have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that's a common story. So, I entered therapy in 2009, and I've been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I'm very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. So, let's keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There's a long-term outpatient stay, Skyline Trail. I'm thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. So, finally, gosh, I can't quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I'm not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I'd have an excuse until I finally was like, "I'm going to get found out that I'm not working full-time. I'm going to jump the gun, I'll voluntarily go down in part-time." So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, "I've failed. I've quit so many things – college, AmeriCorps." I was a summer camp counselor and I left early. "Now this job. I need something." So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, "Well, one problem is you have OCD." I was like, "What? No, I don't have that. I don't wash my hands. I'm not a messy person. I'm not organized." Gosh, I'm so thankful for her. Kimberley: Yeah, I want to kiss this person. Andrew: Yeah. But here's the duality of it. She diagnosed me with it. I am forever grateful. And she didn't do ERP. She didn't know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn't feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, "Oh, this isn't working for me. I've been doing the same type of therapy for a decade and I'm not making progress." Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. Kimberley: No, I've got goosebumps. Andrew: I'm unemployed, I have my diagnosis, but I'm not making any progress. So, I go, "Throw this in as well. Not really that important." But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, "I need you to commit to this." And I said, "But I don't think this is helping me either," because the conversation was about relationships, my relationship was great. It was about work, I wasn't working. It was about parents, my parents were great. They were supporting me financially. They're super helpful and loving and kind. It's like, "None of this is external." I kept saying, "This is internal. I have something going on inside of me." And she said, "Well, I want you to commit to it." I said, "I'm sorry, I found a local OCD clinic. I'm going to try them out." So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we'll talk about this in a bit, what ERP is. So, built the hierarchy, I'm afraid of cutting my veins and bleeding out. So, let's start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, "Okay, you need to find the juiciest, bumpiest vein, and that's where you put it in." And my therapist, pause the video. She said, "Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins." Oh my gosh. Can you imagine? Kimberley: The imagery and the wording together is so triggering, isn't it? Andrew: Right. She's amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it's doing all three of these things. So, I went around. And of course, it's an OCD clinic, so nobody's against it. They're like, "Sure, here you go. This one looks big. Here, let me pump it up for you." And I'm like, "No, I don't like this." Kimberley: Well, it's such a shift from what you had been doing. Andrew: It's totally different. I'll speak to the rest because that's really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I'm an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP. Kimberley: Right. Oh, my heart is so exploding for you. Andrew: Oh, thank you. Kimberley: My goodness. I mean, it's not a wonderful story. It's actually an incredibly painful story. Andrew: You can laugh at it. I told it humorously. How Andrew Applied Erp For His Ocd Kimberley: No. But that's what I'm saying. That's what's so interesting about this, is that it's such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you're obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you'd been put through the wringer. Andrew: Yeah. There's a lot to talk about, but there are a couple of key moments when you mention it. So, one, we're going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don't do the compulsion? "Oh, never. I've never stopped. But you can do that?" It was just this moment of, "What do you mean?" If it's hot, I'm going to make it colder. If it's cold, I'm going to make it warmer. If I'm uncomfortable, I'm going to fidget. I'm a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and "just right" OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. Am I Doing Erp "Just Right"? But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, "I don't know. Who knows? Maybe, maybe not." So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, "I know there is a right way to do it. There is. I know there is." But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you're doing it wrong, maybe you're not. I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don't know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It's good I'm doing the exposure. I'm preventing the response by staying there. I didn't get out. But in my head, I'm doing, "Just get through this. Just get through this. I hate this. It's going to be over soon. You'll get through it and then you'll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh." And then you get to the end and you go, "Okay, I made it through." And of course, that didn't really prevent the response. That reinforced my dread of it. And so, I would say that's definitely a lesson as we get into that. Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who'll say early in treatment, "You'd be so proud I did the exposure." And I'd be like, "And the RP, did that get included?" So, let's talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from? Andrew: I would say it's been slow going over the years where-- I don't know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they're not clinical level OCD and maybe it's just anxiety or I think, as I emailed you, just stress. But it's this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, "Oh, I cannot try to solve this." And so, I see people that I really care about and I joked with my wife, I said, "Why is it that all of our best friends are anxious people?" And I think that comes with this care and attention and that I've suffered and I don't want anyone else to suffer. And so, I see that anxiety in others. But getting back to what I see in them, maybe someone is socially anxious so they're avoiding a party or they're leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don't know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It's worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it's a little too loud or it's too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it's helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I'm not cured, I think. I'm still listening to your six-part rumination series because I think that's really what I'm working on now. So, I think those physical things, I've made tremendous improvement on blood and veins and all that. But that's also not why I quit work. I didn't quit working. I didn't quit AmeriCorps because there's so much blood everywhere. No, it's nonprofits, it's cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I'm going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn't have that response prevention piece, all I had was the exposure piece, then it's-- I can't remember who said it, but like, ERP without the RP is just torture. You're just exposing yourself to all these miserable things. Kimberley: You're white-knuckling. Andrew: Yeah. And it's-- I love research. I am a scientist by heart. I'm a Physics major and Environmental Studies master's. I love research and all this. And so, I've looked into neuroplasticity, but I also am not an expert. Correct me if I'm wrong, but from what I hear, you're just reinforcing that neural pathway. So, I'm going into work and I dread it. I'm saying, "I hate this. I can't wait to go home. I hate this." So, that's reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let's see how we can do ERP with the things you don't like and so you're not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that's meaningful. But I'm watching you get more and more deteriorated at work. And that's hard to do that in others. ERP Is For Everyone Kimberley: Yeah. I resonate so much from a personal level and I'll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I'm watching how anxiety is forming them. They're being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there's so many times-- I've used the example before of both my kids separately were absolutely petrified of dogs. And they don't have OCD, but we used a hierarchy of exposure and now they can play with the neighbor's dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, "You're fine. Let's never be around dogs." And so, it's so interesting to watch these teeny tiny little humans being formed by like, "Oh, I'm not a dog person." You are a dog person. You're just afraid of dogs. It's two different things. Andrew: Yeah. So, it's funny that my next-door neighbor, when I was young, had a big dog. And when we're moving into the house for the very first time, very young, I don't know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the "Stay off my lawn, don't let your soccer ball come over." So, for years, I had this like, "I'm not going to root for Germany in sports. I don't like Germany." And then here I am living in Germany now. Kimberley: Like an association. Andrew: Yeah. So, I think fear association, anxiety association. And then I'm also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don't know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, "That's how a girl sits. You have to sit with your foot up on your leg." So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, "Oh, you can't wear that, guys don't wear that." So, I didn't. I stopped wearing that and all these things, whether it's about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. I don't know if you agree, but I see this under the umbrella of ERP. So, you're exposing yourself to this potential situation where there's shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, "What are you doing with painted nails?" And I'm going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can't wear pink, or you can't be that when you grow up, or just these associations where I think you can, I think you can do that. Kimberley: I love this so much because I think you're so right in why ERP is for everyone. It's funny, I'll tell you a story and then I don't want to talk about me anymore, but-- Andrew: No, I want to hear it. That's fine. Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, "It's a beautiful day to do hard things." I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it's so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn't realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don't have to wear your bathing suit right into the thing. So, I'm like, "Cool, that's fine. I'm comfortable with my body." But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it's still learned avoidance from something I don't even suffer from anymore. And I think that, to speak to what you're saying, if we're really aware we can-- and I don't have OCD, I'm open about that. If all humans were really aware, they could catch avoidant behaviors we're doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, "Oh, no, no. I don't even have anxiety." But it's funny what you can catch in yourself that how you're running actually literally running. Andrew: Literally running. Yeah. Kimberley: Away. So, that's why I think you've mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that's why I think that's so cool. It's such a cool concept. Andrew: Yeah. And so, help me since I do consider you the expert here, but I've heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let's say that's what ERP is proposed for. But then we also have generalized anxiety and I think we're seeing that. I've heard Jenna Overbaugh talk about that as well. It's this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I'll find a way to skip it. Or I have this stressful family event, I'll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone. Kimberley: Yeah. No, I mean, clinically, I will say we understand it's helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren't OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody's self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that's why I think like, again, even if you're not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they're in an environment that's safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it's also-- this is my opinion, but I'm actually more interested in your opinion, is I think ERP is also a mindset. Andrew: Yeah. Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That's what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn't handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP? Andrew: Yeah. That's a good question. I've had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don't want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, "You'll be the mayor of this town someday, Andrew." And I watched this slip away and I had to change that identity. And not to say that you can't ever get that back with recovery, but what I will say is through recovery, I don't have that desire to anymore. I don't have that desire to be a hundred percent. I'm a big fan of giving 80%. And mayor is too much responsibility. I don't know, maybe someday. So, that changed. And then definitely, through that down downturn, I thought, I can't handle this. I can't handle anxiety, I can't handle stress. People are going to find out that this image I've built of myself is someone who can't handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don't have to fix it. You don't have to solve the problem. I think that was me. And that's not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain "Dolores" after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we're nine hours apart right now. "Oh, did I get the time difference right?" I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn't eat right before we talked, so I didn't burp on camera, made sure I had my water, and it was just all these-- and if I wasn't about to meet with an OCD expert, I wouldn't have even noticed these. I wouldn't have even noticed all of these checking, fidgeting, optimizing, best practicing. But it's exhausting. And so, I'm going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, "Oh, I'm doing an avoidant behavior," or "I'm fixing something to fix my anxiety that gives me temporary relief"? Because I didn't notice them for 10 years. Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It's knowledge that that-- but it's a lot to do with awareness. It's so much to do with awareness. I'll give you an example, and I've spoken about this before. As soon as I'm anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there's no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It's like this thick, and I look at it and I go, "Okay, be aware as you go into the day." And then I can work at catching as I start to speed up and speed type. So, I think for the person who doesn't have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it's being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don't have to change it. I'm not doing any harm by typing fast. In fact, some might say I'm getting more done, but I don't like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question. Andrew: So, I think you bring up a good point though that I'm curious if you've heard this as well. So, you said you're typing fast and you're feeling anxious and you don't like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don't realize those are connected. I didn't realize that was connected. In college, I'm wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I'm very, very anxious and miserable and I don't know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I'm going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It's still something I'm trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn't realize that was giving me that anxiety. So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I'm not a therapist, I can't diagnose and I'm not going to go up, I think you have this. But seeing that they're coming to me and saying, "I'm exhausted. I just have so much going on," I think in their head, it's "I have a lot of work." Kimberley: External problems. Andrew: Yeah. I may be seeing-- yeah, but there's all this tension. You're holding it in your shoulders, you're holding it here, you're typing fast and not realizing that, oh, these are connected. Kimberley: And that's that awareness piece. It's an awareness piece so much. And it is true. I mean, I think that's the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren't previously aware of. I go to therapy and sometimes even my therapist will be like, "I got a question for you." And I'm like, "Ah, I missed that." So, I think that that's the beauty of this. Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there's a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, "Well, can I read some self-help books, and then if those don't work, go to therapy?" "No, I think go to therapy right away. Big fan of therapists. I'm not a therapist. You need to talk to a therapist." "Okay. But what if I did some podcasts and then if that didn't work, then I go to therapy?" "Nope. Therapy is great. Go to therapy now." "Should I wait till my life gets more stressful?" "Nope. Go now." Kimberley: Yeah, because it's that reflection and questioning. Everyone who knows me knows I love questions. They're my favorite. So, I think you're on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion? Andrew: How do we put this with a nice bow on it? Kimberley: It doesn't have to be perfect. Let's make it purposely imperfect. Andrew: Let's make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, "Hey, actually, ERP is an evidence-based gold standard. We know it works, we've seen it work. It's helped us. Let it help you because we care about you and we want you to do it." And then moving down stress from work, from life. You have a big trip coming up. There's a fun scale, home's rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, "Oh, that's a stressful thing?" "Yeah, It can be." And so, noticing the stressful things in your life and saying, "Well, because of these stressful things are the things I'm avoiding, things I'm getting anxious about, can I learn to sit with that?" And I think that mindfulness piece is so important. So, whether you're clinical, whether you're subclinical, whether you have stress in your life, whether you're just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don't know if people roll their eyes at people like us, "Follow your values, talk about your values." Do you value spending time with your friends, but you're avoiding the social gathering? Sounds like ERP could help you out with that. Or you're avoiding this, you want to get a certification, but you don't think you'll get it and you don't want to spend the time? Sounds like ERP could help with that. We're in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you're embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I've become almost evangelical about it. Look at this thing, it works so well. It's done so much for me. Kimberley: Love it. Okay, tell me where-- I'm going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work. Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It's JustRught but with right spelled wrong. So, it's R-U-G-H-T. Kimberley: That is perfect. Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, "You know what, Andrew, leave it. This works. This works just fine." Kimberley: Oh, it is so good. It is so good. Andrew: Yeah. So, I'm also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I've learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I'm currently an OCD advocate as well. You can find me on IOCDF's website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, "Guys, Kimberley Quinlan is at the same level as me." I was so excited. Kimberley: You're so many levels above me. Just look at your story. That's the work. Andrew: The imposter syndrome, we talked about that earlier. Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It's so beautiful. So, thank you so much. Andrew: I will add in, if you allow me a little more time, that it's not magic. We're not saying, "Oh, go do ERP for two days and you'll be great." It's hard work. It's a good day to do hard things. I think if it was easy, we wouldn't be talking about it so much. We wouldn't talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It's given me my life back, it's saved my relationships, it's helped me move overseas, given me this opportunity, and I'm just so thankful for it. Kimberley: Yeah. Oh, mic drop. Andrew: Yeah. Kimberley: Thank you again.

Oct 28, 2022

In This Episode: Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. addresses the benefits of ERP and how ERP is for Everyone How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety Links To Things I Talk About: Andrew's Instagram @justrught ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 308. Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you're going to love it. But the main point we're making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don't technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I'm so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. Before we head into the show, let's quickly do the "I did a hard thing" for the week. This one is from Christina, and they went on to say: "Thought of you today, and you're saying, 'It's a beautiful day to do hard things,' as I went down a water slide, terrified, as I'm well out of my comfort zone." This is such great. They're saying that's on their holiday, the first time they've taken a holiday in quite a while. "It's difficult, but I'm doing it. I'm trying to lean into the discomfort." This is so good. I love when people share their "I did a hard thing," mainly, as I say before, because it doesn't have to be what's hard for everybody. It can be what's hard for you. Isn't it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I'm totally with you on that. But some of the people find it thrill-seeking. And then I'm sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don't miss that point, guys. It is such an important thing that we don't compare. If it's terrifying, it's terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew's amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said: "Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you're truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)" So, for those of you who don't know, I wrote a book called The Self-Compassion Workbook for OCD . If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. All right, let's get over to the show. Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here. Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit. Kimberley: Yeah. How fun. I'm so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about. Andrew: I might bring some of them up because I think, anyway, it's related to our big topic. Erp Is For Everyone Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you. Andrew: Yeah. So, there's a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn't know what it was and really didn't know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it's probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn't want to talk about it then, I think. Andrew's Story About Having Obsessive Compulsive Disorder A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we're South Midwest, East Coast, whatever. But still there, there's a culture that mental health is for "crazy people." Of course, we don't believe that. So, my tiptoe around it was saying, "I'm having trouble focusing in class. Maybe I have ADHD." And that's what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, "Hey, you have a problem." And so, ended up talking more. So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn't know about it. I didn't know about it. I didn't have the language to talk about it at the time because I didn't have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that's a common story. So, I entered therapy in 2009, and I've been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I'm very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. So, let's keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There's a long-term outpatient stay, Skyline Trail. I'm thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. So, finally, gosh, I can't quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I'm not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I'd have an excuse until I finally was like, "I'm going to get found out that I'm not working full-time. I'm going to jump the gun, I'll voluntarily go down in part-time." So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, "I've failed. I've quit so many things – college, AmeriCorps." I was a summer camp counselor and I left early. "Now this job. I need something." So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, "Well, one problem is you have OCD." I was like, "What? No, I don't have that. I don't wash my hands. I'm not a messy person. I'm not organized." Gosh, I'm so thankful for her. Kimberley: Yeah, I want to kiss this person. Andrew: Yeah. But here's the duality of it. She diagnosed me with it. I am forever grateful. And she didn't do ERP. She didn't know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn't feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, "Oh, this isn't working for me. I've been doing the same type of therapy for a decade and I'm not making progress." Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. Kimberley: No, I've got goosebumps. Andrew: I'm unemployed, I have my diagnosis, but I'm not making any progress. So, I go, "Throw this in as well. Not really that important." But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, "I need you to commit to this." And I said, "But I don't think this is helping me either," because the conversation was about relationships, my relationship was great. It was about work, I wasn't working. It was about parents, my parents were great. They were supporting me financially. They're super helpful and loving and kind. It's like, "None of this is external." I kept saying, "This is internal. I have something going on inside of me." And she said, "Well, I want you to commit to it." I said, "I'm sorry, I found a local OCD clinic. I'm going to try them out." So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we'll talk about this in a bit, what ERP is. So, built the hierarchy, I'm afraid of cutting my veins and bleeding out. So, let's start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, "Okay, you need to find the juiciest, bumpiest vein, and that's where you put it in." And my therapist, pause the video. She said, "Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins." Oh my gosh. Can you imagine? Kimberley: The imagery and the wording together is so triggering, isn't it? Andrew: Right. She's amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it's doing all three of these things. So, I went around. And of course, it's an OCD clinic, so nobody's against it. They're like, "Sure, here you go. This one looks big. Here, let me pump it up for you." And I'm like, "No, I don't like this." Kimberley: Well, it's such a shift from what you had been doing. Andrew: It's totally different. I'll speak to the rest because that's really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I'm an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP. Kimberley: Right. Oh, my heart is so exploding for you. Andrew: Oh, thank you. Kimberley: My goodness. I mean, it's not a wonderful story. It's actually an incredibly painful story. Andrew: You can laugh at it. I told it humorously. How Andrew Applied Erp For His Ocd Kimberley: No. But that's what I'm saying. That's what's so interesting about this, is that it's such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you're obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you'd been put through the wringer. Andrew: Yeah. There's a lot to talk about, but there are a couple of key moments when you mention it. So, one, we're going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don't do the compulsion? "Oh, never. I've never stopped. But you can do that?" It was just this moment of, "What do you mean?" If it's hot, I'm going to make it colder. If it's cold, I'm going to make it warmer. If I'm uncomfortable, I'm going to fidget. I'm a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and "just right" OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. Am I Doing Erp "Just Right"? But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, "I don't know. Who knows? Maybe, maybe not." So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, "I know there is a right way to do it. There is. I know there is." But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you're doing it wrong, maybe you're not. I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don't know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It's good I'm doing the exposure. I'm preventing the response by staying there. I didn't get out. But in my head, I'm doing, "Just get through this. Just get through this. I hate this. It's going to be over soon. You'll get through it and then you'll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh." And then you get to the end and you go, "Okay, I made it through." And of course, that didn't really prevent the response. That reinforced my dread of it. And so, I would say that's definitely a lesson as we get into that. Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who'll say early in treatment, "You'd be so proud I did the exposure." And I'd be like, "And the RP, did that get included?" So, let's talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from? Andrew: I would say it's been slow going over the years where-- I don't know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they're not clinical level OCD and maybe it's just anxiety or I think, as I emailed you, just stress. But it's this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, "Oh, I cannot try to solve this." And so, I see people that I really care about and I joked with my wife, I said, "Why is it that all of our best friends are anxious people?" And I think that comes with this care and attention and that I've suffered and I don't want anyone else to suffer. And so, I see that anxiety in others. But getting back to what I see in them, maybe someone is socially anxious so they're avoiding a party or they're leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don't know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It's worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it's a little too loud or it's too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it's helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I'm not cured, I think. I'm still listening to your six-part rumination series because I think that's really what I'm working on now. So, I think those physical things, I've made tremendous improvement on blood and veins and all that. But that's also not why I quit work. I didn't quit working. I didn't quit AmeriCorps because there's so much blood everywhere. No, it's nonprofits, it's cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I'm going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn't have that response prevention piece, all I had was the exposure piece, then it's-- I can't remember who said it, but like, ERP without the RP is just torture. You're just exposing yourself to all these miserable things. Kimberley: You're white-knuckling. Andrew: Yeah. And it's-- I love research. I am a scientist by heart. I'm a Physics major and Environmental Studies master's. I love research and all this. And so, I've looked into neuroplasticity, but I also am not an expert. Correct me if I'm wrong, but from what I hear, you're just reinforcing that neural pathway. So, I'm going into work and I dread it. I'm saying, "I hate this. I can't wait to go home. I hate this." So, that's reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let's see how we can do ERP with the things you don't like and so you're not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that's meaningful. But I'm watching you get more and more deteriorated at work. And that's hard to do that in others. ERP Is For Everyone Kimberley: Yeah. I resonate so much from a personal level and I'll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I'm watching how anxiety is forming them. They're being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there's so many times-- I've used the example before of both my kids separately were absolutely petrified of dogs. And they don't have OCD, but we used a hierarchy of exposure and now they can play with the neighbor's dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, "You're fine. Let's never be around dogs." And so, it's so interesting to watch these teeny tiny little humans being formed by like, "Oh, I'm not a dog person." You are a dog person. You're just afraid of dogs. It's two different things. Andrew: Yeah. So, it's funny that my next-door neighbor, when I was young, had a big dog. And when we're moving into the house for the very first time, very young, I don't know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the "Stay off my lawn, don't let your soccer ball come over." So, for years, I had this like, "I'm not going to root for Germany in sports. I don't like Germany." And then here I am living in Germany now. Kimberley: Like an association. Andrew: Yeah. So, I think fear association, anxiety association. And then I'm also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don't know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, "That's how a girl sits. You have to sit with your foot up on your leg." So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, "Oh, you can't wear that, guys don't wear that." So, I didn't. I stopped wearing that and all these things, whether it's about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. I don't know if you agree, but I see this under the umbrella of ERP. So, you're exposing yourself to this potential situation where there's shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, "What are you doing with painted nails?" And I'm going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can't wear pink, or you can't be that when you grow up, or just these associations where I think you can, I think you can do that. Kimberley: I love this so much because I think you're so right in why ERP is for everyone. It's funny, I'll tell you a story and then I don't want to talk about me anymore, but-- Andrew: No, I want to hear it. That's fine. Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, "It's a beautiful day to do hard things." I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it's so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn't realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don't have to wear your bathing suit right into the thing. So, I'm like, "Cool, that's fine. I'm comfortable with my body." But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it's still learned avoidance from something I don't even suffer from anymore. And I think that, to speak to what you're saying, if we're really aware we can-- and I don't have OCD, I'm open about that. If all humans were really aware, they could catch avoidant behaviors we're doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, "Oh, no, no. I don't even have anxiety." But it's funny what you can catch in yourself that how you're running actually literally running. Andrew: Literally running. Yeah. Kimberley: Away. So, that's why I think you've mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that's why I think that's so cool. It's such a cool concept. Andrew: Yeah. And so, help me since I do consider you the expert here, but I've heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let's say that's what ERP is proposed for. But then we also have generalized anxiety and I think we're seeing that. I've heard Jenna Overbaugh talk about that as well. It's this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I'll find a way to skip it. Or I have this stressful family event, I'll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone. Kimberley: Yeah. No, I mean, clinically, I will say we understand it's helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren't OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody's self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that's why I think like, again, even if you're not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they're in an environment that's safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it's also-- this is my opinion, but I'm actually more interested in your opinion, is I think ERP is also a mindset. Andrew: Yeah. Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That's what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn't handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP? Andrew: Yeah. That's a good question. I've had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don't want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, "You'll be the mayor of this town someday, Andrew." And I watched this slip away and I had to change that identity. And not to say that you can't ever get that back with recovery, but what I will say is through recovery, I don't have that desire to anymore. I don't have that desire to be a hundred percent. I'm a big fan of giving 80%. And mayor is too much responsibility. I don't know, maybe someday. So, that changed. And then definitely, through that down downturn, I thought, I can't handle this. I can't handle anxiety, I can't handle stress. People are going to find out that this image I've built of myself is someone who can't handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don't have to fix it. You don't have to solve the problem. I think that was me. And that's not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain "Dolores" after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we're nine hours apart right now. "Oh, did I get the time difference right?" I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn't eat right before we talked, so I didn't burp on camera, made sure I had my water, and it was just all these-- and if I wasn't about to meet with an OCD expert, I wouldn't have even noticed these. I wouldn't have even noticed all of these checking, fidgeting, optimizing, best practicing. But it's exhausting. And so, I'm going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, "Oh, I'm doing an avoidant behavior," or "I'm fixing something to fix my anxiety that gives me temporary relief"? Because I didn't notice them for 10 years. Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It's knowledge that that-- but it's a lot to do with awareness. It's so much to do with awareness. I'll give you an example, and I've spoken about this before. As soon as I'm anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there's no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It's like this thick, and I look at it and I go, "Okay, be aware as you go into the day." And then I can work at catching as I start to speed up and speed type. So, I think for the person who doesn't have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it's being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don't have to change it. I'm not doing any harm by typing fast. In fact, some might say I'm getting more done, but I don't like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question. Andrew: So, I think you bring up a good point though that I'm curious if you've heard this as well. So, you said you're typing fast and you're feeling anxious and you don't like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don't realize those are connected. I didn't realize that was connected. In college, I'm wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I'm very, very anxious and miserable and I don't know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I'm going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It's still something I'm trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn't realize that was giving me that anxiety. So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I'm not a therapist, I can't diagnose and I'm not going to go up, I think you have this. But seeing that they're coming to me and saying, "I'm exhausted. I just have so much going on," I think in their head, it's "I have a lot of work." Kimberley: External problems. Andrew: Yeah. I may be seeing-- yeah, but there's all this tension. You're holding it in your shoulders, you're holding it here, you're typing fast and not realizing that, oh, these are connected. Kimberley: And that's that awareness piece. It's an awareness piece so much. And it is true. I mean, I think that's the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren't previously aware of. I go to therapy and sometimes even my therapist will be like, "I got a question for you." And I'm like, "Ah, I missed that." So, I think that that's the beauty of this. Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there's a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, "Well, can I read some self-help books, and then if those don't work, go to therapy?" "No, I think go to therapy right away. Big fan of therapists. I'm not a therapist. You need to talk to a therapist." "Okay. But what if I did some podcasts and then if that didn't work, then I go to therapy?" "Nope. Therapy is great. Go to therapy now." "Should I wait till my life gets more stressful?" "Nope. Go now." Kimberley: Yeah, because it's that reflection and questioning. Everyone who knows me knows I love questions. They're my favorite. So, I think you're on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion? Andrew: How do we put this with a nice bow on it? Kimberley: It doesn't have to be perfect. Let's make it purposely imperfect. Andrew: Let's make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, "Hey, actually, ERP is an evidence-based gold standard. We know it works, we've seen it work. It's helped us. Let it help you because we care about you and we want you to do it." And then moving down stress from work, from life. You have a big trip coming up. There's a fun scale, home's rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, "Oh, that's a stressful thing?" "Yeah, It can be." And so, noticing the stressful things in your life and saying, "Well, because of these stressful things are the things I'm avoiding, things I'm getting anxious about, can I learn to sit with that?" And I think that mindfulness piece is so important. So, whether you're clinical, whether you're subclinical, whether you have stress in your life, whether you're just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don't know if people roll their eyes at people like us, "Follow your values, talk about your values." Do you value spending time with your friends, but you're avoiding the social gathering? Sounds like ERP could help you out with that. Or you're avoiding this, you want to get a certification, but you don't think you'll get it and you don't want to spend the time? Sounds like ERP could help with that. We're in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you're embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I've become almost evangelical about it. Look at this thing, it works so well. It's done so much for me. Kimberley: Love it. Okay, tell me where-- I'm going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work. Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It's JustRught but with right spelled wrong. So, it's R-U-G-H-T. Kimberley: That is perfect. Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, "You know what, Andrew, leave it. This works. This works just fine." Kimberley: Oh, it is so good. It is so good. Andrew: Yeah. So, I'm also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I've learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I'm currently an OCD advocate as well. You can find me on IOCDF's website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, "Guys, Kimberley Quinlan is at the same level as me." I was so excited. Kimberley: You're so many levels above me. Just look at your story. That's the work. Andrew: The imposter syndrome, we talked about that earlier. Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It's so beautiful. So, thank you so much. Andrew: I will add in, if you allow me a little more time, that it's not magic. We're not saying, "Oh, go do ERP for two days and you'll be great." It's hard work. It's a good day to do hard things. I think if it was easy, we wouldn't be talking about it so much. We wouldn't talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It's given me my life back, it's saved my relationships, it's helped me move overseas, given me this opportunity, and I'm just so thankful for it. Kimberley: Yeah. Oh, mic drop. Andrew: Yeah. Kimberley: Thank you again.

Oct 21, 2022

SUMMARY: In This Episode: What to do what your chronic illness causes anxiety The Difference between POTS and anxiety. How to manage POTS related anxiety What is an "Adrenaline Surge"? The Treatment for POTS and Anxiety POTS AWARENESS MONTH Links To Things I Talk About http://www.dysautonomiainternational.org/page.php?ID=30 Overcoming Anxiety and Panic https://www.cbtschool.com/overcominganxiety ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 307. Welcome back, everybody. I am so thrilled to be here with you today. As most of you may know, it is OCD Awareness Month or Awareness Week. It's just passed, and that's something I'm so passionate about advocating for. But in addition to that, it's also Postural Orthostatic Tachycardic Syndrome Awareness Month. For those of you who don't know, I suffer from postural orthostatic tachycardic syndrome. We call it POTS for short. I've had multiple people ask me to do an episode about when chronic illnesses cause anxiety, and I thought this is probably the best week to do it. Not only is it awareness week or awareness month for POTS, but I actually have had a little blip in my own recovery in my POTS. So, I wanted to share with you my story and share with you how I'm handling the anxiety and health anxiety and stress and grief of that, and also just address some tools that have worked for me and that I'm hoping will work for you as well. If you have a chronic illness or even if you don't, I think that these are really core skills that we need to practice just in regards of managing daily stress as well. You know what, before we do that, let's go and do the "I did a hard thing" because this one is actually really touching and I would really like to feature. This was actually an email we received. I love getting your emails. If you guys are not on our newsletter list, please do go and sign up for our newsletter. We do give you access to the whole series. I created a whole website for the six-part mental compulsion series. It will be private just for people who sign up for the newsletter, and it's got some amazing additional resources, PDFs, links that you really should check out. So, if you want to sign up for that, head on over to CBTSchool.com and you can sign up for our newsletter. This person said: "I took a big leap of leaving my family and moving to China on my own." Now, I totally resonate with this because I am in America on my own, even though I have my family. Leaving your home country is a big deal. It's a huge deal. They go on to say, "The only thing, I haven't been home to see my family in over three years, and I've been struggling so much. We hadn't had a holiday in over two years, and I had been stuck in our complex for months. It was really, really hard. We finally were allowed out of our city, so we decided to go to Yunnan Province." Hopefully, I pronounce that okay. "I was so worried that my OCD would come in hard and stop me from enjoying this amazing holiday we had planned for. I was strong and I did the hard things, thanks to you. I did a six-day hike at the start of the Himalayas, and I'm like, 'Holy moly, that is amazing.' I got engaged on Tiger Leaping Gorge. I ran down a bear and wolf-infested forest, and I slept in a tiny house next to pigs and cows." What an adventure. "Kimberley, thank you. You have given me strength I needed. You are my inspiration." This is what I mean by why I love the "I did a hard thing" because sometimes the hard thing is getting out of bed. Sometimes the hard thing is facing a fear that you know is in your daily life. But sometimes your fear is like living a life according to your values and doing some pretty huge, openhearted things. And so, I absolutely love this "I did a hard thing." Thank you so much, Leanne, for submitting this because there was something about it that just made me giggle like, holy moly, you really packed in some adventure into a short period of time, and well-deserved after being in a complex for so many months and years. Thank you so much for leaving that here in my inbox. Real quick, let's do the review of the week so that we can head on over. This one is from Young Math Mama and they said: "BEST podcast for a daily mindset reset. This podcast was recommended to me by my therapist, and it is one of my favorite 'homework assignments' to help me have a good mindset and feel inspired to try my best. I've learned so much great information from Kimberley, but the most important thing, in my opinion, is that I feel motivated to improve one small thing every time I listen. I'm taking better care of myself, which helps me take better care of my family." Literally, Young Math Mama, that is the absolute goal of this. I consider myself part therapist and part coach. I do a lot of coaching in my work and hopefully, I inspire you and motivate you all as well. Thank you so much, Young Math Mama, for submitting, and also Leanna. Update On My Pots/Chronic Illness Okay, so let me give you a little background here. I haven't shared this with you because I actually didn't feel it was appropriate at the time for me to share, but I will share it now. As you guys know, I did a whole podcast about health anxiety, and this whole shocking episode where I had to get my teeth removed, one of my teeth got pulled out. Interestingly, since I had that infection in my tooth and I had it removed, almost all of my POTS symptoms went away. And the reason I didn't want to share that, which is strange in hindsight why I wouldn't want to share that, is number one, I wasn't convinced it was long-term. Number two, I was really concerned that saying that would be really disheartening to some people who are still really struggling. Number three, I was a little worried. I had a bit of a placebo effect if I'm not going to lie. The doctor said it could actually help my POTS and then when it did, I was a little bit like, "Oh, is this the placebo?" I was just waiting for the shoe to drop, which is really not good practice. I wish actually now in hindsight I didn't do that, but that is the way it played out. I have actually had an almost full remission. I do have some bad days. I do have some bad blood pressure days. But I was able to stand for the first time in many years. What I mean by "stand" is the day that I actually realized that I was in recovery from that. In the mornings, I always fill up my kids' drink bottles and we have one of those filters in the fridge. And usually, it takes probably like 45 seconds, maybe a minute to fill up a drink bottle. But because I can't stand up for very long or I get really dizzy and I can faint, it usually takes me two goes to fill up a drink bottle. I would fill it up for maybe 20 seconds, then I would go sit down just for a minute or two. I could feel myself get less dizzy and then I would go to do it again. You Must Find Rhythms I have found a rhythm in my life, that's how debilitating it is. But I had found these rhythms and routines in my life to where I could still fill up my kids' drink bottles and no one needed to know that I was dizzy. I had found routines to mask it and I'd found routines so I could get through the day. And then I started to notice, oh my God, I'm halfway through filling up the drink bottle and I don't need to sit down. I could actually fill this whole drink bottle without feeling really dizzy and nauseous, which to you might seem like an easy part of the day, but to me, that's just a luxury I didn't have for two years. So, I've been so thrilled and so overjoyed and actually really protective of my body because I'm like, "Oh my gosh, I'm in recovery. I'm really doing so well." And then really why the "I did a hard thing" segment resonated with me is because when I came back from Australia, I was so happy and just my heart was so full and we hit the ground running. We really hit the ground running. My daughter started middle school, my son started second grade. They're in two different schools now. My husband had gone back to another job. We'd just had some house remodeling done. The house was a disaster. We'd had a couple of other stressful events happen. About three weeks ago, I had gotten some really scary news about a loved one. I remember sitting on the couch and just being overwhelmed with anxiety. A massive cortisol, adrenaline surge just went through my body because I was really worried the lasted several days and then I didn't sleep very well for a few days and then I stopped exercising as much as I was and probably didn't drink enough water, which is all these things are really important if you have POTS. And I had also not kept up with how much salt I need to eat. I need to eat the most disgusting degrees of salt. It's a common treatment for POTS. Most people are encouraged not to eat a lot of salt. People with POTS usually have to eat an immense amount of salt. My Pots Relapse Unfortunately, I just started to have all of my symptoms returned. All of them I can manage, but the one that I'm struggling with the most is what they call an "adrenaline surge." It's common for people who have POTS. It just feels like you're having a panic attack, but you're not having a panic attack. You're not worried about anything. I think that all of the stress and me loosening my recovery treatment is what caused it. But all of a sudden, I remember I woke up at three in the morning and I thought I was having a panic attack, but it was, now I understand, an adrenaline surge. It was just like someone had injected me with adrenaline and cortisol. At that time, I was like, "This makes sense. We've just had a couple of some scary things happen and life is pretty stressful. I'm obviously having a panic attack." So, first I want to teach you or show you or demonstrate to you that even though I had woken up in the middle of the night with a panic attack, I used every single one of my tools. I was like, "All right, brain, thank you for waking me up and bringing this to my attention in the middle of the night. There is nothing I can do about it right now. I'm just going to let you be there and we're going to lay here until you're ready to leave. You don't have to leave if you don't want to." It took about two hours, three hours, which is pretty long and strange. I was like, "This is a bit strange." When Your Chronic Illness Causes Anxiety & Panic But then the next night, again, all day feeling anxious, on edge, but also using all my tools. Like, "It's cool, anxiety can come along, no big deal, I'm cool with it" kind of thing. And then next night, wake up in the middle of the night at 11 o'clock because I go to bed pretty early. 11:00 PM, massive panic, adrenaline surge. Oh my gosh. Okay, now what? I get up and I'm like, "Something is up. I'm obviously struggling." I do what an average person would do, would be like look around and be like, "What's going on with me? Is there something really anxiety-provoking that's going on? Should I be worrying about something? Is this a sign?" And then I was like, "No, no, no, I'm going to use my tools." This happened for several days until I realized this actually could be just generalized anxiety because I do struggle sometimes with generalized anxiety, but I actually think this is a part of my POTS. So, I did some research and spoke to a doctor and yes, it is in fact a part of my POTS symptoms and it's one that I didn't have before. But the reason I'm sharing this with you today is, this is actually so common for people with chronic illnesses. If you have a chronic illness, there are these weird things that happen to your body and then it's so easy just to chalk it up as like, "Oh, I'm having a panic attack," or "I'm having anxiety." And then you start panicking and having anxiety. If you're not careful, you'll start to do hypervigilant behaviors and avoidant behaviors and mental compulsions, and then it's a full-blown anxiety disorder. Pots And Anxiety: The Dreaded Adrenaline Surge If there's one thing I have learned from having a chronic illness is to be so skilled with physical sensations that show up in my body because it can seem so similar to anxiety – dizziness, lightheadedness, agitation, feeling like you're going to faint. These are all symptoms of POTS, but they're also symptoms of anxiety. POTS and Anxiety can feel almost exactly the same. So, I've had to become very, very skilled. And I use the word "skilled" because this is not an innate thing I know. I had to practice what I preach and I had to be very objective, not subjective about what's going on, and go, "Okay, you're having dizziness. It could mean that you're going to faint, but it also could mean you're anxious." So, let's actually be really skilled in how we respond to this. Or you're having a panic attack. In this case, you're having a massive adrenaline surge is what they call it in the POTS world. You're having this adrenaline surge, it could be a panic attack and it could be your POTS. Let's work at being very logical and wise in our response to it. Let's not be responding to it as if it's a catastrophe or that there's actually danger. This has been so key for me. What I have found, and this is literally as we speak this week and I can say to you as we speak right now, I actually am having a massive adrenaline surge as we speak. It is so easy to interpret it as something is wrong, there must be danger, we've got to get out of here. But I'm working at just allowing it to be there and going, "Thank you, brain, for setting off this alarm. I understand. I'm going to allow it to be there." The reason I'm sharing this with you and the reason I actually had scheduled to do this recording tomorrow, but today's the perfect day to do it because I'm actually in quite a lot of suffering right now. It's pretty painful. It's pretty uncomfortable. I'm at like an eight 8 of 10 anxiety level, maybe even a 9 depending on where I'm at. I'm just actually going to go about my day. As I speak to you, I'm actually in a pretty big degree of suffering and I just want to be completely real with you. The reason, again, that I wanted to record this today is I was getting ready for work and I started to notice, I was putting all these black clothes on because I don't feel so great. And I was like, "Wait a second, this is how invasive this can be in that I'm actually choosing black clothes. Not that there's anything wrong with black clothes, but I'm choosing it because my body feels so uncomfortable. What could I do right now to fully embrace joy, fully just embrace the fact that it's here?" Choosing Your Values I have this bright, yellow dress that's like a full circle dress. If you did a spin, it would go into a full circle and I love this skirt. I was like, you know what? I'm going to wear my yellow skirt today. Today is a perfect day to wear my yellow skirt, even though my body is having a massive reaction. My body is obviously in some kind of response to something, chronic illness-wise, and my body wants me to panic. My body wants me to be hypervigilant. My body and my brain want me to tighten up my whole body. But I'm going to put on this yellow skirt and I'm going to sit down with my friends, you guys, and I'm going to talk about this thing that I have to handle. As I'm sharing about this, I'm just going to pause here for a second because it brings me to tears. I'm in a lot of pain emotionally. But in that pain, if you could see me right now, I actually have a huge smile on my face because I am so grateful that I gave myself the opportunity to practice these skills because they are actually reducing how much suffering I could have. I remember when I first had these symptoms that I did go into hypervigilance and panic because I was like, "Something is seriously wrong. Something is really wrong. We have to fix it. We've got to go to the emergency room." And now I have these skills to where I'm not actually increasing my suffering by doing all of those compulsive behaviors. And that is key when you have a chronic illness. Treatment For Pots And Anxiety (and other chronic illnesses) All the research I have done shows that having a chronic illness requires medical attention and therapy. Cognitive behavioral therapy, I did a whole bunch of research in prep for this, a whole bunch of research. If you have POTS, they recommend cognitive behavioral therapy. That's because along with having a chronic illness comes anxiety and depression and other emotions. Along with having other chronic illnesses comes anxiety and depression, diabetes, Crohn's disease, celiac disease. It could be even just having a chronic illness of having a disorder. A mental health disorder also creates a lot of anxiety in your life. This is key. I'm just so grateful that I have the ability to practice these skills and the ability to just sit in the mud. I am just sitting in the mud today. That's what I'm doing. I'm so grateful that I have those skills and I really want to teach you guys those skills by modeling to you today. So, let's break it down. When you have anxiety, whether it's in association to a chronic illness or it's just regular anxiety, what I'm going to encourage you to do is do nothing at all. It's actually quite easy when you think about it, but it's actually really hard at the same time, is to do nothing at all different. Today, I am going about my day. I am going to allow my heart rate to go through my chest and beat so hard. I'm going to allow that lightheaded, blood pressure issue that I'm having to be there. I'm going to allow the dizziness to be there. I'm going to allow the raising thoughts to be there. I'm going to still show up in my yellow skirt. If I spin in a circle, it would be a full spinning circle. It would be so beautiful. And I'm going to keep my heart open. If you could see me right now, I'm not hunched up. My hands are soft, my cheeks are soft, my heart is open, my shoulders are dropped. I'm just here for it. I'm allowing it. Is it hard? Yes, it is painful as. Is it exhausting? Yes. Every night this week I've been going to bed at seven o'clock and just resting my body because I'm working really, really hard. And my body is exhausted because it's pumping adrenaline all day long. These are some ideas I want you to implement into your life if you can. And a lot of it, one thing, of course, I didn't discuss because it's just such a part of my practices, I'm also really gentle with myself. Like, "Yeah, Kim, this is rough." I use the word "suffering." You even heard me use it. "This is a lot of suffering for you right now, hun. You deserve to go to bed a little early and it's okay if you don't show up perfect and you might drop some balls. Yeah, that's okay." That's the main point. Pots Awareness Month What I will say at the end here is please-- you're probably hearing some of this and going, "Oh my gosh, maybe I have POTS." I really want to make sure you know the difference. Given that it's POTS Awareness Month, postural orthostatic tachycardic syndrome is not an anxiety disorder. It is a disorder of the autonomic nervous system. It does mean that when you stand up, there is changes in your heart rate and in your blood pressure that cause you to faint. Lots of people with POTS can't stand up at all. So, I'm so grateful for the fact that I can stand up, even though it takes me two goes to fill up a drink bottle. I can stand up better than a lot of people who have postural orthostatic tachycardic syndrome. I can walk. I can exercise. I've been building up my exercise routine according to the POTS exercise program. Difference Between Anxiety And Pots It's important for you to understand that just having these anxiety symptoms doesn't mean you have POTS. If you are fainting and you are actually having a really difficult time with nausea and multiple different autonomic nervous system issues, well then definitely go see your doctor and share with them your symptoms. If they think that you are a candidate for maybe getting tested for POTS, the type of test you would need is called a tilt table test. It is usually administered by a cardiologist or a cardiologist nurse. It's a horrible test, and if you have POTS, it will be very painful and very difficult. But basically, it's where they put you on a table and then the table tilts up really fast, and then you're connected to all these cardio nodes, I guess, all over your body and they're got a blood pressure machine and some people even faint during the test. They raise you and then they drop you down flat and then they raise you and they drop you down flat and they're monitoring whether there's shifts in your heart rate and blood pressure. And that is the test that will get you diagnosed for POTS based on whether you meet criteria. It's a very unpleasant test if you have POTS because it does induce fainting for a lot of people or a severe amount of nausea for a lot of people. But if you are concerned, you can reach out to your doctor and see if you meet the criteria to get that test. That's it. I wanted to share with you what it's like to have POTS and to share my ups and downs with having POTS. Also, one thing I will say, if you don't mind and you want to stay with me just for a few more minutes, is having a chronic illness is also a very anxious experience. You never know whether you're going to have a good day or a bad day. You never know what your symptoms are going to be. For me, I've actually been very blessed and the treatments have helped me a lot. For some people they don't, but for some people, they can't guarantee they can show up for work tomorrow. They can't guarantee they can take their kids to the park. They just don't know. It depends on the day and it depends on their body. So, there's so much uncertainty with what your body will do and how your body will react. That in and of itself creates a lot of anxiety and uncertainty and it can be very, very depressing. For those of you who have severe POTS, they can't play with their kids. They can't stand up long enough to run in the park. It can be very, very debilitating. So, if you have a chronic illness and you have anxiety and depression, that doesn't mean there's something wrong with you. It actually means it's a normal natural part of having a chronic illness. I wanted to really make sure I advocated for that because some people think if you have a medical problem, it's just a medical problem. But often medical problems create mental health problems and we have to look at the whole human. Even though I'm an OCD and Anxiety Specialist, I'm still going to admit to you guys, it still creates anxiety for me. I handle it pretty well, but some days I don't. Some days I'm very sad about it and have a lot of grief and a lot of anger and a lot of frustration around it and sometimes even jealousy. Just jealous. I wish I could A, B, and C. I'll tell you one story. There's a person on social media and they constantly do their posts while they're standing at a computer desk. Even just looking at her stand at a computer desk, she's got one of those standing desks, I have so much envy because I'm like, "I could never ever do that." Never ever do that unless somebody-- I don't know. I didn't even know how I would do it, but-- yeah, a lot of emotions show up. All right. So, that's it for today. I wanted to share with you a whole little update on what happens when your chronic illness causes anxiety. I wanted to highlight that it's Postural Orthostatic Tachycardic Syndrome Week or Awareness Week. Actually, I think it's Awareness Month. I hopefully inspired you to lean into your fear and not give it all the power because you're actually stronger than your anxiety. All right. Thank you so much for listening. I know it may have been a bit of a rambling episode, but hopefully, you took a few pieces away from it. I really, really appreciate you checking in. Please do go and leave a review. It is the best gift you can give me because it does allow me to then get trust of other people who are new coming to the podcast, and then we can help some more people. Take care and I will talk to you soon.

Oct 20, 2022

In This Episode: The difference between Reassurance seeking vs. holding in emotions Why Reassurance seeking OCD is problematic and keeps you stuch What tools you can use to help you manage emotions with OCD Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp https://kimberleyquinlan-lmft.com/32-reduce-reassurance-seeking-behaviorscompulsions/ Newsletter https://www.cbtschool.com/newsletter Chatter Book: https://www.amazon.com/Chatter-Voice-Head-Matters-Harness/dp/0525575235 Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 306. Welcome back, everybody. We are well and truly into OCD Awareness Week, and I have been so excited to be a part of some amazing awareness projects, being an advocate for the International OCD Foundation, doing a lot of social media on self-compassion this week. It's been such a treat. This week, I actually wanted to discuss a concept that I-- actually, I say this often these days, but I get asked this question a lot in some various forms by my clients, so I wanted to address this question that I got with you. This is actually a question from one of the people in ERP School, which is our online course for OCD. If you click the link here in the bio or you can go to CBTSchool.com, we have a course called ERP School where we teach, or I teach step by steps that I take with my patients on how to set up an ERP plan so that you can slowly face your fear and reduce your compulsions and take your life back from OCD. Reassurance Vs Holding In Emotions One of the members asked a question, and there's a whole portal in there where you can ask questions to me directly, and they asked: "I have a question to you regarding reassurance seeking." They said, "I've been trying to stop doing my compulsions and my go-to is reassurance seeking ." "What is the difference between Reassurance vs holding in emotions?" Reassurance Seeking OCD Reassurance seeking is a type of compulsion where you usually go to Google or you go to a loved one or another person and you ask for reassurance on your fear or your uncertainty. They go on to say, "One thing I do understand about is why it's bad and how it keeps the cycle going." So, they do understand that reassurance seeking OCD is a problem. They do understand how it keeps the OCD cycle going. We talk a lot in ERP School about this OCD cycle. It's a huge component of the treatment. We have to first understand the cycle so that we can then know how to stop the cycle. And they go on to say, "I know that I have to learn to rely on myself to manage my anxiety and seeking reassurance makes me dependent on others for my relief, which can increase my anxiety when they're not around. But I've always been told by friends and family that talking about things that are bothering you is healthy because that way you get it out as opposed to bottling it in. When I don't seek reassurance, I worry that I'm bottling it in and that the only way to feel better is to let it out by talking to others. How do I join these two seemingly healthy ideas?" This is such a core component of all the work that we do. And so, I really want to go deep into this with you here in just a sec. Now, before we move on, if you aren't quite sure about reassurance seeking yet, you can go back and listen to a previous podcast we did, Number 32, which is called How to Reduce Reassurance Seeking Behaviors. It's an amazing podcast episode that really goes deep into what is a reassurance compulsion. You can click that there. But let's talk more about this specific question. Before we do that, let's quickly do the review of the week. This is from Isha.Isha and they said: "An invaluable resource. I have read many books on anxiety and OCD, and yet I am continuously surprised to learn new things with this podcast. It is thought-provoking and brings forward new, helpful, and interesting content." She went on to say: "Kimberly, your 6 Part series on Mental Compulsions has truly been life-changing for me. Despite reading dozens of books on OCD and Anxiety, including yours, I was astounded to realize how many mental compulsions I actually have. The approaches to dealing with them, suggested by a few of the guests (thank you, Hershfield, Nicely, and Reid), have been nothing short of miraculous for me. Thank you for your hard work here! It is deeply appreciated!" Again, you guys, if you go to CBT School and you sign up for our newsletter , you will be given a gift from me, which is a link where I have put all of those six-part mental compulsion audio files together and we've thrown in a whole bunch of PDFs that will help you really strategize your own way of managing mental compulsions. So, go sign up for the newsletter. If you go to CBTSchool.com, you'll be able to get access to it there. And then one more thing before we move on, let's quickly do the "I did a hard thing" segment. It sounds like this person who asked the question is doing hard things too, but this one was so fun, I wanted to share it with you. Anonymous says: "Having OCD has made wedding planning and the wedding process in general challenging for me. But this weekend, I made it to my bridal shower and I had the best time, even despite my OCD being along for the ride. I actually took the day as an opportunity to face the disorder head-on. I left feeling empowered as F***." Amazing, Anonymous. I'm so happy and congratulations on your bridal shower. I hope you had the most incredible time. All right, so let's look at this question. Let's break it down. Okay. So, yes, this person has already shared they understand that reassurance-seeking keeps us in the OCD cycle, keeps the fear going strong, and only makes more problems. It makes problems for the person with OCD, but it also impacts the relationship. In fact, I would go as far as to say, those who engage in reassurance-seeking behaviors tend to have a bigger impact on their family members because they're constantly going to their family members saying, "Would this happen? Could it happen? Do you think it could happen? What would happen?" And that person, because they're not trained as a clinician, they don't know how to respond. They haven't been trained. Usually, they try many different ideas and it actually ends up making the person with OCD even more confused. And then that can create conflict in the relationship. We know this. We know that reassurance-seeking can be very, very problematic and we want to slowly reduce it. It sounds like this person is doing amazing work, but they've got this dilemma in saying, "But I thought I was supposed to let things out." Let's take a look here. Managing emotions with OCD When you have an obsession, naturally, your instincts are, "How can I make this fear go away or this discomfort or feeling go away?" You're going to want to do a compulsion. The goal of ERP is to reduce those compulsions. So, now what are you doing? So, you're reducing the compulsion, you're not trying to get reassurance, and now you're handling a large degree of anxiety and stress. Yeah, that's true. You will have to rise and fall in discomfort. Absolutely. We know that that's a part of the work. Willingly, ride the wave of discomfort. So, what I want to say to you here is you have some choices. You could ride that wave on your own. Let it go high, let it go low, let it go up and down, do what it wants, and you can practice actually allowing that discomfort and really building a resilience to that as you go. Similar to what Anonymous said in "I did a hard thing" is they left feeling empowered. When we do it on our own, we can actually feel incredibly empowered. Now, that is one option. That doesn't mean to say that when things are really hard, naturally, we do want connection. That's what human beings want. So, sometimes we do want to go to our loved one and say, "I'm having a hard time." But there's a really big difference between going to a loved one and saying, "I'm having a hard time. Will this bad thing happen? Or do you think it will happen?" and saying to your partner, "I'm going through some stuff right now, would you sit with me?" One is very compulsive and one is not. But this is where OCD can be very, very tricky. Sometimes, just having a partner there forms reassurance. If your fear is like, "Well, what if I'm going to go harm someone?" keeping them in the room, even though you're not talking, that can still serve as a reassurance because you're like, "Okay, they're here. They'll stop me if I'm going to do something bad and I snap." So, we want to keep an eye out for how reassurance seeking doesn't have to be just verbal, it can be physical, it could be us just looking at them to see their face and go, "Okay, they look fine, they don't look stressed. Okay, that gives me the reassurance that nothing bad is happening." Catch the little nuances that can happen here because as we know, OCD can be very, very sneaky. Again, we can use the option and it is healthy to go to your partner and say, "Hey, I'm really dealing with something. This is really hard. I'm riding a wave of discomfort." But you're doing that without getting any reassurance, without seeking any reassurance, without them reducing or removing your uncertainty or anxiety. So, you can do that. There are ways to do it. But the main thing to remember here is, are you doing this with urgency? Because that's usually a very good sign that you're doing something compulsive. Are you doing it in attempt to reduce or remove your discomfort? If you're able to be in conversation with them and discuss and seek support from them without seeking it in an urgent way or trying to reduce or remove your discomfort, well then that's fine. But here is what I want you to consider just to start, is I am all for support. In fact, it is a human need to have support. But what I'm going to offer you is an idea, which is, when it comes to OCD, if you're going to them for support because of this discomfort, there is a chance you're still treating the fear like it's important, and you will suffer. I get that. You're going to have a lot of emotions. But if you have the emotions and you're like, "Oh my God, I feel so bad, I just have these thoughts, or having this anxiety," and you're giving that too much attention by saying, "I need your support, I'm really, really suffering," sometimes that in and of itself can actually reinforce the anxiety. I guess you're still probably thinking, well, what's the balance? And there is no perfect answer. I'm sorry, I can't give you a yes or a no. What I can say is, when it comes to OCD or anxiety, I personally am always going to encourage that you do it yourself as much as you can because that's where you actually learn how much you can actually tolerate. Remember here, anxiety is always going to be sneaky and say in the back of your mind, "Kimberley, just in case, just so you know, my anxiety is high, but I can really turn it up and freak you out, so you better be careful. Do your best to avoid me." That's what anxiety says in some way or form. So, if we still treat ourselves as if we're really fragile, we can actually reinforce that belief in that thought or intrusive thought. So, I personally am always for myself going to say, "Okay, fear is here, how can I ride this one out 100% by myself?" and this is the key point to remember. Ask yourself in that moment, because you're probably having some pretty strong reactions right now. Ask yourself in this moment if you are having a strong reaction, "What is my strong reaction to that?" Is it "it's not fair"? Is it "that's uncool, that's too much to handle"? That just shows you where our work is and here is the key point. What is it that you want them to provide you? Is it warmth? Is it compassion? Is it relief from the shame you feel? Is it to know that they won't leave you or they're not judging you? What is it that they're, this one particular person in that moment, what is it that they can provide you? And now, can you provide it for yourself? Or, is this thing you're looking for even really that helpful? So if you're like, "Oh my gosh, I just need a safe place to land right now," I beg for you to practice being the safe place to land. Not your partner, not your family, not your friends. You be that for you. You deserve to be the safe place to land. If there's a sneaky part of this where you're like, "No, I just want them to tell me that I'm good and not a terrible human being," well, that is in fact still reassurance. Yes, we're all allowed to get that reassurance, but you have to ask yourself, is that reassurance a healthy reassurance or is it something keeping you stuck in the cycle? You get to choose. I'm not saying what's right or wrong here because each person is different. If I'm with a patient, we will look at this and go, "Okay, let's talk about why you want your partner to provide you support. What is it that the partner support provides you?" And we pull apart whether that support is in fact benefiting their long-term resilience and success in treatment or actually slowing them down. There's nothing wrong with getting support at all, but is this an opportunity where you can show up and be your best person? Be the first person that's standing there going, "I got you." Mindfulness & Self Compassion For Reassurance Seeking Now here is the other piece of this, which is they're talking about bottling it in. Let's say you decide, "Kimberley, I'm on with this idea and I am going to commit to 30 days or seven days or one day or 10 minutes where I'm actually going to be the support for myself. I am going to practice my self-compassion skills, my mindfulness skills, my radical acceptance skills, and I'm going to be it for myself." That doesn't mean you're technically bottling it in. Bottling it in is when you have the emotion and you shut it down and you refuse to let it pass through you and you hold it in and you pretend it's not there and you're faking your way through it. If sometimes you need to do that, that's still fine. But this question is around saying that's a problem. Now here's what I'm going to say. There's really no scientific evidence to say that bottling things in is particularly bad, because how do we know what's bottled in really? We can't really measure what's being bottled in, but we do know that if you don't talk to people and you aren't processing stuff that, yeah, it can create some problems. So, this again is, how can we be healthy in our expression and effective in our expression of what's going on for us? Can you journal? For me, this might sound a little weird, but I am a little weird, is when I really have something I've got to get off my chest, I record an audio, I take a walk. I leave my kids and my husband and I take a walk and I record an audio of me just venting it out because, the truth is – this was particularly true during covid – me venting it out to my partner when he's got his own stuff he's working on, he's also going through some things as well. It's not helpful for me to dump it on him, so I would audio it into myself and listen back and listen for things that I could maybe work on. So, there are ways. Another way is to practice just feeling your feelings. That's probably the most important thing I want to mention here and which is why I wanted to really report it, is feel your feelings instead of bottling them in. Now, we recently did an episode about this and how this idea of sitting with your emotions. Go back and listen to that because that's important. When we talk about feeling your feelings, it doesn't mean lashing out and having them all over the place and being really unskilled in how you manage them, and it also doesn't mean having your feelings and staring at the wall and just being like, "Oh my God, I'm just so overwhelmed with this feeling, but I'm sitting with it." It's saying, while you go and engage with your life, you allow and embrace whatever emotions to come up. That's not bottling it in. You saying them out loud is not what's preventing you from bottling it in. They're two completely different concepts. Let's finish up by really talking about what is a healthy way to ride a wave of discomfort instead of having reassurance-seeking compulsions play out. You could journal, you could feel your feelings while you engage with your life, and use skills that you have, mindfulness skills, skills from this podcast. Go all the way back to the beginning. We've got tons of good stuff at the beginning of the podcast episodes where you can actually mindfully experience your emotions while also engaging in life. You could do those. You could also go and ask for support and say, "Hey, it's a really hard time. I just did a really hard exposure. My anxiety is really high. I don't want you to try and reduce or remove my anxiety, but your presence here is really wonderful. Thank you." You could be the one who shows up for you radically so hard. You could be like, "Hey Kimberley, what do I need? What do you need right now? How can I show up for you? Do you need my fear support? Do you need my nurturing support? Do you need my champion support? What do you need? And I'm here for you, sister." That's what I really want you to practice. You could also find an OCD therapist who's trained in ERP and say, "Hey, I'm working through some things. Can we talk about it in a way that doesn't provide me reassurance?" Because you trust that they understand how to not provide reassurance. And that can be a really helpful way. But there's one thing I want you to remember here at the very end. The reason I'm saying it at the very end is I think this is probably one of the most groundbreaking things that I learned just this year, and this has changed my marriage. I'm not going to lie, it's changed my marriage, which is this: At the beginning of this year, I read a book called Chatter . I will link it in the show notes. The book is-- let me pull it up really quick. The Voice in Our Head, Why It Matters, and How to Harness It by Ethan Kross. It is an amazing book. One of the things that blew my mind was the research that venting actually increases a person's distress and does not benefit them. What? That is the opposite of what I have been trained in my career. I was trained that venting is a really healthy thing. I know some of you may be like, "Well, duh, I've had issues with this in my past." But the truth is, it really showed the data on why venting actually makes us feel worse. It actually has a negative impact and there's no benefit to venting. So, I'm going to leave you to think about that because for me, when I read that, I can be-- I'm not going to lie, one of my not-so-great traits is I can be a little bit of a ventor. A ventor? Is that a thing? I can be a person who vents and unfortunately, my husband is the one who has to hear me process stuff. I'm a real process kind of person. What I realized when I learned this is, holy moly, I've been thinking that this is important and this keeps us connected, but the truth is, it doesn't. It doesn't impact me positively. It doesn't impact him positively, even though he is the most kind, supportive man in the history of the world. This is actually not a good behavior and I got to stop it. So, what I did is I called my best friend and I called my husband and I said, "From now on, I'm going to be much more mindful around venting. There will be times when I'm really struggling where I'm actually going to choose not to share about it in that moment. You might see that I'm spiraling on something." I'm going to say, listen, now is not the time because I now understand the science that venting is not in fact beneficial. It just makes me feel worse and works me up more. So, I use all my tools and I double down and I ride the wave and I journal and I audio in and I ride the wave on my own. So, here are some ideas you take and choose what you want, but that's the main concepts I want you to consider. And there's your answer, is this whole idea of holding it in is not the only option. You can, in a healthy way, ride your emotions and your wave of anxiety and you can do it in a way that actually is very effective that doesn't require anybody else. However, if you require somebody, no problem. That's wonderful. I hope that you have the most amazing, supportive people in your life and it's all good. So, that is it. I hope that is helpful for you guys. We did go around and around into all of the little cracks and crevices of this topic. If you've got any questions, you can always let me know. Please do leave a review because I hope this is helpful for you. I will see you next week. Next week, I'm actually doing a little bit of a personal episode, talking about a few shifts that I've had with my own chronic illness and how it's impacted my own anxiety. All fun and games. Not really. No fun and games is what I should say. All right, my loves, have a wonderful day. Please do remember it is a beautiful day to do really freaking hard things. You're not alone because I'm doing the hard things and your friends are doing the hard things and all the people listening here, thousands and thousands of people are doing the hard things too. Have a wonderful day, everybody.

Oct 13, 2022

In This Episode: We talk about how the ton of your voice really matters when it comes to self-compassion practices USING SELF-COMPASSION TO INCREASE MOTIVATION USING SELF-COMPASSION TO BETTER APPRAISE EVENTS How you can improve your self-compassion practices to include a warm nurturing voice. How you can practice a kind coach voice in your daily life. Links To Things I Talk About: Self-Compassion Workbook for OCD: https://www.amazon.com/dp/168403776X/ref=cm_sw_em_r_mt_dp_2JG8H4VWFSBMBJVQ4AD8 ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit – Episode 305. You guys, 305. That sounds like a lot of episodes to me. Oh my goodness. So exciting. All right. I am really feeling so connected to the message that I have with you today. It has been an ongoing lesson I have learned in my life. It has been something that I have had to fine-tune in my own self-compassion practice. And I know I've spoken about this before, but I wanted to come on and do a quick reminder of why the tone of your voice matters more than anything. When I say the tone of your voice, I mean like how you speak to yourself, and that would also include how you speak to other people. That both. Both are very, very important. I'm sure you know this from experience of talking to other people. When your tone is a little off, it tends to create some problems. Am I right? I definitely have some stories to tell you on that one. But there have been so many times over the summer and going now into the fall where I have had to really keep reminding my patients and myself. And I'm going to tell you a couple of stories here about my family where this has gotten so, so important. Why the tone of your voice matters more than anything? Because tone sets a scene for how things land. Here is an example. If I said to you-- let's use last week's example, we did a podcast on what does it actually mean to sit with your emotions. Now, as I talked about how frustrated I was about how-- sometimes we use this term and we don't explain what it actually means. If the tone of my voice, as I said that, was like, "Oh my gosh, it's so important that you use it in the right way," I was saying those actual words. But if I'm using a tone that's like, "You have to use it this way because you can't use it this way!" that's going to create inside a massive degree of anxiety and defensiveness and rejection from you guys. We can all agree. In fact, if you have read any of Dan Siegel's work, he's an amazing researcher, an amazing author – he talks about how the word "no" and how we say the word "no" can actually create a massive emotional approach or a response in people than if you were to say "yes" very kindly. Just a one-word difference. What I want to talk about here with you is tone and why tone needs to be a major part of your recovery. Let me tell you a story. The other day, for those of you who don't know, I have this beautiful, young daughter who just started middle school. Yeah, get ready for the ups and the downs. It's been a total ride since she started. But my husband was actually at the end of the day reflecting to me in a very compassionate way and he was saying, "Isn't it interesting how you can say to her, 'Get your bags, let's go,' and that can land so different than 'Get your bags, let's go!'" Same words, different tone. Five words, same five words, but those five words and the tone that we use can shift their experience and the way we feel as we express it. We were talking about-- and he was actually giving me a little bit. I'm not going to lie, he was giving me a little bit of feedback that my tone could be a little calmer. In the morning, things are stressful. I know I have some work to do. I'm not going to lie. I was like, "Okay. Yeah, you're so right." Coincidentally, I was already going to record this podcast, because so much of how we talk to ourselves is about motivating. I'm motivating her to "Get your bags, let's go, come on. We're going to move to the next step. We're going to be late for school." And it's about how do we motivate ourselves. I've got some examples for you here and I want you to think about them and how they apply to you. These are personal examples, but I'm pretty certain you may or may not resonate with most of them. So, here we go. Using Self-Compassion To Increase Motivation The first one is how we motivate ourselves to get things done. So, what was shocking to me while I was in Australia, because things were much more calm and my workload was much less, is there were certain tasks I had to keep doing. Even though I was on vacation visiting with my family, I still saw my clients and I still had to respond to emails and so forth. But it was so interesting that when I sit to my desk, which I'm sitting at right now, I often use a tone, which is like, "You've got to write your email, get going!" Not that mean, but you hear what I'm saying. Maybe I'm going to be a little overdramatic in this today just for the sake of getting the message across. But like, "You've got to get your email done before you see your clients!" Whereas when I was in Australia, I had more space and I was like, "Okay, hun, you've got to get your emails done before you get and see your clients." Same words, but the tone was so different. And so much of the motivating we deal with ourselves has a tone that is aggressive and unkind and bossy and anxiety-provoking and creates a defensive anxiety-driven experience. We all know when we are having anxiety, we actually then tend to build into that cycle even more. So, I want you to think about, how do you motivate yourself? You might even want to pause this and sit down and be like, "What specifically do I say and where's the tone that gets me in trouble?" What's the tone that brings on emotions that create more suffering for us? Another one, and this is true for a lot of my patients, this is where I pick up in them, is they know they have homework for therapy. And for those of you who are in therapy, usually, if you're doing any kind of CBT, you get homework, so you have to get it done. And how you talk to yourself about that homework can determine whether you're suffering or not. You could say, "I should get my homework done before I see my therapist!" or you could go, "Okay, I'm going to get my homework done before I see my therapist. When might I get that done?" Same topic, same motivation, same intention. The tone makes such a difference. Again, we're talking about motivation. Using Self-Compassion To Better Appraise Events What about your appraisal of events? You could say, "That was really hard." You've honored that you just did an exposure, let's say, or you did your homework or you got your emails done, and then you go, "Wow, that was really hard." That's a lot different if you were really in a wrestle, "That was really hard! Urgh!" Because when we're in that tone, we're in, again, a resentful, angry tone. Not that there's anything wrong with that. Again, there's an important place for every tone. You're allowed to be angry. You're allowed to be frustrated. You're allowed to be sad. You're allowed to be resentful and all those things. I just want you to question your tone and be curious about your tone and ask, is it helpful? Is it effective for you? An example of this is, we're talking about motivation, if you're in the last mile of a marathon, you might need to take on a tone that's very coaching, very like, "Come on, you could do it!" And you're like, "Ah, just get it done!" I have a dear friend who is suffering with a lot of grief. She lost her father. When she's playing her sports, she says, "I swear I can't stop the whole time, and I use my anger to belt out the ball." So, there is a great example. If it's effective for you, go ahead and do it. But I want you to really question and be curious about your tone and really ask if it's working for you. And then you have this great opportunity to start to play around with tones that work for you. Same goes for when we talk about it's a beautiful day to hard things. A client of mine once mentioned to me that this really, really made her mad. She hated this term. She was like, "This is very annoying. I don't want to do hard things. I know I can do them, but I don't want to do them." Again, you can absolutely use any tone you want, but check in on the tone you're using. Does it motivate you? Does it give you a sense of inspiration? Does it move you towards the behavior you're using? Is it kind? Absolutely the most important. Does it feel safe to use that tone? These are just questions to think about. One of the biggest ones is you made a mistake. You could say to yourself, "Okay, Kimberley, you made a mistake," or you could say, "Kimberley, you made a mistake!" Same words, massive in different tone. Hugely different in the tone, same words. I keep saying same words. The tone is so much different and can really impact how much you suffer. For me, the one that actually-- I got it last, but the one that actually blew my mind the most is the saying, "Keep going." I could say to myself, "Keep going. Keep going, Kimberley. Keep going. You've got this. Keep going. Keep going." And that's this idea of just one more, you can do one more. But if I were to be saying, "Keep going! Just keep going!" Same words, totally different effect. So, there's some examples. You probably have dozens more, or the ones that are really, really different, but I really want, if you can implement, just checking in on your tone each day. You might find that you go leaps and bounds in your self-compassion practice. In fact, I found that the ones who mastered this idea, or not even mastered, just work towards having a kinder tone, tend to be people who end up embracing self-compassion and really reaping the benefits from it. Because again, this is why I'm saying, this is why the tone of your voice matters more than anything. It propels us towards healthier motivation. It propels us towards a bigger, wider self-compassion practice. It propels us away from having emotions that are brought on by this really mean tone, like more fear, shame, guilt, embarrassment, humiliation, irritability. When we use that tone, that really creates a really negative vibe for us. So, that is what I want you to take away. So, so important. All right. Before we finish up, let's quickly go over the "I did a hard thing" one. This is from Sienna and they said: "In high school, I developed an eating disorder, and in college, I was diagnosed with anorexia nervosa. I'm currently one year out of college and weight restored, but eating is so difficult for me. I'm now in therapy for OCD, which my therapist and I realize, intersects with my eating disorder. It is very challenging for me to eat anything. I think I might be unhealthy and then continue to eating healthy foods that make me feel good. As a part of my ERP, I was assigned to drink kombucha once a day at lunch, and then continue eating healthy for the remainder of the day and to eat pizza once per week. These things scare me because of the pizza with my friends after a pool party, when I normally would have avoided the situation. I am so happy I was a part of my friend group in a way I previously couldn't be and that I was able to face some of my fears." Sienna, this is so good. Oh, I love it. You're doing such hard things. And I love how you've identified the specifics, like eating unhealthy, but then going back to your other. I think that is such a great-- you've identified what the trigger is. That is so, so important, and it's such an important part of exposure therapy. We talk about this a lot in ERP School, which is our signature course for OCD, which is, as you plan your exposures, you really want to be clear on the obsessions that you're going to be targeting. Because once you've identified a good obsession and what you want to target, then you can create some really great exposures and some really specific exposures for it. So, so good. All right. Let's finish up with the review of the week. It's from Love Heart 2 and they went on to say: "Kimberley knows her stuff. I discovered Kimberley's podcast a few months ago, and I really love listening to her Aussie-American accent as I am an Aussie in the US myself." How fun, Love Heart 2. That makes me feel so close with you. "So it feels like a little piece of home. Secondly, she's very informed on OCD, which I have had for a long time and anxiety. When you get down on yourself as a result of a mental illness, you need someone like Kimberley in your ear, reminding you that you can do hard work and that you are worth it." Oh my goodness. Thank you so much for that review, Love Heart 2. If you haven't left a review, please do so. It allows me to reach more people. When they see my podcast, it allows them to feel like they can trust what we're saying. And that's so important to me. The more people who feel that they can trust me, the more I can help them, and hopefully, I can bring just a little bit of joy into their day. So, thank you so much, Love Heart 2, and thank you so much, Sienna, for contributing to the "I did a hard thing" segment. All right, my loves, I'm going to sign off. Please do remember that the tone of your voice matters. It really, really does. Have a wonderful day.

Oct 12, 2022

In This Episode: We talk about how the ton of your voice really matters when it comes to self-compassion practices USING SELF-COMPASSION TO INCREASE MOTIVATION USING SELF-COMPASSION TO BETTER APPRAISE EVENTS How you can improve your self-compassion practices to include a warm nurturing voice. How you can practice a kind coach voice in your daily life. Links To Things I Talk About: Self-Compassion Workbook for OCD: https://www.amazon.com/dp/168403776X/ref=cm_sw_em_r_mt_dp_2JG8H4VWFSBMBJVQ4AD8 ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit – Episode 305. You guys, 305. That sounds like a lot of episodes to me. Oh my goodness. So exciting. All right. I am really feeling so connected to the message that I have with you today. It has been an ongoing lesson I have learned in my life. It has been something that I have had to fine-tune in my own self-compassion practice. And I know I've spoken about this before, but I wanted to come on and do a quick reminder of why the tone of your voice matters more than anything. When I say the tone of your voice, I mean like how you speak to yourself, and that would also include how you speak to other people. That both. Both are very, very important. I'm sure you know this from experience of talking to other people. When your tone is a little off, it tends to create some problems. Am I right? I definitely have some stories to tell you on that one. But there have been so many times over the summer and going now into the fall where I have had to really keep reminding my patients and myself. And I'm going to tell you a couple of stories here about my family where this has gotten so, so important. Why the tone of your voice matters more than anything? Because tone sets a scene for how things land. Here is an example. If I said to you-- let's use last week's example, we did a podcast on what does it actually mean to sit with your emotions. Now, as I talked about how frustrated I was about how-- sometimes we use this term and we don't explain what it actually means. If the tone of my voice, as I said that, was like, "Oh my gosh, it's so important that you use it in the right way," I was saying those actual words. But if I'm using a tone that's like, "You have to use it this way because you can't use it this way!" that's going to create inside a massive degree of anxiety and defensiveness and rejection from you guys. We can all agree. In fact, if you have read any of Dan Siegel's work, he's an amazing researcher, an amazing author – he talks about how the word "no" and how we say the word "no" can actually create a massive emotional approach or a response in people than if you were to say "yes" very kindly. Just a one-word difference. What I want to talk about here with you is tone and why tone needs to be a major part of your recovery. Let me tell you a story. The other day, for those of you who don't know, I have this beautiful, young daughter who just started middle school. Yeah, get ready for the ups and the downs. It's been a total ride since she started. But my husband was actually at the end of the day reflecting to me in a very compassionate way and he was saying, "Isn't it interesting how you can say to her, 'Get your bags, let's go,' and that can land so different than 'Get your bags, let's go!'" Same words, different tone. Five words, same five words, but those five words and the tone that we use can shift their experience and the way we feel as we express it. We were talking about-- and he was actually giving me a little bit. I'm not going to lie, he was giving me a little bit of feedback that my tone could be a little calmer. In the morning, things are stressful. I know I have some work to do. I'm not going to lie. I was like, "Okay. Yeah, you're so right." Coincidentally, I was already going to record this podcast, because so much of how we talk to ourselves is about motivating. I'm motivating her to "Get your bags, let's go, come on. We're going to move to the next step. We're going to be late for school." And it's about how do we motivate ourselves. I've got some examples for you here and I want you to think about them and how they apply to you. These are personal examples, but I'm pretty certain you may or may not resonate with most of them. So, here we go. Using Self-Compassion To Increase Motivation The first one is how we motivate ourselves to get things done. So, what was shocking to me while I was in Australia, because things were much more calm and my workload was much less, is there were certain tasks I had to keep doing. Even though I was on vacation visiting with my family, I still saw my clients and I still had to respond to emails and so forth. But it was so interesting that when I sit to my desk, which I'm sitting at right now, I often use a tone, which is like, "You've got to write your email, get going!" Not that mean, but you hear what I'm saying. Maybe I'm going to be a little overdramatic in this today just for the sake of getting the message across. But like, "You've got to get your email done before you see your clients!" Whereas when I was in Australia, I had more space and I was like, "Okay, hun, you've got to get your emails done before you get and see your clients." Same words, but the tone was so different. And so much of the motivating we deal with ourselves has a tone that is aggressive and unkind and bossy and anxiety-provoking and creates a defensive anxiety-driven experience. We all know when we are having anxiety, we actually then tend to build into that cycle even more. So, I want you to think about, how do you motivate yourself? You might even want to pause this and sit down and be like, "What specifically do I say and where's the tone that gets me in trouble?" What's the tone that brings on emotions that create more suffering for us? Another one, and this is true for a lot of my patients, this is where I pick up in them, is they know they have homework for therapy. And for those of you who are in therapy, usually, if you're doing any kind of CBT, you get homework, so you have to get it done. And how you talk to yourself about that homework can determine whether you're suffering or not. You could say, "I should get my homework done before I see my therapist!" or you could go, "Okay, I'm going to get my homework done before I see my therapist. When might I get that done?" Same topic, same motivation, same intention. The tone makes such a difference. Again, we're talking about motivation. Using Self-Compassion To Better Appraise Events What about your appraisal of events? You could say, "That was really hard." You've honored that you just did an exposure, let's say, or you did your homework or you got your emails done, and then you go, "Wow, that was really hard." That's a lot different if you were really in a wrestle, "That was really hard! Urgh!" Because when we're in that tone, we're in, again, a resentful, angry tone. Not that there's anything wrong with that. Again, there's an important place for every tone. You're allowed to be angry. You're allowed to be frustrated. You're allowed to be sad. You're allowed to be resentful and all those things. I just want you to question your tone and be curious about your tone and ask, is it helpful? Is it effective for you? An example of this is, we're talking about motivation, if you're in the last mile of a marathon, you might need to take on a tone that's very coaching, very like, "Come on, you could do it!" And you're like, "Ah, just get it done!" I have a dear friend who is suffering with a lot of grief. She lost her father. When she's playing her sports, she says, "I swear I can't stop the whole time, and I use my anger to belt out the ball." So, there is a great example. If it's effective for you, go ahead and do it. But I want you to really question and be curious about your tone and really ask if it's working for you. And then you have this great opportunity to start to play around with tones that work for you. Same goes for when we talk about it's a beautiful day to hard things. A client of mine once mentioned to me that this really, really made her mad. She hated this term. She was like, "This is very annoying. I don't want to do hard things. I know I can do them, but I don't want to do them." Again, you can absolutely use any tone you want, but check in on the tone you're using. Does it motivate you? Does it give you a sense of inspiration? Does it move you towards the behavior you're using? Is it kind? Absolutely the most important. Does it feel safe to use that tone? These are just questions to think about. One of the biggest ones is you made a mistake. You could say to yourself, "Okay, Kimberley, you made a mistake," or you could say, "Kimberley, you made a mistake!" Same words, massive in different tone. Hugely different in the tone, same words. I keep saying same words. The tone is so much different and can really impact how much you suffer. For me, the one that actually-- I got it last, but the one that actually blew my mind the most is the saying, "Keep going." I could say to myself, "Keep going. Keep going, Kimberley. Keep going. You've got this. Keep going. Keep going." And that's this idea of just one more, you can do one more. But if I were to be saying, "Keep going! Just keep going!" Same words, totally different effect. So, there's some examples. You probably have dozens more, or the ones that are really, really different, but I really want, if you can implement, just checking in on your tone each day. You might find that you go leaps and bounds in your self-compassion practice. In fact, I found that the ones who mastered this idea, or not even mastered, just work towards having a kinder tone, tend to be people who end up embracing self-compassion and really reaping the benefits from it. Because again, this is why I'm saying, this is why the tone of your voice matters more than anything. It propels us towards healthier motivation. It propels us towards a bigger, wider self-compassion practice. It propels us away from having emotions that are brought on by this really mean tone, like more fear, shame, guilt, embarrassment, humiliation, irritability. When we use that tone, that really creates a really negative vibe for us. So, that is what I want you to take away. So, so important. All right. Before we finish up, let's quickly go over the "I did a hard thing" one. This is from Sienna and they said: "In high school, I developed an eating disorder, and in college, I was diagnosed with anorexia nervosa. I'm currently one year out of college and weight restored, but eating is so difficult for me. I'm now in therapy for OCD, which my therapist and I realize, intersects with my eating disorder. It is very challenging for me to eat anything. I think I might be unhealthy and then continue to eating healthy foods that make me feel good. As a part of my ERP, I was assigned to drink kombucha once a day at lunch, and then continue eating healthy for the remainder of the day and to eat pizza once per week. These things scare me because of the pizza with my friends after a pool party, when I normally would have avoided the situation. I am so happy I was a part of my friend group in a way I previously couldn't be and that I was able to face some of my fears." Sienna, this is so good. Oh, I love it. You're doing such hard things. And I love how you've identified the specifics, like eating unhealthy, but then going back to your other. I think that is such a great-- you've identified what the trigger is. That is so, so important, and it's such an important part of exposure therapy. We talk about this a lot in ERP School, which is our signature course for OCD, which is, as you plan your exposures, you really want to be clear on the obsessions that you're going to be targeting. Because once you've identified a good obsession and what you want to target, then you can create some really great exposures and some really specific exposures for it. So, so good. All right. Let's finish up with the review of the week. It's from Love Heart 2 and they went on to say: "Kimberley knows her stuff. I discovered Kimberley's podcast a few months ago, and I really love listening to her Aussie-American accent as I am an Aussie in the US myself." How fun, Love Heart 2. That makes me feel so close with you. "So it feels like a little piece of home. Secondly, she's very informed on OCD, which I have had for a long time and anxiety. When you get down on yourself as a result of a mental illness, you need someone like Kimberley in your ear, reminding you that you can do hard work and that you are worth it." Oh my goodness. Thank you so much for that review, Love Heart 2. If you haven't left a review, please do so. It allows me to reach more people. When they see my podcast, it allows them to feel like they can trust what we're saying. And that's so important to me. The more people who feel that they can trust me, the more I can help them, and hopefully, I can bring just a little bit of joy into their day. So, thank you so much, Love Heart 2, and thank you so much, Sienna, for contributing to the "I did a hard thing" segment. All right, my loves, I'm going to sign off. Please do remember that the tone of your voice matters. It really, really does. Have a wonderful day.

Sep 30, 2022

SUMMARY: Today we have Natasha Daniels, an OCD specialist, talking all about how to help children and teens with OCD and phobias. In this conversation, we talk all about how to motivate our children and teens to manage their OCD, phobias, and anxiety using Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and other treatments such as self-compassion, mindfulness, and ACT. We also address what OCD treatment for children entails and what changes need to be made in OCD treatment for teens. In this episode, Natasha and Kimberley share their experiences of parenting children with phobias and OCD. In This Episode: What does sitting with emotions mean? How to sit with difficult feelings How to sit with your sadness How to sit with uncomfortable feelings, Sit with the feelings Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 304. Welcome back, everybody. It's a delight to have you here with me today. Oh, I've got so much I want to talk to you about and this is actually coming from an emotion of frustration, this episode, which every time I check in and I begin a podcast, I try to come from a place of fun. And am I feeling calm? And am I feeling completely connected to you, the listener? But today, just for fun, I'm coming to you from a place of frustration. And the frustration, promise, this is not going to be a vent episode – it's actually a frustration in that I caught an error that I've made, and I think a lot of clinicians are making. And it's not an error in that it's bad or wrong or problematic. It's just that I caught something in my own practice, and I was like, "Oh, hold up, we have to talk about this." So, saddle in, get your cup of tea, settle in, because we're going to have to have a conversation about wording. It might be really nuanced and I want you to take what's helpful and leave the rest. I want you to think about it with an open, curious mind, and decide what's best for you. So, before we get into the show, as always, let's start with the "I did a hard thing." Let's do it. This one is actually from someone that says-- the handle name is GottaCatchEmAll, and they said: "Thank you so much for your recent series on mental compulsions. Your podcast is truly a godsend and I've been listening nonstop ever since my friend shared it with me last month." Now, for those of you who don't know, the mental compulsion series was a six-part series that we created here on the podcast. It had so many amazing clinicians on. If you want access to that series, you can go back and listen to previous podcasts. Or, if you sign up for our newsletter, you'll go to CBTSchool.com/newsletter. I will actually send you an amazing webpage, just one link where all the episodes are there, all the PDFs are there. It's so pretty. I have to say it is so pretty, and it's like a one-stop shop for that series. So, go over to the newsletter, CBTSchool.com/newsletter. Sign up for the newsletter. You'll get an email from me every week. But on the front end, you will receive that link. I'm so proud of it. I love it. So, I digress, sorry. They went on to say: "I suffer from a plethora of different anxieties, OCD, scrupulosity, hoarding, body dysmorphia, perfectionism. So, basically a bunch of normal human things, right? Exactly. The other day, I told my therapist that dealing with all of these issues felt like playing a game of whack-a-mole in my head, except that instead of the typical game, the mole would pop up and then a zebra and a giraffe, and so on, in a quick succession throughout the course of the day. While sobbing, I told my therapist that I didn't want to have a zoo in my head and I didn't know how to treat so many issues simultaneously. Imagine my surprise when I heard a recent episode called Whack-a-mole Obsessions, it was a relief to discover that I wasn't alone and weird or broken as I thought. I realized, instead of trying to resist or whack the zoo in my head, I could approach my anxieties and compulsions like they were different Pokemons that I could catch and train and carry around with me while I live the rest of my best life. Thank you, Kimberley, for putting on such an incredible content and for helping me and so many others navigate this difficult thing." That is so good. Look at you working through that whack-a-mole ongoing struggle with different thoughts, different disorders, and so forth. I think so many of us resonate with this and you are definitely doing hard things. So, so, so cool. All right. Real quick, before we get to the frustration that we're all hanging out for, let's just quickly do the review of the week. This one is a shorty from Inventedcharm, and they said: "It is a mental pick me up. I love listening when I need a mental pick me up. Kimberley's voice is soothing, and she offers great tools for self-compassion and interviews other experts in the field of mental health." So, thank you, Inventedcharm, and thank you, GottaCatchEmAll. Okay. So, here we go. I'm going to tell you a story of why I'm landing here on this episode with you today. So, once I got back from Australia, a lot of you know I spent five and a half weeks in Australia over the summer with my children. It was so beautiful. I can't tell you how full my heart was when I returned. I was energized. I was the happiest I've ever been. And you know where this is going. Yeah, we do. I crashed big time. I just went through so much sadness. I missed my family. I was angry. I had so much grief. I was feeling, actually, if I'm going to be completely honest, quite a lot of resent towards even my husband, who I love and is such a wonderful human. But I was observing resent show up because I was like, "I don't understand. I just want to be with my family and why can't I have all the things I want?" So, all these emotions started showing up. WHAT DOES IT MEAN TO SIT WITH EMOTIONS? My therapist – of course, I talked with a therapist – was saying, "Everything, Kimberley, that you're saying makes complete sense. Why don't you practice sitting with your emotions?" And of course, I was like, "Yeah, that makes sense. I have given that advice myself." And so, off I went right onto the roller coaster, or we could say the whack-a-mole to talk about the "I did the hard thing" segment, the whack-a-mole of emotions with the agenda of not numbing them like I often do. Sometimes when I work, I engage in these numbing behaviors where I just numb all of everything out by working. It's something that I've overused as a coping skill, is when I work. So, I'm not doing that anymore. I'm not using any other problematic safety behaviors. I caught all these problems. So, it's like, "I think really all you've got left to do is just sit with your emotions." So, I went, "Okay, let's do it. There's no solution. There's nothing I can do about this. Let's just sit with it." And I started to play with this idea of, okay, let's talk about what does it mean to sit with your emotions. Now, this is where, again, I'm going to identify, I've given this advice and I'm going to say, I don't think I'm going to give that advice anymore. Or if I do give it, and for any reason you don't catch me doing this, you can always bring it to my attention, but I'm going to do my best, is I'm going to add another sentence to the whole "sit with your emotions" concept, because let's say often you guys have heard me say, "Sit with anxiety, sit with your anxiety." And that's helpful because we know that doing compulsions with anxiety is a problem. If you resist or avoid or try and remove your anxiety, it's going to create more problems. But where that gets in the way is it doesn't mean you just sit there and do nothing but stare at the wall and just let the anxiety beat you into a pummel. No. I think that the mistake I'll make, and I'm going to be completely transparent, I think the mistake I make is I'm assuming you guys know what I mean by that, and I'm assuming that you know, I mean, don't just sit there and stare at the wall. There were a couple of days where I was so overwhelmed with emotion that I did just sit there and be like, "Okay, I'm allowing this. I have to allow it. I'm sitting here. I'm allowing it. Oh man, this is hard," until I was like, "Wait a second. This is not helpful. Just sitting here and letting it pummel me, that's not the whole picture. There has to be tools and skills associated with it." That's where I'm talking about in regards to anxiety. It's a great concept, but what do we actually mean when we say, "Sit with your emotions"? We mean, allow it, particularly when we're talking about fear. We're saying, don't interfere with it. Don't engage with it. Don't wrestle with it. Don't stir it up. And we're also saying, don't run away from it. We don't thought suppress. So important. So, I totally believe that sitting with emotions is an important concept, but we must, and I am sorry if I haven't mentioned this and I haven't gone a full explanation, we then must engage back into life. We must engage back into the things that we value. We must engage, even if we don't like it. Sometimes you have to do the dishes. Sometimes you have to get out of bed. And sometimes we have to allow emotions, embrace emotions, bring on emotions in order to get up and do those things. But that's just anxiety. HOW TO SIT WITH DIFFICULT EMOTIONS? Now, let's talk about which emotions should you sit with and which ones shouldn't you? Now, number one, there is no bad emotion. There's no such thing as a bad emotion, a negative emotion, a problematic emotion. They're all just neutral. And that's huge to know. But as I was sitting in the chair of the client instead of being the therapist, and I was really going, "Okay, I'm not going to engage in these behaviors. I'm going to instead just allow them and sit with them," I realized sometimes asking yourself to sit with an emotion, particularly ones like guilt and shame, that too isn't completely helpful. We need to put an extra sentence on the end of that as well. So, we can say, "Sit with your emotion of shame, but also be aware of the stories it's telling you, not taking it as a fact." Because as I was noticing, so much shame showed up for myself in this specific situation. I was thinking, wait, if I told my client to sit with shame, but I hadn't taught them the skill of diffusing from shame or observing the story of shame, they're going to have shame and be like, "Oh yeah, it's true. I am bad. I'm just going to sit with the fact that I'm bad." So, no, no, no, no, no. That's not what we mean, again, by sitting with emotions. We're not saying we're going to sit with them and accept them as fact. Let's talk about sitting with sadness and grief because, boy oh boy, did I have sadness and grief. And it would come in waves that punch me in the face. I'd be like-- and again, I want to validate grief. Doesn't matter, it's not just losing a human body. Nobody passed away. That's definitely grief. But I was handling grief and loss of like, "Oh, I missed my family. I wish I was there. I wish I lived there. I wish I could just snap my fingers and be there. I wish the world was different. I wish COVID didn't happen." All these things. So, I just was getting these waves of sadness. And it was important as I was "sitting with sadness." That's okay. We want to do that. We want to allow it. We don't want to interfere with it. We don't want to run away from it. We want to embrace it. But we don't want to thicken it with hopelessness as we sit there. We don't want to thicken it with like, "Yeah, bad things are going to keep happening and there's not hope." That will only create more problems. HOW TO SIT WITH SADNESS? So, when we say "sit with your emotions," particularly the one of sadness, we actually want to sit in sadness again with non-judgment, with curiosity, with awareness of other things. And when I did that, when I sat with my emotions and was curious and open, I noticed like LA's got a beautiful, beautiful scene. The vibe is really cool. I love my house. I really do love my house. I love the fact that my house is surrounded by trees. I love my family. And I allowed me to be open to sadness and other parts of my life here. So, again, I'm bringing this up of just like in that moment of doing the action, I was thinking, oh my goodness, we need to make sure we expand our description of what it means to sit with your emotions. If you need more step by step, in my book, The Self-Compassion Workbook for OCD, if you have OCD, I actually have a full chapter on managing strong emotions. And in that book, I actually did, I believe, a good degree of explanation. But I wanted to get on here and set the-- what do you say? Set you straight? That's not right. Set the story straight. I don't really know what that saying is, forgive me. But I wanted to be really clear and actually correct if I've ever said this term, "sit with your emotions." It's not a bad term. I actually almost called this episode "Why I'll never say sit with your emotions again." But the truth is, I won't. I can't hold that as true. So, I changed it to "What does it really mean to sit with your emotions," and how can we add additional context to that statement so that it doesn't mean you're just indulging the emotion and all of the trash that some emotions can leave behind. And what I mean by trash, I'm not judging, it is like, with sadness comes hopelessness sometimes. So, we want to be careful not to engage with that and infuse too much with that. With shame comes a story that you're bad, that you're wrong, that you don't have any worth. We don't want to indulge or engage in that while we allow and experience the emotion of shame. HOW TO SIT WITH ANGER? Anger was another one. I went through these crazy waves of anger and talking with a therapist like, "Okay, you're having your anger." Of course, don't lash out or say me unkind things, or catch yourself if you're starting to feel highly dysregulated. And then just sit with your emotions. And I thought, wow, again, there's that saying. But if I'm angry and I'm sitting with it, I could easily percolate on some pretty hateful thoughts. I could be sitting with and ruminating with that emotion. And that is not what we mean when we say "sit with your emotions." So, I really wanted to just drop into this. If I were to sum up this whole episode, the thing I want you to think about the most is, there is no right way to manage an emotion and there is no right or wrong emotion. There is no-- and I talk with my patients all the time about this. There is no playbook on how this is supposed to go. The metaphor I often use is, it's like any sport. Some of you may know, I'm learning tennis. I actually pretty suck at it, but that's a whole nother story. The whole thing I'm learning is, and the reason that I suck, and I don't say that in a judgmental way, I actually think it's hilarious, is it's all about being super flexible. So, I'm standing and my knees are bent and I'm holding my racket and I'm going left to right, left to right on my feet, and I'm getting ready for this constantly changing direction of a ball. And I have to stay really flexible. So, if the ball goes all the way to the right, I have to move my legs so I can move to the right. And then if next time it goes to the left, I have to be ready to make that maneuver. HOW TO SIT WITH OTHER DIFFICULT EMOTIONS Same goes with emotions. Your emotions are going to flip flop and go from left to right and north to west, and it's going to give you a run for your money. And we have to be able to adjust the strategy depending on what's coming to us. And that's true of emotions. In simple, we're always going to observe it, allow it, acknowledge it. In some points, we have to be curious instead of being closed and judgmental. These are skills you can use with all of them. But as I've gone through some of the more difficult emotions today, sometimes we have to catch the themes that percolate and loop us into it when "sitting with emotions." So, that's the main thing I want to talk to you. Again, I'll tell you, as I-- I was actually driving to the dentist and I called a very dear friend of mine, and I just said, "I actually just had a major epiphany. We can't keep saying 'sit with your emotions' as clinicians. We have to make sure we add context to what that looks like, and it means not just sitting still and doing nothing, except focusing on the emotion." So, if this resonates with you, I hope it does. It was such an important thing I wanted to talk with you about again. Does it mean it's wrong? Absolutely not. If you're a clinician or you hear this, or you've probably even heard it from me – if you've heard it, it doesn't mean they've done anything wrong. I just want you to understand what it actually means when they say that and to add those extra sentences at the end and give context to like-- again, don't interfere with them. Don't run away from them. Allow them. Also, don't calculate and ruminate on them either. Sending you so much love. As always, this is really hard work. So, please do remember, it is a beautiful day to do these hard things. And I will add, for any of you who are writing out waves of emotion right now, I salute you. I have such deep respect for you because it's no easy feat to choose an emotion, to choose to tolerate it and interrupt behaviors that are problematic and allow emotions to rise and fall. That is some pretty impressive work you're doing. And I just want to give you a massive shout out because it's not fun. It's hard. It's not easy. It's skillful work. It takes some stamina to do it, and it's exhausting. And so, if you're doing even 10% of this work, I applaud you. All right, my friends, I will see you next week. Have a wonderful, wonderful week. Again, please do go to CBTSchool.com/newsletter if you want access to that mental compulsions worksheet. And I'll be seeing you in a week.

Sep 23, 2022

SUMMARY: In this episode, I addressed a question that was asked of me by a loyal follower. They asked, "What do I do if the present moment totally sucks? Like, what if I have a migraine , nausea , chills , pain? Any suggestions ?!" This is such a great question and one we probably have all asked ourselves or our therapist at some point. Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor:This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety...If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 303. Welcome back, everybody. Thank you from the bottom of my heart for being here with me. Thank you for listening. Thank you for supporting me. I know how valuable your time is, and I know there are so many people that you could spend your time with, especially out on the podcast field. So, I am so, so grateful to have you here with me. Really, really, really I am. I hope that you find these episodes incredibly helpful. My hope is to give you bite-size tools so that you can get on with your life and live your best life. I hope this podcast is everything that you wanted to learn. This week's episode, I am totally, totally amped for. The reason being is, it was actually a response to a previous podcast where we talked about being present. Somebody had written back because they subscribe to my newsletter. If you haven't subscribed to my newsletter, please do so. I will leave a link in the show notes, or you can go over to CBTSchool.com and sign up there. They had responded and said, "But Kimberley, what do I do if the present moment totally sucks?" And they went on to say, "I have a migraine or nausea or chills or pains." And they said, "What are your suggestions?" I figured, this is probably the question you all have for me. I come on, I share with you tools. And then you guys are probably always going to have a question and this is a really common one. WHAT TO DO IF THE PRESENT MOMENT TOTALLY SUCKS Today, I want to talk about what to do when the present moment totally sucks. Before we do that, let's first do the "I did a hard thing" segment. This one is from Rachel and they said: "My thoughts get the best of me. I recently started teaching and I needed to stay long after the students go home. And I decided it just needs to be a busy time to distract me. I use your book to help me with any meditations and I just let my thoughts come and go. It was scary the first time, but now I'm used to it." Thank you so much, Rachel. I'm so grateful my book can be of assistance. I think you're doing some really, really hard work there. So, congratulations on that. And then last of all, before we get into the bulk of the episode, let's first share a review of the week and this is from Meldevs and they said: "I am so thankful to have found this podcast! Kimberley is such a compassionate, warm, honest, and insightful person for those struggling with anxiety disorders as I do. I have learned more listening to her than I have in my years of therapy. The way that she presents each and every podcast episode so that I feel challenged and understood. Thank you, thank you, thank you for being there for people struggling with anxiety!" Thank you, Meldevs. That is such a beautiful review, really. That brings me so much joy and I really, really appreciate all your reviews on the podcast, because it helps me to reach more and more people. Meldevs and Rachel, thank you so much for being a part of my community. Let's get into the episode. What do we do when the present moment totally sucks? Let's break it down. When we talk about being present, one of the biggest mistakes we make, and I talk with my patients about this all the time, is we assume that being present means everything feels great. I think we have in our mind that being present is when we are most mindful, when we are most at peace, when we're most compassionate. And I'll tell you honestly, that has not been my experience. Oh no. HOW TO BE PRESENT WHEN ANXIOUS Being present, the art of being present, the practice of being present in your most mindful sense has never meant being comfortable in my experience, especially as my experience with it as a clinician, especially as my experience of having my own mental illnesses and my own medical illnesses. No, it's not that. Most of the time, when we need to be present are the times when things totally suck, when we're in a great deal of distress. Because otherwise, if you're not in distress, usually, you don't have to be as present because often you naturally are. So, let's just remember that our brains, when we are uncomfortable, is wired to focus on that discomfort. That's how we've survived all these years. And it's going to focus on the pain because it is trying to send a message to you to get the pain to go away. But when we have something where the pain won't go away, have it be migraine, like you said, nausea, chills, discomfort could be also anxiety or intrusive thoughts because we all know we can't stop those. When we experience those, yes, naturally, you're going to want to run away from it. But as a part of this team and as part of this community, you guys know and hopefully, I've taught you that running away from discomfort only makes it worse. Resisting the pain we feel and the suffering we feel only makes it worse and increases our suffering. So, what do we do? Friends, we settle in. I'll give you a personal example of when I actually recently had COVID. Some people bless your hearts. And also, I'm really still very mad at these people, but still, bless your hearts. I wish this was the case for everybody. But some people have very few symptoms when it comes to having COVID. I am not one of those people. When I have COVID and when I got COVID, I get bone pain. It is like the deepest pain in my bones. It goes right to the center of my bones and it is so painful. My daughter and my husband both had COVID as well. My daughter came in. And I, when I'm in this state where my bones hurt this bad, I've had it several times in my life. She said, "Mama, you're tensing up. Your face is all squished." I was holding my muscles tight. And thank goodness, because I was in so much pain that I actually needed somebody outside of my body to tell me this was happening because I just was so entrenched in the pain I was feeling that she said, "Mama, you're all tense." Thank goodness I've taught her that tensing up around pain actually makes it worse. Her and I have had many conversations around this. STEP ONE: VALIDATE And so, I naturally was able to go, "Oh, okay, Kimberley, let's pause." Number one, validate. "Hun, you're in a lot of pain." You could even say, "This present moment totally sucks." Or you could say, "Wow, I'm observing that you're really uncomfortable right now." So, if that's you and your present moment really sucks, I'm strongly encouraging you first validating. The alternative would be you go, "It shouldn't be this way." But the truth is, it is this way. So, don't go down the road of fighting it. STEP TWO: STOP RESISTING THE PRESENT MOMENT The second piece is then check for where you are resisting the present moment and how much it sucks. Now I'm going to keep saying the word "sucks" really passionately because it does sometimes really suck, like really suck. And so, when it really sucks, it's almost like the more it sucks, the more we have to soften around how much it sucks. If you have a migraine, the worse it is, the more you need to soften your brow and close your eyes and soften the environment that you're in. The more you feel nausea, the more you feel your stomach nodding up. And some of you may feel that just by me mentioning it. The more you feel that, the more you need to soften around that physically by relaxing your muscles and softening your thoughts around it. Meaning now is not the time to beat yourself up for it. Now is not the time. Some people are going, "Yeah, but it's my fault. I have nausea because I drank too much," or "I ate too much," or whatever it may be. Now is not the time to go through that. Now, the facts are, the present moment totally sucks. And so, let's be gentle around it because our resistance makes it worse. If you were like me and you have the chills and you've got literal, like feels like every bone in your body is broken, now is not the time to fight that and tense your muscles. Now is the time to soften. If you're having a full-blown panic attack, first acknowledge, "Okay, I'm noticing I'm having a panic attack." And then soften around it physically and cognitively in your thoughts. Don't resist it. Now, that being said, let me bring a very important concept to the table. And this actually just came up this morning. So, as many of you know, I have my online business, which is CBTSchool.com, and then I also have a private practice where we see clients. Because I can't see all the clients that come to me, I have 10 amazing therapists who work for me and who I have trained and who I supervise every single week. We have a meeting every Monday, and we talk about cases. One of my staff was telling me today that one of her patients took what she said literally, which actually is pretty common. She was explaining to her patients that when you have anxiety and panic or discomfort, you sit in the discomfort or sit with the discomfort, or be with the discomfort. And this patient and client took it literally, which is fair. We have to be really descriptive and give lots of steps and explanations. And so, while they were feeling this discomfort, they literally sat in a chair and just stared and suffered. So, if I've ever said, sit with your discomfort, please don't take it literally. And so, what I want to remember here and what I remind you of, I should say, is once we've acknowledged and we stop the resistance to it, we must then reengage in something we value. So, let's use me as an example. I had COVID. I literally felt like every bone in my body was broken. That doesn't mean I'm going to get up and go for a run. It doesn't mean I'm going to get up and see patients because I'm actually in pain. I wasn't able to. But what I can do is instead of putting my attention on how much it's painful, I'm going to put my attention onto something else. And it could be as little or as minute as the sound of the leaves rustling outside, the sound of music, the, the smell of the cough medicine I had taken, the taste of the cough medicine I had taken, the touch of the blanket. So, you just get really in touch with that. And then you catch how your mind then keeps offering you thoughts that make you want to reengage back with the pain. Now, again, I'll give you another example. Most of you know, I have a chronic illness. I have postural orthostatic tachycardic syndrome. I am dizzy almost all the time. It's under control now. I don't faint nearly as much as I used to. But dizziness is actually a very normal part of my existence, particularly when I'm standing up. And so, my job is to allow it and then to catch when my brain starts to say, "It shouldn't be this way. This isn't fair. It's not good. This is bad. It could be better. Your life could be better." My brain offers me those thoughts and I choose not to entertain them. Now, I'm not perfect at this, and this is something I've been practicing for a long time, so please be gentle with yourself. My job and your job, when the present moment totally sucks, is to be an observer to our brain. And of course, as I said, at the beginning, it's going to present to us all the problems and why this shouldn't be the problem. And you just say, "Thank you for showing up. I totally get what you're saying, brain. Thank you for being there for me, but I'm going to keep directing my attention to whatever it is in front of me." If you have anxiety and you're having panic, you're having high levels of anxiety, I'm going to say to you, ask yourself the question, what can I do or what would I be doing if anxiety wasn't here right now? And go do those things. Don't just sit in the discomfort. Only go engage back with life. Do the most that you can with your life WHILE you have anxiety. Now, let's also address one other main issue. In no way am I saying to dump toxic positivity on yourself here. In no way am I saying things like, "Oh, you should be happy. The leaves are so beautiful." Again, like I was saying to you, no, absolutely not. That is not what we're talking about. If you feel sad about this, if you feel down about it, if you feel a little discouraged or irritable, that's okay. We can also be mindful and acknowledge, "Yeah, I'm feeling really frustrated with how I feel so terrible." We're not here when we're mindful. We're not here to say it shouldn't be this way and just be happy about it. No, like I said to you, in my experience being present, my most mindful is actually when things totally suck. And I don't try and change it that often. In fact, I just try to allow it, bring it in and then add other valuable things into my life. Can it be positive? Absolutely, if you want it to be. But if the suffering you're experiencing is depression or hopelessness or grief or panic, we don't need to throw a bunch of positivity on there unless it's really helpful to you. All I'm here trying to do is get you to not fight how painful it is because that usually makes it more painful. And also, we don't want to thicken the pot of it by going, "You're right. It does suck. It's not fair," and all those things. That can actually often-- we have research to show that that rumination actually makes our suffering worse. I know I said that was the last thing, but I have one more important thing to say, which is, please, please practice nonjudgment. If you're going to be mindful, you have to practice nonjudgment. You can't have mindfulness without nonjudgment. I have a whole episode on that. The whole point here with nonjudgment is, when we say this moment totally sucks, it's actually a judgment. And I don't want to take that from you. I don't want to take that from you. It's okay. You're allowed to acknowledge it. But we also want to catch that how sometimes when we're judgmental, this is good and this is bad, we actually train our brains to send out more anxiety hormones when we have that experience the next time, especially when we tell ourselves it sucks and it shouldn't be there. So, keep that in mind. Anytime I'm going through something difficult, and this is very true of my work that I did around dizziness, with my POTS, is I had to take all the judgment out of it to reduce my suffering around my dizziness. Because the more I judged it, the more I felt completely hopeless and depressed about the situation. The more I felt like, oh, I just don't have an answer, there is no answer. Again, I didn't say, "Wow, I love dizziness. It's so positive and wonderful." I just said, it's a sensation. I'm going to be gentle. I'm going to acknowledge it and allow it and lean into it, but not give it too much attention. And it's neither good nor bad. And that was a conscious, intentional decision. Again, be careful that it doesn't become toxic in that you're pushing too much positivity on yourself, but again, it's a balance. So, there it is. That is what I would encourage you to do when the present moment totally sucks. And as I said, the present moment, especially when you're suffering, it will totally suck sometimes. But that doesn't mean you're going in the wrong direction. It doesn't mean it's going to stay that way forever. There's another piece to catch. I am just in love with you guys. I really am. What an amazing, amazing community. Please, if you want to be part of my community, you can go over to Instagram @YourAnxietyToolkit. You can listen to this podcast and go right back to the beginning and listen to the beginning ones. You can go over to Facebook. We actually have a private Facebook group called CBT School Campus. You're welcome to come and join us there. Thank you. Just love you, love you, love you. Have a wonderful day and I'll talk to you next week.

Sep 16, 2022

In This Episode: What is the difference between a Panic Attack and an Anxiety attack? What is the prevalence of Panic Disorder? Are anxiety attacks dangerous? Are Panic Attacks dangerous? How does anxiety affect the body? What anxiety does to your body when expereincing a panic attack? What is the best treatment for panic disorder Links To Things I Talk About: Overcoming Anxiety and Panic Online Course Natasha's Parenting Survival Online Program www.ATparentingsurvivalschool.com Natasha's instagram @atparentingsurvival ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). This is Your Anxiety Toolkit - Episode 302. Welcome back, everybody. Today, we are talking about a question I get asked very commonly: Are panic attacks dangerous? Now I get this question a lot from clients who are just starting treatment. However, I will say I do get this question a lot on social media. People like doing the last-minute panic DM. What's happened usually is they've experienced a panic attack or an anxiety attack, and then they have the thought, what if this panic attack is dangerous? What if this panic attack creates some illness in my body or is unhealthy for my body or unhealthy for my baby, if they're pregnant. And so, from there, now they're having anxiety about their anxiety and, as you guys know, then anxiety just takes off from there. So, I wanted to address this with you first. I've got a series of questions that I want to go through here with you. I will be looking a little bit at my notes because I wanted to make sure I got everything today. Before we do that, let's first do the "I did a hard thing" segment. This is a segment where you guys write into me and tell me the hard things that you've been doing – facing your fears, staring your fear in the face, or maybe it's something not related to fear. It's just something that you've been going through. So, go ahead and submit those to me anytime you would like. Let's go over. This one is amazing. It says: "Honestly, Kimberley, you have changed my life in the last two weeks. I was in such a low place and coming across your podcast gave me so much power. I even faced my fear of heights last weekend and I went bungee jumping." Love it. "That was frightening. And as I was falling, I screamed F-U-C-K," but they said it in real life, excuse the language. "And I just thought, if I can do this, which is honestly terrifying, I can stop my mental rituals that are just so hard and scary." This message is so good and it's exactly the epitome of the work that we do and you do, which is when we face our fear, we realize how strong we actually are. And then we go on to face our fears again, which helps us to feel even more strong and courageous, which makes us do even harder things. And from there, our life turns away from getting smaller and smaller to getting bigger and bigger. So, I love this. All right, let's get to the show. So, we really want to pull apart, are panic attacks dangerous? But what's interesting about this is, often when we talk about panic attacks, people start to talk about what's called an anxiety attack. So, let's first just pause and really talk about what is what. So, what is the difference between a panic attack and an anxiety attack? Let's just go through that first so that we all know we're talking about the same thing. What Is The Difference Between A Panic Attack And An Anxiety Attack? A panic attack or panic disorder is a disorder that is in the DSM, which is the Diagnostic Statistical Manual of Mental Disorders. That's what we use to diagnose people. It usually involves a sudden onset of panic. It can last for minutes, sometimes longer than that or hours. For some people who are really struggling, it usually involves shaking or trembling or it may be heat flashing, hot flashes through your body. Some people experience a sense of detachment from their body. They may experience dizziness, sweating, heart pounding, maybe depersonalization and derealization, which we have episodes on if you want to go back and listen, trembling, sweating, weakness, feeling of extreme terror. Some people have numbness in their hands and feet, again, which is why they then question, is this dangerous? You can imagine, if you're having any of these symptoms, it's terrifying. It's terrifying. But once we really get educated about what that is, then we can actually work with it. Now, as I said, when it comes to having panic disorder, you need to have had at least one of those panic attacks. And then that's usually followed by one month or more of the person then fearing having another panic attack. And that can actually lead to some people having panic disorder with agoraphobia. Some have it with agoraphobia, which is where you feel like you can't leave the house, and some do not. So then the other part of this question is, what about an anxiety attack? Now, here's the thing to remember. I asked quite a few clinicians, what do you think the difference between these is? And I actually got a ton of different answers, which I know isn't super helpful for you guys, but some just basically said, "I don't consider them any different at all." Others said, yes, there is a difference in that an anxiety attack isn't usually a disorder of its own, and it's usually in relation to an actual threat. So, let's say, panic disorder is very sudden, it's often irrational, but not always. And so, it's coming on very strong out of nowhere. However, an anxiety attack often gradually builds. It can last for several months. It can cause restlessness, sleep issues, fatigue, muscle, tension, and irritability. That though can all show up with panic disorder as well, but the main key thing that a lot of clinicians, and I've done some research online, is some people believe that it's about what the trigger is. So, with an anxiety attack, if the trigger is an actual threat, like there is a dog running towards you and it's going to bite you, or there is an actual threat in your society, a gun or weather issues, extreme weather, that that would be a trigger that would cause an anxiety attack and that's how you would separate them. Now, for the sake of today, I'm going to use them interchangeably. Whether it's from a current stressor in your life that is actually a danger or whether it's panic disorder in that it's just sudden and out of the blue or related to a specific fear or phobia you have, I'm going to talk about them as if they're the same, given that their symptoms are often the same. And really, what I want to look at today is about whether these symptoms are dangerous or not. What Is The Prevalence Of Panic Disorder? Before we move on, let me quickly give you a little prevalence here, because I just wanted to normalize if you're having panic, and I'm going to read directly here. The National Institute of Mental Health reports that approximately 2.7% of the adult population in the United States experience panic disorder each year. That's pretty big. They went on to say, approximately 44.8% of those individuals experience a panic disorder that is classified as severe. Now, I think that's actually really interesting because anyone who's had a panic attack is going to say it's severe because a panic attack is 10 out of 10. So, I think that that's actually-- I'm surprised. I would be surprised if it's actually not way more than that. But what I'm guessing they're also talking about here is the degree in which it impacts their functioning. Because a panic attack in and of itself, and we'll talk about this here in a second, isn't a problem. What can get in the way is it starts to make your life very, very small and can impact your functioning, your ability to have conversations, interact with people, go to work, go to school, sleep, eat, and so forth. So, really important that you get those points. Are Anxiety Attacks And Panic Attacks Dangerous? But then we want to move over to: Are these anxiety and panic attacks dangerous? So, let's talk about that. Let's look at those symptoms – chest pain, hot flashes, dizziness, pounding heart. Often when we experience those symptoms, we would make the assumption that something is terribly wrong with our body and we better get to the hospital pretty quick. Chest pain – what do you see often on advertisements and so forth? You can imagine, when you have those sensations, it makes complete sense that your brain is going to set off the alarm. I do encourage you all, if you've had these symptoms, go and see a doctor, explain to them what happened and have them do a check on you so that you are really clear that what you're experiencing is a panic disorder or a panic attack or an anxiety attack. We all know the common TV show where they get rushed to the hospital and they're having a heart attack. And then the doctor, in a comedic way, says, "You're having a panic attack. It's common." It is true. Statistics show it. I think this is correct that the most admissions into an ER is panic attacks. Isn't that so fascinating? So, it makes sense that people are afraid. But once you've had that clearance and I do encourage you to get clearance and just speak with your doctor always about that stuff, and if they've defined like you're having a panic attack, then your job is actually, when you have those sensations, to not respond to them as if they are threats. If you respond to them as if they're threats, you're going to create more panic. We've got a whole ton of other episodes out about panic, so I'm not going to talk about too much there. But what I want to talk about is, are they dangerous? And the same goes for anxiety attacks. What I'm going to tell you once and once only is, no, they're not dangerous. Our body can withstand all of these symptoms many, many times. Lots of people who've been through very difficult times or had panic disorder can go on to live wonderful, healthy lives. But here is where I want to maybe address the elephant in the room. If you don't follow me already, there is a chance you found this podcast because you saw the title and you were like, "Oh yes, I want to know if they're dangerous." And once you listen, you may actually feel compelled to come back and listen to this episode again and again to reassure yourself that they're not. If that is the case, I'm going to strongly encourage you not to keep listening after you've listened to the first time. Let me give you some information about that. When I see a patient for the first time, I do a lot of psychoeducation. I share with them, these are common sensations, this is normal if you've got panic. If you have these sensations, we're going to treat them like we would treat panic symptoms. I would educate them if they're concerned about the dangerousness. But then I would say to them, after today, we're actually not going to keep revisiting these questions because what will happen is, the more you tend to these questions, the more you actually be fueling your panic disorder. Anytime you respond in a way that's urgent and need to reduce your anxiety or your uncertainty, the chances are, you're making the anxiety worse. So, I want to give you permission to go and see your doctor. I want you to get permission to share all of the details that you're experiencing. Then I want you to give yourself permission to have your panic attacks without trying to solve whether they're dangerous or not. Not tending to all of this, because the truth is, number one, nobody knows, number two, even I don't know for certain, for every different person, and number three, the more you try and solve it, the more that you're putting too much attention on this question that can actually keep you stuck in the cycle. How Does Anxiety Affect The Body? Once we look at that, and that's probably as far as I would go with my patients as well in terms of addressing that, often people have questions like, well, then what's the impact of anxiety on my body? How does anxiety affect my body? How does panic impact my body? And again, I want to tread very gently because you deserve to have some psychoeducation about that, but we also want to be careful that we don't spend too much time, again, tending to fears about what anxiety is doing to our body. Remember here, a lot of anxiety disorders is ultimately the fear of fear itself. Even though the content might be on something specific, it's usually our resistance to having fear and experiencing fear and doing so without response or reaction. So, does it impact the body? Yes and no. Meaning it does tend to make us increase sleep struggles. It makes it difficult to eat. There are many impacts that it can have on the body. But again, catch – the question, how does it impact my body – if that's actually you saying, is this dangerous? Think of it this way. When we ask questions and we pose questions to our mind, the words we choose and the emphasis we ask them can actually create more anxiety. If we say, "That's so dangerous, we shouldn't be doing that," it's true of anything. When you label anything as good and bad, you actually increase your resistance and your wrestle with it. If you say something is bad, you're going to have anxiety about it next time. And so, what we want to look at here is, yes, it does impact our body in terms of it's exhausting and it creates struggles without regular functioning. So then what I would encourage you to do, instead of tending to back and forward on, is this anxiety good or bad for my body, what does it do to my body, does this anxiety impact my body in a healthy way – instead, put your attention on, what will help me overcome this anxiety in the long term? Anytime we ask for the short term, we're always going to do something that's a safety behavior or a compulsion, an avoidant behavior, a reassurance-seeking behavior. So, just keep asking yourself, what will help me in the long term overcome this fear? And often that involves not ruminating about whether it will be dangerous or not because when we ruminate, we get stuck. And when we get stuck, it makes the fears look bigger. Isn't it interesting, and I'm going to call myself out here, in that in my attempt to address the question, are panic attacks dangerous, my advice or my encouragement to you is to practice not trying to solve that question, i not giving attention to that question. Yes, you can get basic psychoeducation or you can go to your doctor and get a checkup, but anything beyond there, you're always, and hear me if you can, if you can take one thing away from today's episode, is really remember that anxiety is about willingness to tolerate discomfort and it's about your willingness to be uncertain, especially if you have disorders like panic disorder, OCD, phobia, social anxiety, generalized anxiety. It's almost always going to be, can I be uncertain? How can I be more uncertain? How can I practice riding the waves of uncertainty? And that's very much the case with this specific question. So, I hope that is helpful. Again, catch your urgency to listen to this over and over and do your best to acknowledge the thought that you're having, treat it like a thought and not a fact, and then move on into the things that actually bring you value into your life because that is what recovery looks like. Thank you so much for being here with me today. I am honored to have this special time with you. I hope that was helpful. Do please remember, it is a beautiful day to do hard things because this work is hard, but it is done in effort to really serve and nurture the future you. Even though it's hard right now, we're really tending to the wellness of the future you when we take on these really difficult concepts Have a wonderful day, everybody, and I will see you next week.

Sep 9, 2022

This is Your Anxiety Toolkit - Episode 301. Managing OCD Relapse (with Jazzmin Johnson) Welcome back, everybody. I am covered in goosebumps. I literally, as we speak, just finished the recording of this episode. I wanted to come on and do the intro right away just because I'm so moved by this week's guest. This week, we had Jazzmin Johnson. She's a mental health advocate and she came on to talk about something she felt really, really passionate about, which is relapse, particularly related to relapse with anxiety disorders, even more particular and specific is with OCD. And she brought to the conversation the same struggles that I have seen my patients have over and over with relapse and how hard we can be on ourselves when we relapse and how difficult it can be to pull ourselves out of relapse. It's a topic that I haven't touched on nearly enough. And so, I'm just so grateful for her to come on and share her story and the steps she took to overcome any kind of relapse that she was experiencing, and identifying the difference between a lapse and a relapse I thought was really profound. I'm just so excited to share this episode with you. I actually had scheduled it to be out much later and I'm like, "No, no, no, we just have to get this out. This is so, so important." So, I'm so thrilled. I'm not even going to do an "I did a hard thing" because this whole episode is Jazzmin explaining to us how to do hard things. So, I'm again impressed with how she's handled it. So, let's get straight to the show. I love you guys. I hope you can squeeze every ounce of goodness out of this episode. I think the main real message we took away is it's a beautiful day to do hard things. So, enjoy the show. Kimberley: Welcome, everybody. I am so excited to have a special guest on the show that I've actually been wanting. We've been talking back and forth. I'm so excited to have Jazzmin Johnson on today. Thank you for being here, Jazzmin. Jazzmin: Thank you so much. I'm absolutely honored and really, really excited to chat. Can OCD Relapse? Kimberley: Yeah. So, let's dive in. We are going to talk about relapse, which is a topic I think you brought to my attention. I have not covered barely at all. So, let's dive into that. But before we do that, can you give us a little background and fill us in up to where we're at with relapse? Can OCD Relapse? Jazzmin: Yeah, absolutely. So, my name is Jazzmin. I'm 28 years old. I was diagnosed with OCD when I was just freshly 23. So, it's been a while. Looking back on my life, I've had OCD for a very long time, long before I was 23. So, definitely fun to look back on your life and the moments and say, "Oh, that was an interesting behavior and no one really caught that." My story is I always love to tell it, but it started off with a really simple night of not sleeping, something that we think we've all experienced. And up until that point, I had assumed I was this rock-solid girl who was tough and I skateboarded on the weekends and just knew that nothing could touch me. And I remember having a hard night of sleep one night and my heart was beating really fast and I just felt really panicky. It was such a bizarre feeling for me. I remember at the time reaching out to my sister who also struggles with anxiety and OCD as well, and I just said, "Hey, have you ever dealt with this weird heart palpitation thing at night and you can't relax?" And she just sent me a text in all caps and was like, "Yes, that's anxiety." And I think it was just this bonding moment where we were just like, "Oh, okay, I guess I'm like you like. Let's do this." But with that I think came a lot of fear too, because as someone who was assuming I was this rock-solid gal, who was tough and never stressed about anything, to have that identity switch that happened when I was told that I might have anxiety. As all of us know, listen to this, anxiety is a terrible feeling and it's even harder when it really sticks around for a long time. I remember feeling like my body was buzzing all the time and I remember trying to explain it to my boyfriend and he was just like, "That's really strange." And I'm like, "You don't understand. My whole body feels like it's vibrating all the time and I just couldn't sleep at night." And so, I ended up reaching out to my mom and she helped me find a therapist, which I'm really grateful that my family is really pro helping people with mental health disorders. So, they knew exactly how to help me. So, I popped in with a therapist and was just like, "I don't have anxiety. Why am I having anxiety? What's going on?" And she just asked me if there were things that made me anxious. And I just remember telling her, "No, there's no reason. My life is really good. I really enjoy where I'm at and I love my job and I love my boyfriend and I love my life. So, why am I feeling this way?" And she just said, "Well, have you talked to anybody about it?" And I remember telling her, "Yeah, my mom and my sister, and they've told me the things that make them anxious." And so, now when I think about those things, I plan to be anxious in those scenarios too. And I just told her I was having a hard time figuring out what was causing this anxiety. And she just said-- I will remember these words forever because they started everything for me. But she said, "Maybe you just need to find yourself in all of this." And so, I went home and was just like, "What does that even mean, how do you find yourself?" I was so lost. And at the time, I was thinking, okay, I'm 23 years old. What do I need to do? Do I need to eat, pray, love, and go to Italy and dump my boyfriend? And then that's when that thought popped in my head. And I thought, what if I need to leave my boyfriend in order to not feel anxious anymore? And of course, that terrified me at the time. I'd been with my boyfriend for five years. We were high school sweethearts. I knew in my bones I would marry him one day. And the idea that the only way out of how I was feeling was to lose something that I really valued was just life-shattering. And so, I just spent so much time thinking to myself, no, that can't be it. But OCD is the doubting disorder and I just hated this idea that what if that was the key to it all and it was something I didn't want to do. And so, I fought it and I probably struggled with that thought for another three or four months. I spent every day thinking about it the first time I woke up in the morning. And it got to a point where my body and my brain was trying really hard to convince me to leave because it wanted this relief from this anxiety. So, I was almost trying to convince myself and arguing with my mind on why I need to leave. And it would jump from maybe I didn't like the way he looked or he has a mustache this week and I don't like mustaches, so maybe I need to leave. Or his jokes are really bad. I can't be with someone whose jokes are bad. I mean, it's almost comical to the point where the things that my brain was trying to do to get me out of this scenario that felt like anxiety was ruling at all. I remember going to therapy every week, and my therapist just said, "You've been talking about this for a long time and it sounds like you might be struggling with some obsessive thinking, and it might be OCD." And that crushed me because at the time, I thought of OCD as flicking light, switches on and off, and I did not know what it was and that it could look different. So, I just got really scared and she just said, "Nope, we're going to work through this. You're going to be fine." And so, we did my first exposure in that appointment and it was absolutely horrible and it was so hard, but we sat down and we mapped out what my life would look like for the next five years if I chose to leave. My life looked great. I was like, "I would move. I would go to LA and become a fashion designer," whatever I was into at the time. And she was like, "You'd probably be okay. So, why is this so scary to you?" And I just told her, "I just don't like this feeling of losing agency over my choices and feeling like anxiety was making those choices for me." And that really made me spiral into a bit of a depression and just really struggled with feeling like I could do anything really. My therapist and I, we talked and I was prescribed antidepressant, which I owe my life to because that antidepressant gave me the strength to stand up against OCD for the first time in my life. And so, I started and I started just diving into the OCD community and listening to stories online, reading about it. Not just reading about people that were struggling, but people that had made it out or had worked through it and were doing really well. I just loved listening to specifically Stuart Ralph's The OCD Stories podcast and your podcast really. I just loved hearing people's stories about OCD, because I would listen to it on my way to and from work on my hour-long commute. And I would always smile when I was listening to these people's poor traumatic stories, just because I could hear how different our obsessions were, yet we were all doing the same thing. There were so many similarities that I heard and I just felt such a sense of community and belonging. And so, I just really dove into that and was like, "Hey, let's talk about this. Now, why isn't anyone talking about relationship, anxiety, and relationship OCD?" I reached out to Stuart Ralph and he let me post a little blurb on his website about what I was going through and that started my advocacy journey. And so, now I just float through life and deal with what it throws at me. And of course, I struggle at times. OCD will always stick around, but I try really hard to always have all of my social media channels open for people that just want to talk. And I find that's just such a good space to have for people when they just need someone to understand. So, that's a brief, little rundown of my life with OCD so far. Kimberley: I had goosebumps for quite a bit of that. It's just like it gives me the chills in the best way and that you've gotten through so many bumps and windy corners and stuff. Then we come to here now. So, you've got this progression, this windy story and you arrive. And obviously, you're doing pretty well. Tell me about this idea of relapse and what that means to you. How to Deal with OCD Relapse Jazzmin: Yeah. So, I look at lapses and relapses, in my opinion, a little differently. So, of course, in my journey, I had a few lapses. There were things that life happens and stress trauma happens. A few instances, I was really unfortunate to be in a space at my work where someone chose to take their life. And I was not at work, but I walked in about two minutes after it happened, because it happened at my work. I didn't see anything, but just the feelings of the people around me just was really traumatic. And so, my OCD latched onto that for a while and that sense of safety that I felt and the fear of being in another instance or something else that would be traumatic. And of course, there's been other moments in my life where really wild, crazy things have happened. And my OCD does always find something to latch onto for a short while. But usually, I'm able to notice a behavior and feel like, "Oh, that feels familiar. Uh-oh, I think I might be stuck again," and then I can usually spot it. But this last spring, I had a bit of a relapse and I call it a relapse more than a lapse because it looped back into my old themes that I had worked through a lot. And it lasted for a really long time. And I really had a hard time finding that kind of pathway out. I couldn't really find where on the cycle, the OCD cycle I was to where I could see where to get out. And so, at the time, I looked at relapses as failure and I think that's one thing I really wanted to talk about. But I imagined that since I had come so far in my recovery, that when OCD shows its face again, I would know that it was OCD. I would see it and I'd be ready and I'd have my warrior gear on and I'd fight it and I'd carry on with my life. I think this last spring, just with the chaos that happened in my life, I learned that that's not always the case. And sometimes it takes a little bit longer. But also, I think it always unlocks new layers to your recovery journey and healing that I think I needed to learn. So, I'm really grateful that it happened, which is so funny. I wish I could tell myself that four months ago and I was really in the thick of it, but yeah, I'm really grateful that I had that experience. OCD Relapse Story…or is that not the right wording? Kimberley: Why do you think-- because I really resonate with what you're saying and I think I've had, even in the last couple of weeks, some clients who've come back to treatment after doing really well with ERP and therapy. Can you tell us your OCD relapse story? Why do you think we consider it a failure to relapse? Where did that come from, do you think? Jazzmin: I think for me, I hear a lot about in the OCD community of just this idea of being fighters and warriors and we're going into this battle. And once you've won the battle once, you feel not untouchable, but you just have that upper hand. And I think with every new theme that it throws at you, which it always will, it's something new and it might take longer to recognize that, oh, this is the same thing. But for me, it felt like I was just losing a game, losing a battle, and that I knew how to fight. And I always would use this metaphor with my therapist that I felt like I had my toolkit with all of the things I had learned over the years, all of the exposures I can do and scripts and stuff I can write, but it felt like it was in a toolbox that was locked. Like I had to find the key before I could get to that toolbox. And when you're feeling so terrible, you're frantically searching to find that specific key. And I just found myself fumbling. And so, I think that idea of failure comes from just knowing better too. I felt like I knew better. I know what OCD looks like. I know this cycle like the back of my hand, yet, somehow it sneaks into my life again. I don't realize it until either it's too late and I've been doing compulsions for months maybe. And that is always a real letdown just in your personal self-esteem, and your idea of where you were in recovery can sometimes shift. And that's scary because you think you're through it or you're better than that or that you know better. And then to find out maybe you were wrong, it's really hard to sit with. Kimberley: Yeah. It's an interesting reframe, isn't it? We think of being a fighter and getting through it as if you won the battle and the battle is over. It can be a massive dent to your self-esteem would you say? Or tell me a little bit about, did it shift your perspective of yourself being a fighter for a while or were you able to be like, "No, no, this is the work"? How was that feel? Jazzmin: I think it's a little different for me because at the time, I really considered myself an advocate. And I felt as an advocate, I guide other people and I help them through these things. And I remember a really specific moment with my husband after we had just met my baby niece for the first time. And the entire time we were visiting her, I was having intrusive thoughts probably every second and it was jumping themes. It was harm and then pedophilia and then harm again and harming myself. And I remember getting in the car with him as we left and just crying. And he just was like, "What's going on? Talk to me." And I just told him, "I'm so tired. I know what this is. I had those thoughts. I knew they were OCD. I knew the moment they showed their face, because why would I ever want to do that to my beautiful baby niece?" And yet, they still made me anxious. And I had made the story to myself that if an intrusive thought made me anxious, I'd already lost. So, my reaction to it was the first thing I could control. And when you get thrown a new theme, it knocks you down because you've never seen it before and it's scary. I just remember crying to him and just explaining, "I am so frustrated with myself because I know what this is. I know what I'm doing and I can almost step outside of myself and see the cycle. I can draw it on a piece of paper. In fact, I did that often, and yet I couldn't stop." It was just a lot of disappointment in myself. I think as an advocate, you feel like you should know better and I helped people through this. In fact, there were times when I was in that relapse that people reached out to me for help. And I strapped on my booth and helped them and walked, talked them through it all and found them therapists and then was like, "Why can't I do that for myself? Why am I so good at helping others and not giving myself the tools that I know are sitting right in front of me?" Kimberley: Yeah. I thought it was really interesting. You said like you were mad at yourself, or maybe I didn't use that word correctly, for having anxiety about your thoughts. Oh my God, when did the expectations get so high? What are your thoughts about that? Jazzmin: I have no idea. It's so funny too, because when I look back on the themes that I've always had, it's always been around feeling anxiety. I have a fear of feeling anxiety. And that first thing I had was, maybe this will get rid of my anxiety. So, all of my obsessions were what's the key to get rid of it. In fact, I often have an intrusive thought to this day that maybe my anxiety disorder is caused by the fact that I have hair and I need to shave my head to not feeling anxious anymore. And I have the best hair. I love my haircut. I have the best hair stylist, so I'm just like, "No, I don't want to shave my head." Kimberley: You don't want to go all Britney Spears on yourself. Jazzmin: No. But it's so funny to me how that works and the way-- yeah, I lost my train of thought there because we were laughing about Britney Spears, but-- Kimberley: But no, I think going back to what I was saying is I think you're right. I think that we judge ourselves based on whether we're anxious about something, like, "Oh, I shouldn't be anxious about that." But that's just our brain doing its thing. Jazzmin: I was holding a newborn baby that I was related to for the first time in my whole life. Of course, I'm going to be terrified. I'm going to throw her against the wall. That's a normal thing to feel really anxious about. But I think also when you're in recovery, there's a certain acceptance you have with anxiety. You learn that anxiety is going to be a part of my life and I'm going to accept it. And I'd always thought that I had done that. And then I remember doing ERP School this last spring. And you mentioned something about, I believe it's willingness versus willfulness. Is that what it is? Kimberley: Yeah. Jazzmin: And I remember feeling angry with you when you mentioned that because I knew you were right. And I was like, "No," because that was that missing piece that I had yet to figure out. I was always like, "Yeah, I get that I'll have to feel anxious sometimes in my life. But I'm only feeling anxious and allowing myself to feel anxious because I hope that that will be the key to get rid of it." So, it was just, that was always the way out. And for the first time, I had to realize that while I was allowing anxiety to happen, I wasn't really welcoming it in a way. And so, that was what unlocked that little portion in my head. Kimberley: Okay. So, I just have a question. The therapist/educator in me is like, tell me more – you obviously took ERP School – what is it about? And I'm so happy that that was helpful. But I want to know, because you're not alone. I love knowing when things make people mad because it means there's a roadblock there. There's a common human roadblock that we all get to. So, what about that made you mad? I'm so curious. Jazzmin: Yeah. I think in all honesty, it was a little bit of resistance because it was like, I knew that that was that next step and I really didn't want to do that. Everything that I've ever done was to get rid of my anxiety. Even my OCD, all of my research, and all of the exposures that I worked on was only to get rid of that anxiety. And at the beginning of every video, you talked about, you said, "Hey, if that's your goal, let's reframe that." And I was just like, "How do I do that? How does someone want to feel anxious?" I just really struggled with understanding how-- it's such a terrible feeling. I hate it so much. How am I supposed to be happy to experience that? And I wasn't sure how to connect those two. I also was always looking for someone to just tell me how, like to give me steps and just say, "Hey, this is how you become willing to be anxious, or the willfulness, this is how you do it." I remember talking to my therapist about it and I just said, "Kimberley was talking about this, and can you just tell me how to do that?" I was like, "How do I lean in? Is that something I should just tell myself? Is it something I need to write down?" And she just said, "I think it's not something I can tell you. I think it's a little more abstract than that." And I just said, "Okay. So, you can't give me a step-by-step on how to get out of this," because that's how I am. And she just said, "No, I think it's a feeling." It scared me more than it made me angry. And I think that's why it made me angry because I knew that that was what I needed to do. So, that anger really comes from fear of just knowing what's next and what I need to do. And it's something I think I've put off for a very long time. Kimberley: Yeah. Listen, this week alone, I've had multiple of these conversations with my clients. I think it's such a common roadblock for everybody. Like how often people who have recovered said, "When I stopped trying to not be anxious is when I actually got relief from my anxiety." And it's like what you resist, persist, is always this sort of thing. Jazzmin: Absolutely. Kimberley: I love that you told me that. Number one, I'm terrible. I always giggle when people say that my stuff made them mad because I'm like, "What happened?" But I think it's such an important point, right? It's such an important piece of the work. So, how would you encourage people to manage relapse or lapse? Jazzmin: Yeah, I think I was really lucky to have my sister by my side through this relapse, especially if someone who understands OCD. And encouragement was a huge thing in having a support system because I had my husband, I had my sister, I have grown a community on Instagram of people that know I have OCD and I don't shy away from putting on my Instagram like, "I'm relapsing right now. Give me a minute. Let me figure this out." And my comments are always flooded with like, "You got this. We believe in you. Hang in there if you need anything." And so, I think that was a huge part of that healing for me, was just the support. But I also think there's a huge part about self-compassion that fits into this, about allowing yourself the opportunity to stumble. And I think it gives us its humanity. We're going to fall and we're going to trip and that's going to happen. And also, life is not perfectly straight and boring where nothing bad ever happens. That's what makes life exciting. So, I think there's a big self-compassion piece to it all of just allowing yourself to be wherever you are. Kimberley: Is the self-compassion piece the work you'd, like you'd said, sometimes when we relapse? And I've had these conversations. It's like, "Oh, there's a layer of your therapy that you hadn't done, or that this is a good thing for your long-term recovery." Was the self-compassion work you had previously done or did you have to take on the self-compassion once you realized you had relapsed? Jazzmin: Self-compassion was not at all a part of my previous healing and it was something that I was really missing. I bought your book too, The Self-Compassion Workbook. I wrote through when I was on an airplane ride once. And again, it also made me frustrated because I remember you had me write like how I felt about me if my OCD was flaring up or what I thought to myself about the fact that these intrusive thoughts were present. And all of the things that I wrote were really nasty about myself like, "Why are you thinking that? Even if I know everyone has intrusive thoughts, people don't have those ones or they don't make them feel the way that mine make me feel. So, I'm not strong enough or I'm not doing well enough or I'm not as well as I thought I was." And so, self-compassion was that layer of my healing that I don't think I had reached yet but I think I really needed because again, I think I have that tough girl mentality and I want to be strong for everybody. And when it comes to doing that for myself, I fall short. So, I think it was really helpful to just learn, to give myself grace and to watch the way that I was speaking to myself when I was struggling and allowing myself to struggle, allowing myself to feel bad because that's life. Kimberley: Yeah. I love that you had support. I love that you had those people cheering you on, like clapping their hands, "You can do this." What would you encourage people to do if they didn't have that support? And in the same question, were you able to start to have that voice? Where you were like, "I can do it" and have that kind of coaching voice as well? Or was that not a part of your experience? Jazzmin: So, I think if anyone doesn't have that support, the first thing I would encourage them to do was to find the community online because that's how I mostly got that sport in the beginning, was just finding people that were struggling in a similar way. But also, I think a huge part of that self-compassion in your voice is to be that voice for yourself and to be an advocate for yourself in those moments. And so, yeah, I think there's a part of just doing it for yourself in a way. And there was a second part of that question you asked. Kimberley: No, no, you answered it beautifully, because I think that is a piece of it too, is I have found for myself and I could be-- you may not feel this at all or the listeners may not feel this at all, but a huge part of my self-compassion journey was instead of going to other people to cheer me on, I had to learn to do it myself. Not to say you don't deserve to go and get it. It's not a problem if they cheer you on, that's not a problem at all, but that was a huge piece of it. And I try to practice that with my patients as well, like can you cheer yourself on just a little, can you reframe that you're strong while you suffer kind of thing. I think there's so many reframes that we can make. Jazzmin: Yeah, absolutely. And I think back to the things that I did to encourage myself and I remembered one thing that I did is, I would have a full day of negative thoughts and negative intrusive thoughts and really struggling. And then maybe for two minutes out of that day, I would feel this overcome of like, "Hey, I got this. Wait a minute, I can do this." And I'd always snap a selfie when I was feeling that. And so, over the course of this relapse, I have tons of these selfies and some of them I'm crying in and some of them I'm in the coffee shop or I'm in my car. And when I was really feeling down, I'd look back on that and I'd be like, "Hey, that's the version of me that's cheering me on right now." And I would look back on those photos all the time and be like, "Hey, yesterday at 2:04 PM, I felt okay for a minute." And even if it was just a minute, I'm going to trust that girl right there, because that's who I am. Kimberley: Wow. That's so cool. I love that. I've never heard that before. What an amazing way to capture you in that moment. I love that so much. Jazzmin: I think I put it in my phone, in my folders as reminders of hope. And I would look at those pictures whenever I needed it because I think seeing proof that you were there at one point too, it's like, that was me and I could be there again. Kimberley: I love that so much. I actually think that that's a piece of the tool belt or the toolkit that we need to have more of, like how can you remind yourself that you're in the game and you're doing the game. I love that so much. I remember many months ago, I did a podcast with Laura. I can link it in the show notes. She talked about, she did a collage of photos of her doing her exposures, even though she's crying or even though-- and I just think that's it, right? Just to remind ourselves that we've been there and we've gotten through it is so huge. This goes back to the very beginning, but how do you-- is there a difference in how you respond depending on whether it's a lapse, your version of a lapse or a relapse? For you, is the response and the tools you use the same or is it different? Jazzmin: I think for me the tools are about the same. I would almost say I use less tools in my lapses and that's always what causes them. So, I relax into this anxiety that I'm feeling and I let my guard down maybe a little bit and I start doing something. But generally, the way that I spot myself out of those cycles is to-- I quite literally will map out. I'm like, "What thought just made me anxious, and then what was my initial-- what did I feel like I needed to do to make myself feel better?" And then once I could take that step back, I could see what was going on. And I think my relapse was a little bit different because it reached that core fear of mine about feeling anxious forever or feeling like I wasn't going to get rid of it. And so, I think it was a little harder to find that exit of that loop because it was something that I was so deeply engraved in my being that I've had for so long that I don't think I ever really looked at. I always treated the surface of my obsessions and never really realized what is the core of this. It's feeling anxious. It's just this fear of anxiety. Kimberley: Yeah. And how are you doing now? Can you give me a realistic description on how to recover with OCD Relapse? How to recover from OCD relapse Jazzmin: Yeah. I would say I'm doing really good right now. I'm actually 16 weeks pregnant. We found out we were pregnant back in May. And so, pregnancy is one big exposure because as someone who doesn't like not knowing the future and is not great with uncomfortable sensations, that is pretty much all this pregnancy has been. But I remember explaining to a friend like sometimes when you're pregnant, at least for me, I'll just have these waves of sadness. Nothing is making me sad. I'm actually having the best day ever, and I'll just have to go cry really hard for 10 or 20 minutes. And I was thinking to myself, this is something a couple years ago that would really scare me. I'd be really fearful of these feelings. And I have just come so far in my journey with anxiety and OCD that when I feel that way, I just surrender to it and I say, "Hey, babe, I'm going to go upstairs. Give me 10 minutes." And I'll just go hang out in the bathroom and let it out and wipe my tears away and just allow that I'm going to feel that way sometimes and it's okay and I think so. So, right now, I'm doing really well and navigating, of course, pregnancy as much as I can as it's super new. And of course, I have a lot of fears about being a mother and when those intrusive thoughts will show their face again, when I'm holding my baby, which I'm sure they will. But I'm really leaning into this idea that the version of me that will make it through that will be born in that moment. So, there's nothing I can really do right now to make that intrusive thought not stick as much when it happens. All I can do is just trust that when it happens, if it happens in that moment, I'll gain whatever resilience I need to work through it. And there's a lot of self-trust that comes into that. And really trusting that I've got this and who knows, maybe I'll stumble and I am fully allowing myself the opportunity to do that. So, I think that's just been a big part of this journey for me, is allowing the unknown to just exist. Kimberley: I love what you're just saying. In fact, I have had clients who've actually written invitations to OCD like, "I welcome you to my baby's birth," or "I welcome you to my wedding," and so forth. And so, I think that this is beautiful in sort of an insurance policy for relapses to say, "I'm inviting you to this big event," which is what you're doing. Jazzmin: Yeah. It's like, "Let's join me. I know you're a part of my life and I want to see what are you going to throw at me. Let's do this." Almost like, "Let's do this together. It's not a fight and I don't want you to go away, but I'm curious to see what you're going to bring to the table and I'm looking forward to seeing how I handle it, learning whatever I need to learn in that moment." Kimberley: See, you have a lot of willingness. Jazzmin: Now I do. Kimberley: You have got it. I'm so grateful to have you on and to share your story. This is so good. So good. Tell me-- let's just wrap it up with like, okay, someone is in the depth of their relapse, they're the lowest of the low. What words of wisdom do you have for them? Jazzmin: Feel it. I think that's what I would say. I think when you're in those lows, you're always looking for that way out. And of course, naturally, you want a way out. There's no way you want to be there forever. But I think just really leaning into this idea that the only way out is through and just really feel what you're feeling and don't be scared of it, because I think fear really holds us back from a lot of healing. Kimberley: So beautiful. Thank you so much for coming on. Jazzmin: Thank you so much. It's so much fun. And I just want to say, I want to sing your praises for a minute. Your podcast and just you as a person are so kind, and I really found that just your content and just your presence was so comforting in the time of really darkness for me. And I think sometimes when you're going through OCD, you have a lot of people that have that fight mentality and they're like, "You got this. Just go at it, run at it." And you just showed a level of gentleness in approaching that. And that was what really helped me find that self-compassionate voice. So, I just want to thank you from the bottom of my heart for the things that you do and what you do on here. It's incredible. Kimberley: Oh, thank you. I'm covered in goosebumps. I can't tell you-- I say this every time, is when you're here talking to a microphone and no one's there, sometimes you don't really know who you're touching and I just love hearing that. Thank you, because it really means so much to me that I could be there without even knowing that I'm being there. So, it brings me just so-- Jazzmin: Sometimes you just need to know. You need someone to tell you like, "Hey, what you're going through is hard and it's okay that it's hard." And I think that's something you've always done for people, that we can do hard things. Kimberley: We can. It's a beautiful day, right? Jazzmin: Uh-hmm. Kimberley: Thank you, Jazzmin. You have been such an inspiration. If people want to follow you, where can they get ahold of you? Jazzmin: So, my Instagram is where I'm the most vocal. It's Jazzmin Lauren. My name is weird. J-A-Z-Z-M-I-N. I have a jazz musician as a father. And I would say I'm not super vocal on big advocacy stuff on my social media. My goal is just to share my life as someone with OCD. So, my DMs are always open though. If you ever want to reach out and just say hi, or if you want help finding a therapist, I know how to do that and I'm always willing to help. So, yeah, you can find me there. Kimberley: You're amazing. Thank you so much. Jazzmin: Thank you.

Sep 2, 2022

Welcome back, everybody. I am so excited to be here. This is my first recording since returning back from Australia, after having five and a half weeks in Australia with my family and I could not be more thrilled. I had the most incredible time. I tell you, my cup was overflowing by the time I left. My heart was full. I didn't realize that my heart was very empty, even though I have so much love in my life and joy in my life, and in many areas of my life, my cup was so full. But I didn't realize how much my heart needed to go home and actually just live in Australia for five and a half weeks and let my kids learn what it's like to live in Australia and be in Australia. It was so wonderful. I'm just so incredibly grateful to have had that opportunity. That being said, I'm really also very, very sad to be back. However, I am making a choice to love-- how can I say it? Like love all of the parts of my life – the hard parts, the good parts, the easy parts, the parts that still don't make sense to me. I'm making a point to love all the parts and feel all the parts and be gentle with all those parts. And I'm guessing you have some-- well, it may not be that exact experience. I'm guessing there's some part of your life that you have to practice that with as well. And I strongly encourage it because it just opens up an opportunity for compassion and kindness and no more fighting in your mind. It's just like, yes, it's hard being an adult or a human. It's hard, right? But again, it's a beautiful day to do hard things. This week on this episode, I've actually been wanting to do this episode since I left, because this was one that I was almost going to record before I left and I just ran out of time. It's funny, I do a lot of Googling for my job, not for reassurance reasons, but often will type in a keyword just to see who's talking about certain topics and how I can talk about it better with my clients. And often when I type in "intrusive thoughts," you know how in Google, it auto-populates what it thinks you're going to ask? It often asks, is intrusive thoughts normal? Are they normal? And the other one that often comes up is, are intrusive thoughts dangerous? And so, I wanted to talk about that because if that's one of the most Googled questions, well, let's talk about it. Okay, let's talk about it because it's another common. It's the question that we get asked with my staff. I have a private practice. We have 10 amazing therapists. It's probably one of the most common questions people ask on their first session. So, let's talk about it. Okay. So, the first question is, are intrusive thoughts normal? Well, let's first get a feel for what is an intrusive thought. Now an intrusive thought is a thought that is intrusive. Meaning you don't want it. It happens automatically. It just pops into your mind. It's usually repetitive. It's usually distressing. Often it will go completely against your values, but not always. Sometimes it could just be a random benign thought, like if you know, we call them "earwigs" here in America. I don't know what we call them in Australia, but it's like where a commercial or a song just goes over and over in your mind. That's actually technically an intrusive thought as well, even though it may not have the presence of anxiety. But that's what an intrusive thought is, and all humans have intrusive thoughts. They're completely normal. Everyone has them. Even, you may have asked a close friend or a parent or somebody and say, "Hey, I have these intrusive thoughts sometimes, or really bizarre and strange. Do you have them?" And if they say no, I actually don't believe them. What I'm guessing they're actually saying is they have them, but they don't distress them. But they do have them. We all have these thoughts that just randomly pop up in our mind that make absolutely no sense, that have absolutely no relation to what we're doing. So, as you're out to lunch with your friends, you might have this most bizarre thought. That's what our brains do. They come up with some bizarre things, just like sometimes our brains have bizarre dreams. So, when we're talking about this question – the question being, are intrusive thoughts normal – the answer is yes. They're very, very common. Now, the next question that often gets asked is a variation of this question, which is, what intrusive thoughts are normal? And I'm here to tell you all of them, every single one of them. When we talk about normal, we're talking about what is average, what the average human experience is, and all of them are. Now let's actually get straight to the weirdness, shall we? You'll most likely find that you have these intrusive thoughts during the most peculiar times, like when you're making love to somebody or having sexual relations with someone, while you're making a phone call to talk to, or when you're making eye contact with someone. Maybe it's someone your boss, or someone who you normally wouldn't have these thoughts about and you normally wouldn't welcome these thoughts about – that's when you're going to probably have them. When you're on a first date, when you're changing a baby's diaper, when you're handing, let's say, you're working behind a cash register. As you hand the money to the person is when you're likely to have the most bizarre or strange intrusive thought. That's really, really common, so I want to normalize that for you. Now when I use the word "bizarre" or "strange," that still has some judgment to it. So, I want to call myself out on that. Our job is to take judgment out of intrusive thoughts. The reason we often struggle with them is because we tell ourselves, "Oh, there are some thoughts that are good and some thoughts that are bad. And there are some intrusive thoughts that are good. And there are some intrusive thoughts that are bad." And I'm here to tell you, or I'm here to remind you that there is no good or bad thoughts. They're all just thoughts. There is no good or bad scenario in which you can have intrusive thoughts. Meaning it's not bad to have intrusive thoughts during sexual intercourse, because we tell ourselves that, or it's not good or bad to have thoughts when you're with your baby or you're at work with your boss or you're doing homework, thinking about your teacher, or you're thinking about someone you deeply love. There's no right or wrong thoughts to have. They're just thoughts. They're thoughts. They're projections that show up in our brain. The only reason they become a problem is when we frame them as a problem that has to go away. And so, again, the main core message of today is, let's not treat thoughts like problems. Let's not treat the anxiety associated to it as a problem. And I do understand it's painful. I do understand there's a large degree of suffering there, but a lot of the time, the suffering comes from the fact that we've told ourselves, or we've put this expectation on ourselves that there's a right and a wrong way to have intrusive thoughts, or there's a right thought and a wrong thought to experience in your mind. Let's not do that anymore. Let's just let thoughts be like raining cats and dogs down on our mind, and we let it rain and rain, cats, and dogs in whatever form it is. Whatever thought and whatever content it is, we just let it come. Okay? Now, let's look at the other big question that people have that seem to be Googling, which breaks my heart, which is, when do intrusive thoughts become a problem? And I'm here again to tell you they're never a problem. They're never a problem. I don't want you to think about intrusive thoughts or frame them as a problem. Now, let's get a little deep into that though, because it's not as black as white as I'm saying it is. So, if you are someone who experiences intrusive thoughts, which we all do, and yours are associated with a large degree of suffering – anxiety, panic, uncertainty, dread, sadness, grief, like again, raining cats and dogs – it's like you're having intrusive thoughts and then all the emotions, rain, cats, and dogs around you too. Am I right? When you're having that experience, I totally get that that is a large amount of suffering that you experience with the intrusive thoughts. So, again, I don't want you to feel like I'm gaslighting you or diminishing the suffering that you experience around your intrusive thoughts. But we will say that when we get really close and we get the magnifying glass really out and look, when we have the intrusive thought and you have the consequential or resultant anxiety and sadness and suffering, it really only becomes a problem. I don't love the word problem, but I'm just going off the question. When we respond to that thought with criticism and punishment and self-judgment, and we beat ourselves up for having a brain that created and generated thoughts, that's the real problem that I see. So, when do they become a problem? They're not, but they can become a problem if we then beat ourselves up because when we beat ourselves up, now we've got two problems. We've got the suffering of the intrusive thought and we've got now you're beating yourself up and suffering even more. Sometimes when we have those thoughts, we then go on to do other compulsions to try and get rid of those thoughts as if those thoughts were problems. So, we could see where this becomes a loop. If you have a thought and you tell yourself they're wrong and that they're a problem, you're probably going to beat yourself up, which is doubled the suffering. And you're probably going to do some pretty stretching, long painful behaviors to get rid of it, which is adding even more to your suffering. So, what we want to do is if we look at that like it's a cycle, instead of judging and instead of responding with some kind of compulsive safety behavior, we can actually intervene at the thought at the top of this chain of reactions and go, "Okay, I'm having thoughts. I'm allowed to have them. I'm going to have them. Humans have them. They're not a problem. I'm not going to treat them like a problem, even though my whole body wants to treat them like a problem. But I'm going to be really gentle and shift the way I respond from one of being critical and responsive to one of being accepting and compassionate." And the last question here is, are intrusive thoughts dangerous? That's what I consider to be the most extreme framing of an intrusive thought, that thoughts are dangerous. And here I want to say to you, no, thoughts are not dangerous. Thoughts are thoughts. Now, again, let's drop down a little bit deeper and look at this a little closer. You can have thoughts about dangerous things. That's different. Meaning thoughts about unicorns aren't dangerous. We can all agree with that unless you have a specific phobia about unicorns. We can laugh at that, but some people do. It's like some people's thoughts attack many areas in our lives. So, you can have a thought about a unicorn and we can all agree that that's not dangerous. But for some reason, if we had a thought about hurting someone we love or dying, which might have the theme of dangerousness, we then go, "Oh no, that thought is more important because it's about danger. It's more important. My thoughts about what I'm going to have for lunch or my thoughts about will I be late for this meeting, that's not a big deal. But my thoughts about harming people or hurting people or something bad having to myself, well, that's a dangerous thought." No, I'm actually going to say, that's not a dangerous thought. That's a thought about danger. Or if we go a little deeper, it's a thought about a possibility of danger, not even an actual certainty. And so, what I'm really wanting you to do as I walk you through these is to learn to have a different perception of thoughts, and learn to be mindful about the thoughts that we're having. So, instead of having a thought and assuming that your thought is a fact, which thoughts are not facts, instead of doing that, we're going to go, "Oh, I'm having a thought about such and such," or "I'm having thoughts about these thoughts," even to go even more deep into the mindful meta response. So, here is where we shift our reaction, and what I'm going to offer you as I finish up this episode is double down here, if you can, on how you frame thoughts and how you perceive thoughts, and how you respond to thoughts. Make it your agenda for this week, month, or year or decade or life in that you start to practice observing thoughts and without framing them as a problem, dangerous, abnormal, as there's something wrong with you because there's nothing wrong with you. We all have these thoughts. Some of us have more than others, yes, but that still doesn't mean there's something wrong with you. Some have more suffering related to them, absolutely, but I still want to frame that it doesn't make you a faulty, broken human. That's not what this is about. Thoughts do not generate worth. Meaning if you have good thoughts, you have lots of worth, and if you have bad thoughts, you have very little worth. That's not a thing. We just want to go back to thoughts being what gets projected in our mind and not give them all that power. So, that's the pieces that I want you to take. Take as much as you need from today. Some things may feel really true, like I'm speaking directly to you. Some may feel like, "Ah, that doesn't land for me so much." That's okay. Take what you need. Consider what your experience of this conversation was, if you got triggered at some point or you feel really angry at some point or resistant or absolutely wonderful. Sometimes this can actually also start to become a compulsion in that you listen to this over and over to get reassurance that you're not a bad person. So, check with that as well and ponder on it. Take what you need. Learn from it and what you needed to hear today. Before we leave, let's do the "I did a hard thing." This one is short and sweet. This is from Natalie. Natalie said: "I had pre-cancerous cervical cells removed yesterday and I was so anxious, but I did it." So amazing, Natalie. I love this. Now, it's short and sweet, but I actually think that's a really, really hard thing. That takes some courage. So, I'm super, super proud of you for that. You should be so proud of yourself. And then before we finish up, we have a review from Coronacouchpotato, and they said: "Brimming with resources. A friend referred me to this podcast and I am so grateful. I had received more helpful information in the past couple weeks listening to this podcast than I have in the past year or so in therapy. I tell everyone I can about this podcast and how it has changed my life. Thank you, Kim!" Oh my goodness. Coronacouchpotato, I cannot thank you enough for your review. I will tell you a little story. I realized while I was away in Australia that I need to slow down enough to really be connected with the people who I am helping. Sometimes I think I go, go, go so fast, and I have this idea of helping all these people. I actually have to slow down and think about like, wow, it's so cool that Coronacouchpotato and I are doing this together. And Natalie and I, we're doing this together. And for you, even though I'm not saying your name, we're doing this together. Isn't that so cool? Oh my gosh, it's so beautiful. It's so beautiful. And so, thank you, thank you, thank you for allowing me to be on this journey with you. I am honored. Thank you for trusting me. And if you would love to leave a review, I would love to feature it. So, go ahead and do that. All right, folks, have a wonderful day. It is a beautiful day to have all the intrusive thoughts. I'll talk to you next week. Thank you again. Amazing for 300 episodes and I'll talk to you soon.

Aug 26, 2022

This is Your Anxiety Toolkit - Episode 299. Welcome back, everybody. 299, wow. That is amazing. I am so excited. I don't know what it is about the word 99 that just makes me so joyful. One of my favorite episodes is actually number 99, which was the only episode and the only time where I actually have a full conversation with my husband on the podcast, and we talked all about agoraphobia and panic disorder specifically related to flying. So, if you want to hear me and my husband have a good conversation about his experience, that was one of my favorite episodes of all time. But here we are, Episode 299, 200 episodes later, and we're still going strong. No need to slow down. If anything, let's speed it up a little. Shall we? Before we get started on this week's episode, I am going to do the two segments that we do every week. First, I want to give you a little bit of a peek into where we're going today. So, what we're talking about is a question I get all the time, particularly when I'm talking about having a chronic illness. Specifically for those of you who have a chronic illness and have a mental illness as well, but also, this could be just for anyone because this is a human problem, this is not a mental health problem. We're talking about balancing exhaustion and when you have to "push through" and what do you choose? This has been a huge part of the work for me in my recovery from having postural orthostatic tachycardia syndrome. I feel like I've nailed this. To be honest, this is an area that I have learned very, very well, and it has saved my life literally in terms of I would be crashing and burning with tears and a major tantrum if it weren't for my ability to balance, rest and push through. So, let's talk about that in a second. First of all, we're going to do the review of the week. This is from Carsoccer27, and they say: "There are a lot of things that this podcast has helped me with. It's a great toolbox in many of my anxiety triggers. I never knew where to start to help my anxiety. This podcast has helped me find my starting place and has helped me find my self-identity. Highly recommended!" Thank you, Carsoccer27. What a beautiful thing to say. To be honest, for someone to say that I've helped them find their self-identity, that is an amazing compliment. That sounds amazing to me. So, I'm so happy I've been able to walk along you in the journey of that. That's just so cool. Okay. We now have an "I did a hard thing" from Anonymous. Anonymous said: "I did an exposure exercise. I get anxiety when I'm around people. So, it was hard for me to get groceries at the store, but I conquered my fear and got the groceries. And another important one is that I graduated college dealing with what I deal with." Anonymous, I love this. What I love about this the most is you talk about your struggle to get the groceries while also adding graduating college. Two massive things. Two major accomplishments. And I'm so grateful for you that you shared that because I think some people have said to me like, "Groceries, everybody's getting the groceries. I should be able to do that." But I love that you're celebrating how hard that was for you. We all need to do a better job of celebrating when we face a hard thing, whether bigger and small. Okay. So, let's get into the episode. All right. Thank you first for Carsoccer27 and Anonymous. Let's talk about balancing this push and rest. This balance between push and rest. If you could listen to me right now, you could see me. I'm swaying back and forth like a teeter-totter or a seesaw. It is a balancing act. So, let's just get the truth out. Having a mental illness or a medical illness is the most exhausting thing, and people will not get it. They will not get it until they've been through it. They don't understand the degree of exhaustion that you are experiencing. So, I first want to just straight up validate you. It's okay that they don't get it. It doesn't mean that you're not validated and that you aren't as exhausted as you are, because you do have to go through it to get it. So, let's just be real about that. Now, even though you are exhausted, you still are going to have to have times in your life where you have to push through to get stuff done. Anonymous is a great example of this. They push through despite going through anxiety the whole time, just push through, got through college. But what we have to be careful of here is this push through mentality. I'm actually right now reading a book by Ed Mylett and it's called Max Out Your Life . I personally love it. It's so inspirational. And as I'm listening to it on Audible, I'm like, "Yeah, let's max out our life." It's so empowering and I just want to flex my muscles until I'm like, "Wait." The anxious workaholic in me and the perfectionist in me wants to take that literally. And in the past, I have where I'm like, "Yeah, let's max out our life. Let's just push through and just push and push and push." And then as I've said to you in the intro, I collapse and everything goes into a big pile of mush. So, this is where we call it balancing. It's a great idea and yet, it's so empowering to hear that. But it's not healthy to take on a high percentage of push through mentality. So, if you're hearing this on social media and you're reading books about it, listen with a little bit of a skeptical ear. Because you are already exhausted, pushing through more is probably going to tip the scales so that the scales tip over and you don't recover at all. You're actually in big trouble. What we want to do today is we actually want to really learn the art – again, I'm swinging back and forth now – the art of balancing, the push through, and then making sure there's time to rest. So, you do a little bit of a push through, you get through the class or you get the groceries or you pick up your kids or you go to a dinner that you don't want to go to that exhausts you. And then you balance that with rest. Now what I mostly hear my clients say is, "But Kimberley, I shouldn't need to rest for that one thing. Everybody else is fine. I shouldn't need to rest." And this is where I'll often say-- I look at them dead in the eyes. So, imagine I'm looking you dead in the eyes right now and I'll say, "But whether other people are exhausted or not, you are and you have to radically accept it and you have to listen to your body." It's completely not even a calculation we need to take into consideration on how other people are handling it. You are exhausted. That's the fact. And so, we do need to balance this teeter-totter, this seesaw of you push a little and you rest a little, you push a lot and you rest a lot. There'll be times where you push a little and you still have to rest a lot. And that is, you're doing it. The way I think of it is, if I rest enough today, I'll have more energy for tomorrow so I can push through a little tomorrow, because you do. When I say push through, I mean, just get the things you value done. I'm not saying go hard and max out when you're already exhausted. I actually don't think that's super helpful. I've fallen into that trap way too many times. The other thing here is, a lot of times, when we "push through," meaning we have to. We have to show up for our kids and our partner and our boss and our parents and whatever, yourself. So, you've done that. And then when you go to rest, you look at Instagram and you watch some TV. There's nothing wrong with going on Instagram and watching TV at all. I do it myself. But I want you to really just use this. Again, I love to ask questions. So, the question I'm going to ask you is, is that in fact restful? Does that actually fill your cup up, restore you? Because if you're pushing through, you're using up energy, you're using up resources, you're using up time, you're using up your mental space. Does the resting that you're doing actually restore you? If it's no, I very much encourage you to take a look at what might be restorative for you. Often people will say, "Nothing is restorative. Even when I rest, my anxiety is going through the roof." And so, that's where I would say, "Okay, if that's the case, you may need to actually push through in terms of really double down with your treatment, really double down with your mindfulness, that's the pushing through, so that you do learn how to rest." Often by the time a client comes to me or one of my staff, they're already exhausted. They're already depleted, because they've been trying to work through this disorder by themselves for a very long time. And so, when we say, "Buckle up, let's get going with exposure therapy or we're going to do mindfulness and we're going to practice these skills," they might be like, "Dude, I'm already exhausted. I don't even have the capacity to do that." And so, we'd say, "Yeah. This is an example of how we're going to double down now, "push through" so that we can balance that exhaustion, so we can take away the thing that seems to be exhausting you." So, again, it's a push and a pull. It's a little balance game. It's like juggling, and juggling requires a rhythm and a balance and a practice and a consistency that you'll have to find for yourself. But I strongly encourage you to spend some time looking at this because I think we hear too much about the push through on social media in society. And then on the flip side, we also have like, "Oh, you're exhausted. You should rest." And that's true. But resting alone won't get you better. So, it's this dialectical two opposing things happening at the same time. So, that's what I want you to think about. An example for me, I'll just give you a quick example. When I was really sick and my husband was working so much, I had to push through because I had to take care of two young children. I didn't have a choice. What I did do, though, is when I was "pushing through" and even though I was so exhausted, I then challenged. While I'm pushing through, what am I doing that makes this more exhausting and how can I make it less exhausting? So, an example, often with clients, they'll say, "I have this test and I have to just push through, I have to study for it." And I'll say, "Okay, while you push through, and while you do that hard thing," because pushing through is another word for just saying doing the hard thing, "as you do the hard thing, is there anything you can do to lessen the stress on your body? Could you maybe not tense your neck and shoulders so much? Could you breathe a little more? Could you take some more breaks? Could you have a bottle of water? Could you take little moments to breathe and do a little mindfulness or meditation exercise?" So, the thing here is you can also be resting while doing little intervals of pushing through or doing the hard thing. For me, that was a crucial piece. While you're pushing through, you're letting go of stuff that doesn't matter just to save yourself the exhaustion of taking that story on or that rule on or that expectation. While you push through, maybe lower your expectation. That might be helpful. Maybe lean in with a large degree of self-compassion and like, "Wow, Hun, you're pushing through, you're doing this hard thing. I'm going to be so gentle with you while you do this hard thing." That's so beautiful. Such a beautiful act of kindness. And then by doing that-- or when you're exhausted and you're resting and you're feeling guilty for resting, you'd say, "Hun, you're resting and this is so hard for you and this is triggering for you. Keep going. So brave. Keep going. I'm so grateful that you're taking this time to rest for me." Cool, right? All right. That's all I have for you today, guys. Just play with this. There has to be a balance. If this is still confusing for you, put it on paper, write down how many hours a day you push through and how many hours you rest, and just say, how can I increase the rest by 15-minute increments? What would that look like for me? What would that feel like for me? What would be helpful? Where can that be possible? How can that be possible? And maybe that 15 minutes will make a world of difference. It's better than nothing. I'm going to take a deep breath with you. I'm going to hold my heart for you. I'm going to remind you that you're stronger than you think, that the work you're doing is important and amazing and inspiring, and don't give up. Don't give up. Keep tweaking and tweaking and taking baby steps and you will get there. You will get there. All right, I'm going to send you so much love. Have a wonderful week. It is a beautiful day, it's a beautiful week, it's a beautiful month to do hard things. I'll see you next week.

Aug 26, 2022

This is Your Anxiety Toolkit - Episode 299. Welcome back, everybody. 299, wow. That is amazing. I am so excited. I don't know what it is about the word 99 that just makes me so joyful. One of my favorite episodes is actually number 99, which was the only episode and the only time where I actually have a full conversation with my husband on the podcast, and we talked all about agoraphobia and panic disorder specifically related to flying. So, if you want to hear me and my husband have a good conversation about his experience, that was one of my favorite episodes of all time. But here we are, Episode 299, 200 episodes later, and we're still going strong. No need to slow down. If anything, let's speed it up a little. Shall we? Before we get started on this week's episode, I am going to do the two segments that we do every week. First, I want to give you a little bit of a peek into where we're going today. So, what we're talking about is a question I get all the time, particularly when I'm talking about having a chronic illness. Specifically for those of you who have a chronic illness and have a mental illness as well, but also, this could be just for anyone because this is a human problem, this is not a mental health problem. We're talking about balancing exhaustion and when you have to "push through" and what do you choose? This has been a huge part of the work for me in my recovery from having postural orthostatic tachycardia syndrome. I feel like I've nailed this. To be honest, this is an area that I have learned very, very well, and it has saved my life literally in terms of I would be crashing and burning with tears and a major tantrum if it weren't for my ability to balance, rest and push through. So, let's talk about that in a second. First of all, we're going to do the review of the week. This is from Carsoccer27, and they say: "There are a lot of things that this podcast has helped me with. It's a great toolbox in many of my anxiety triggers. I never knew where to start to help my anxiety. This podcast has helped me find my starting place and has helped me find my self-identity. Highly recommended!" Thank you, Carsoccer27. What a beautiful thing to say. To be honest, for someone to say that I've helped them find their self-identity, that is an amazing compliment. That sounds amazing to me. So, I'm so happy I've been able to walk along you in the journey of that. That's just so cool. Okay. We now have an "I did a hard thing" from Anonymous. Anonymous said: "I did an exposure exercise. I get anxiety when I'm around people. So, it was hard for me to get groceries at the store, but I conquered my fear and got the groceries. And another important one is that I graduated college dealing with what I deal with." Anonymous, I love this. What I love about this the most is you talk about your struggle to get the groceries while also adding graduating college. Two massive things. Two major accomplishments. And I'm so grateful for you that you shared that because I think some people have said to me like, "Groceries, everybody's getting the groceries. I should be able to do that." But I love that you're celebrating how hard that was for you. We all need to do a better job of celebrating when we face a hard thing, whether bigger and small. Okay. So, let's get into the episode. All right. Thank you first for Carsoccer27 and Anonymous. Let's talk about balancing this push and rest. This balance between push and rest. If you could listen to me right now, you could see me. I'm swaying back and forth like a teeter-totter or a seesaw. It is a balancing act. So, let's just get the truth out. Having a mental illness or a medical illness is the most exhausting thing, and people will not get it. They will not get it until they've been through it. They don't understand the degree of exhaustion that you are experiencing. So, I first want to just straight up validate you. It's okay that they don't get it. It doesn't mean that you're not validated and that you aren't as exhausted as you are, because you do have to go through it to get it. So, let's just be real about that. Now, even though you are exhausted, you still are going to have to have times in your life where you have to push through to get stuff done. Anonymous is a great example of this. They push through despite going through anxiety the whole time, just push through, got through college. But what we have to be careful of here is this push through mentality. I'm actually right now reading a book by Ed Mylett and it's called Max Out Your Life . I personally love it. It's so inspirational. And as I'm listening to it on Audible, I'm like, "Yeah, let's max out our life." It's so empowering and I just want to flex my muscles until I'm like, "Wait." The anxious workaholic in me and the perfectionist in me wants to take that literally. And in the past, I have where I'm like, "Yeah, let's max out our life. Let's just push through and just push and push and push." And then as I've said to you in the intro, I collapse and everything goes into a big pile of mush. So, this is where we call it balancing. It's a great idea and yet, it's so empowering to hear that. But it's not healthy to take on a high percentage of push through mentality. So, if you're hearing this on social media and you're reading books about it, listen with a little bit of a skeptical ear. Because you are already exhausted, pushing through more is probably going to tip the scales so that the scales tip over and you don't recover at all. You're actually in big trouble. What we want to do today is we actually want to really learn the art – again, I'm swinging back and forth now – the art of balancing, the push through, and then making sure there's time to rest. So, you do a little bit of a push through, you get through the class or you get the groceries or you pick up your kids or you go to a dinner that you don't want to go to that exhausts you. And then you balance that with rest. Now what I mostly hear my clients say is, "But Kimberley, I shouldn't need to rest for that one thing. Everybody else is fine. I shouldn't need to rest." And this is where I'll often say-- I look at them dead in the eyes. So, imagine I'm looking you dead in the eyes right now and I'll say, "But whether other people are exhausted or not, you are and you have to radically accept it and you have to listen to your body." It's completely not even a calculation we need to take into consideration on how other people are handling it. You are exhausted. That's the fact. And so, we do need to balance this teeter-totter, this seesaw of you push a little and you rest a little, you push a lot and you rest a lot. There'll be times where you push a little and you still have to rest a lot. And that is, you're doing it. The way I think of it is, if I rest enough today, I'll have more energy for tomorrow so I can push through a little tomorrow, because you do. When I say push through, I mean, just get the things you value done. I'm not saying go hard and max out when you're already exhausted. I actually don't think that's super helpful. I've fallen into that trap way too many times. The other thing here is, a lot of times, when we "push through," meaning we have to. We have to show up for our kids and our partner and our boss and our parents and whatever, yourself. So, you've done that. And then when you go to rest, you look at Instagram and you watch some TV. There's nothing wrong with going on Instagram and watching TV at all. I do it myself. But I want you to really just use this. Again, I love to ask questions. So, the question I'm going to ask you is, is that in fact restful? Does that actually fill your cup up, restore you? Because if you're pushing through, you're using up energy, you're using up resources, you're using up time, you're using up your mental space. Does the resting that you're doing actually restore you? If it's no, I very much encourage you to take a look at what might be restorative for you. Often people will say, "Nothing is restorative. Even when I rest, my anxiety is going through the roof." And so, that's where I would say, "Okay, if that's the case, you may need to actually push through in terms of really double down with your treatment, really double down with your mindfulness, that's the pushing through, so that you do learn how to rest." Often by the time a client comes to me or one of my staff, they're already exhausted. They're already depleted, because they've been trying to work through this disorder by themselves for a very long time. And so, when we say, "Buckle up, let's get going with exposure therapy or we're going to do mindfulness and we're going to practice these skills," they might be like, "Dude, I'm already exhausted. I don't even have the capacity to do that." And so, we'd say, "Yeah. This is an example of how we're going to double down now, "push through" so that we can balance that exhaustion, so we can take away the thing that seems to be exhausting you." So, again, it's a push and a pull. It's a little balance game. It's like juggling, and juggling requires a rhythm and a balance and a practice and a consistency that you'll have to find for yourself. But I strongly encourage you to spend some time looking at this because I think we hear too much about the push through on social media in society. And then on the flip side, we also have like, "Oh, you're exhausted. You should rest." And that's true. But resting alone won't get you better. So, it's this dialectical two opposing things happening at the same time. So, that's what I want you to think about. An example for me, I'll just give you a quick example. When I was really sick and my husband was working so much, I had to push through because I had to take care of two young children. I didn't have a choice. What I did do, though, is when I was "pushing through" and even though I was so exhausted, I then challenged. While I'm pushing through, what am I doing that makes this more exhausting and how can I make it less exhausting? So, an example, often with clients, they'll say, "I have this test and I have to just push through, I have to study for it." And I'll say, "Okay, while you push through, and while you do that hard thing," because pushing through is another word for just saying doing the hard thing, "as you do the hard thing, is there anything you can do to lessen the stress on your body? Could you maybe not tense your neck and shoulders so much? Could you breathe a little more? Could you take some more breaks? Could you have a bottle of water? Could you take little moments to breathe and do a little mindfulness or meditation exercise?" So, the thing here is you can also be resting while doing little intervals of pushing through or doing the hard thing. For me, that was a crucial piece. While you're pushing through, you're letting go of stuff that doesn't matter just to save yourself the exhaustion of taking that story on or that rule on or that expectation. While you push through, maybe lower your expectation. That might be helpful. Maybe lean in with a large degree of self-compassion and like, "Wow, Hun, you're pushing through, you're doing this hard thing. I'm going to be so gentle with you while you do this hard thing." That's so beautiful. Such a beautiful act of kindness. And then by doing that-- or when you're exhausted and you're resting and you're feeling guilty for resting, you'd say, "Hun, you're resting and this is so hard for you and this is triggering for you. Keep going. So brave. Keep going. I'm so grateful that you're taking this time to rest for me." Cool, right? All right. That's all I have for you today, guys. Just play with this. There has to be a balance. If this is still confusing for you, put it on paper, write down how many hours a day you push through and how many hours you rest, and just say, how can I increase the rest by 15-minute increments? What would that look like for me? What would that feel like for me? What would be helpful? Where can that be possible? How can that be possible? And maybe that 15 minutes will make a world of difference. It's better than nothing. I'm going to take a deep breath with you. I'm going to hold my heart for you. I'm going to remind you that you're stronger than you think, that the work you're doing is important and amazing and inspiring, and don't give up. Don't give up. Keep tweaking and tweaking and taking baby steps and you will get there. You will get there. All right, I'm going to send you so much love. Have a wonderful week. It is a beautiful day, it's a beautiful week, it's a beautiful month to do hard things. I'll see you next week.

Aug 19, 2022

This is Your Anxiety Toolkit – Episode 298. Welcome back, everybody. How are you? It is a beautiful summer day here in California. I love summer. It is very hot, but so happy to be here with you. I'm sitting in my office. I have a cup of tea. I have my little flowers next to me, and I'm just so grateful to have you here with me as well. Thank you for letting me be a part of your journey. I'm so honored. Really, I am. I know you have many options. It's just an honor to be walking in this journey with you. Today, I want to talk to you about seven questions you can ask yourself every day. It doesn't mean you have to ask all of them. They're just my favorite seven questions. They're questions I ask myself all the time, the questions I ask my patients all the time. They're not groundbreaking in that they're going to change your life, but they will definitely keep you on track. 100%. They're what I call guidance questions. They're questions that prompt you to go in the next best direction, take the next best step. So, I can't wait to share those with you. Before I do, let's do the review of the week. This is from Kendall Wetzel. She said: "Listening to her podcast and following her on Insta--" if you don't follow me on Instagram, head over to Your Anxiety Toolkit on Instagram. She's saying, "Following her on Insta has been so great for keeping me in check with my OCD. She's gentle, positive, and awesome." Thank you. "So thankful for this free resource." Thank you so much, Kendall, for your amazing review. I love your reviews. Thank you for putting in the time to do that for me. It's a gift. Thank you. All right. Before we get into the episode, let's do the "I did a hard thing." This is from Joy. Joy said today: "I told my boss I was resigning. It was a hard conversation to have and I overthought everything leading up to it." Joy, I love that you shared that. We are human beings. We're doing the best we can with what we have. But Joy goes on to say: "But I did it and it went well. This morning I woke up and I said it is a beautiful day to do hard things and that helped me to get through the day. Thank you." Wow, Joy, love it. I mean, such a totally human response. Even though we overthink things, you still did it and that is all that matters. That is all that matters. That is all that matters. So amazing. All right. Let's get into these seven questions. Shall we? All right. I'm actually going to do this pretty quickly, folks. I will leave the questions in the show notes. I strongly encourage you if you're not driving to sit down and write them out and take some time today to journal on them. Again, it doesn't have to be all of them. You can make it into a pretty PDF. You could print it out. You could make it into a daily journal, prompts. But these questions, I just sat down and I looked at my computer and I was like, "Okay, what are the questions I commonly ask my patients?" Now, of course, I always ask my patients, how are you doing? I also ask my patients like, how was your week? I didn't include those questions. Of course, I ask the questions again as guiding questions that lead us towards the whole reason you're here, which is to live the life you want to live and compassionately. Alrighty. So, here we go. Question #1: Does does this behavior line up with my values? So important. Often, I'll just speak for myself, but I'm going to probably assume that you are just like me, given that we're both human beings, but maybe not. Maybe you're way more evolved than me. But often I find myself doing things that don't line up with my values, because either society told me to do it or I'm on autopilot and I'm doing what I've just always done. And so, therefore, I just keep doing it and I catch myself doing it or I'm trying to avoid some emotion or some fear. So, the question is, does it line up with my values? Often it doesn't. So, this is a question that guides me. I want you to think of it like your north star or your compass. These are compass questions as they guide you back on track. Does this line up with my values? If it's a yes, proceed. If it's a no, we might move our way down the other questions, or you might just want to reflect on that. Question #2: Does this behavior line up with my long-term goals? The thing around values is sometimes values will contradict each other. I really value being a good mom, but I also really value being a really good therapist. And sometimes I can't meet both those values. I can't be a really good therapist and a really good mom every single day. I can just do the best I can, but sometimes I have to go to work instead of being with my kids. Sometimes I have to be with my kids and I have to cancel a client. So, it's hard. So, the question I ask myself is, does it line up with my long-term goals? Long-term goals. And I'm talking specifically here in regards to recovery. The last few weeks' episodes are just about this, is getting clear on your goal, holding yourself accountable. Does this behavior line up with my long-term goals? Question #3: What is one thing I can do right now that lines up with my long-time goals and my values? What's the one thing, not the big thing? I struggle with this one so hard because I like to knock things out. It feels so good. It's like a little adrenaline high, and I get discouraged when I can't. So, I have to keep asking myself, just what's the one little thing I can do right now in that direction? What's the one thing? Don't worry about the 17th thing. Just do the first, next best thing. Question #4: Is this behavior effective? This is similar to the other questions. So, again, you might want to ask yourself all of these. You might get overwhelmed. But this is a question I often ask. I think I've mentioned in previous episodes, my 2022 goal is to be more effective. Sometimes I'm doing things and I'm like, "This is not an effective use of my time." Again, you don't always have to be effective. Sometimes we just do things for the pleasure of doing them or for the process of doing them, or for the joy of doing them. But is this actually reaching the goal? Is it effective? Sometimes my mom always to say, excuse me, if I kill this phrase, but she'd say, "You're jumping over quarters to get to pennies." She's talking about saving money. You're jumping over small amounts of money. Excuse me, you're jumping over big amounts of money just to save small things. I told you I was going to kill that. I did the best I could. So, you're jumping over quarters to get to pennies. If you live out of America, you'd say you're jumping over 10 cents to get to a-- you're jumping over 10 cents to get to 1 cent. But that's true too. Are you doing one thing to reduce a little bit of discomfort when you could be doing something that would give you way better outcomes? This is very true of those of you who are doing compulsions. Sometimes we're doing it and we're like, "No, I just have to get this certainty. And if I get this certainty, well, then I'll have relief." But it's like, okay, is that effective for your long-term plans? Yes. It reduces your short-term discomfort, but it actually increases your long-term discomfort. Question #5: How willing am I to be uncomfortable? This is the big one guys. If you're going to ask yourself one question in your whole day, this is the one. How willing am I to be uncomfortable? Whether it be that you're facing your fears on purpose, doing an exposure, how willing am I? Or whether it's just doing something you have to do that you don't want to do, like Joy told us this morning, she had to resign. Even if it's something you have to do, how willing are you to be uncomfortable? How willing are you? Are you in resistance to the fact that this is happening? It's happening. You're anxious. You've got something hard to do. You can fight it or you can allow it. Question #6: Can I do this for another 10 seconds? Oh, I love this one. I love it. I love it. I love it. Here we go. Can I do this for another 10 seconds? A client of mine once told me this. I think I've done an episode on this before, but it was a client of mine many, many, many years ago who said that they'd heard-- actually, I think it was like Grey's Anatomy or some TV show. Well, maybe it was some research. They said anybody could do anything for 10 seconds. And so, they would say to themselves while they're doing their exposure, "Can I do this just for another 10?" And when that 10 seconds is up, "Can I do it just for another 10 seconds?" You may increase it to 30 seconds, a minute, 10 minutes, an hour, or you may reduce it. "Can I do it for five seconds?" But it's a great question. It really challenges this sort of-- we have these thoughts like I can't do it anymore. But when you ask yourself, can I do it for another 10 seconds, well, then the script gets flipped. Question #7: How can I make this fun? I mean this, even if it's doing an exposure that is petrifying and 10 out of 10 anxiety, how can we make this fun? A part of you is probably throwing your phone against the wall and being like, "What the heck, Kimberley? None of this is fun. I don't want to do these hard things. Go away." And that's fine. It's a question you don't have to ask if you don't want, but I want you to ponder, how can you make it fun? How can you make the hard thing fun? So, as we look at these questions, these seven questions through the lens of it's a beautiful day to do hard things-- let's put it into sentences. It's a beautiful day to do hard things that line up with your values, because that was question #1: Does it line up with my values? It's a beautiful day to do things that-- excuse me, let me say it's a beautiful day to do hard things that line up with my long-term goals. That's question #2. It's a beautiful day to do one hard thing. (Question #3) It's a beautiful day to do hard things that are effective. (Question #4) How willing am I to do the hard thing? (Question #5) It's a beautiful day to do hard things for 10 more seconds. (Question #6) And last one, it's a beautiful day to do hard things, making it fun. So, how would I word that? It's a beautiful day to do fun, hard things. I'm being silly now. But it's true. I really want you to think about these. These are my favorite seven questions that I ask my patients. Try them on. See how they feel. If you like them, proceed. If you don't, that's fine. Just drop them. This is where you take what you need and leave what's not helpful. I really want to remind you, this is not therapy. So, I'm not tailoring this specifically to your needs. So, if it doesn't feel right, just leave it. Not everything is for everybody. All right. I love you. Have a wonderful day. It is a beautiful day to do hard things. Thank you so much for your support. Keep doing the hard things and I will talk to you next week.

Aug 12, 2022

This is Your Anxiety Toolkit - Episode 297. Welcome back, everybody. How are you really? Just doing a quick check-in. I love the quick check-in, the drop down into your chest, the drop down into whatever discomfort you may be having. And just take it a minute to actually check-in. So important. How often are you doing this? Hopefully, multiple times every day. All right. Today, we are talking about accountability, and this actually came, I was listening to something. I can't remember even what it was, but someone was having a strong reaction to the word "accountability," which words matter. They really, really do. But what I think is more important is the meaning in which we place on words. It's a huge part of diffusing from what we tell ourselves all day. So, the whole point of today is to talk about this important treatment concept or recovery concept. And I'll come back to why. But it's so important. It's so, so important. I've got a couple of different views about certain things, so you'll have to hang with me each. Everyone is so important, but hang with me. Before we do that, let's first do the review of the week. This is from Maggie Paulson. Maggie wrote: "I love this podcast. I've never been diagnosed with OCD, but I recognize that I have anxiety. This podcast has helped me to learn more about how my brain works, and her gentle and loving approach to treatment has helped me learn to handle my intrusive thoughts and my anxiety. To say that has improved the quality of my life is an understatement. I'm very grateful for Kimberley and her podcast." Thank you, Maggie. You fill up my heart. Thank you so much for your reviews. All of you, even if you just click the five-star review or however many stars you think it deserves. You don't even have to write a review. You can just give it stars, and that helps me. So, thank you so much. All right, drum roll. We have the "I did a hard thing" segment. This is from Anonymous. Anonymous said: "Today, I manage not to lapse into a behavioral addiction that I've been struggling with for over a year. It's very easy for me to use this addiction as a coping strategy for the stresses in my life. But I realized today that a good life free of this addiction is better than a good feeling that only lasts momentarily." Oh my gosh, Anonymous, I want to give you a standing applause right now. "Although every day is going to be challenging when it comes to not lapsing into addiction, if I take each day as it comes and have the attitude that it's a beautiful day to do hard things, I know I can live addiction free." So good. So good, Anonymous. Oh my gosh, lLet me read this line again. It says, "I realized today that a good life free of this addiction is better than a good feeling that only last momentarily." So much wisdom in that sentence. Amazing. So much wisdom. That is true for all of us. Isn't it? So true for all of us in that we just-- the real living we want, the real pieces on the other side of that hard thing. So, so true. Thank you so much, Anonymous, and thank you so much to Maggie Paulson for that amazing review. All right, folks, here is something I want to first start with. So, we're talking about, can you hold yourself accountable without being self-critical? That's a really important question because, and the reason it's so important for recovery is, unless you're in an intensive treatment center, where you have services 24/7, chances are, you're doing a lot of this hard work. You're doing a lot of these "hard things" on your own. And in order to do a hard thing, you do have to be accountable. You have to generate. If you could see me, you can see me like my arms are moving like cogs are turning. You have to generate motivation to do these hard things, because the truth is, no one wants to do these hard things. That's why they're hard. I don't blame you if you don't want to do hard things today because hard things suck. I keep saying that lately and I mean it. It's hard. I don't want to discount and make this podcast out to be like, "Oh, it's just easy. Just do these five mindful things and you're going to be fine." No, it's hard work. You have to generate motivation and you have to generate accountability. The accountability is what gets you to do it, even though you don't want to do it. And here is the point I want you to really take from this episode. Hopefully, this is a shorter episode, because I know I've been going a little longer lately. I'm a bit chatty. I'm chattier lately. I don't know why. Here is the point. Being accountable is not synonymous with blame and harsh treatment. So, let me put that same concept into different words. Holding yourself accountable doesn't mean the same as blaming yourself, beating yourself into doing the thing that you said you were going to do. That's not accountability. Accountability is just holding yourself accountable to do the thing. Saying have some accountability doesn't mean treat yourself terribly. And as I was saying at the beginning, I had heard something and I don't even remember where. I'm assuming it was on Instagram. They were saying like, "Don't tell me to be accountable. That's just mean. That's just mean that you would ask me to be accountable." And I'm over here going, what? No, hun, someone somewhere you've picked up the idea or someone's taught you that accountability means getting whipped and that isn't true. That's not true. Accountability, we just last session, last episode did 196. It was about, what is your recovery goal? So, we got really clear about what do you want your life to look like. If you haven't listened to that, please go back and listen to it. So, we got really clear on that. And accountability is saying, I love myself so much, and I love those recovery goals so much that I'm going to do this thing. That's accountability. I value my well-being so much. I value that goal that I want for myself. I believe in myself so much that I'm going to do that thing. That hard thing. It's not whipping and beating. It's not mean words. It's not saying get off your butt your lazy thing. That's self-criticism. That's not accountability. That's just bullying. That's self-bullying. And so, what I want you to look at is, accountability is simply saying, I'm going to do the thing I said I'm going to do because I deserve it. I deserve the outcome, the dream, the goal, the life that lines up with my values. Accountability isn't saying, push through no matter what, no matter how much pain you're in, just like plow through it. Believe me. I've been there. I've been there. Sometimes you have to do that. I'm not going to say that that's particularly even wrong because sometimes we do have to push through, but you don't have to be mean. And it's asking yourself, how willing am I to show up and do this hard thing so I can get this goal? Exactly like Anonymous said in this "I did a hard thing" segment. That's accountability. Everything that Anonymous said is accountability. I should have actually-- sorry, Anonymous. I should have just read your "I did a hard thing" and said, "There you go, folks. That's the episode. That's what accountability looks like." So, it's accountability. Compassionate accountability will still get you across the finish line. Often when I talk to clients about roadblocks to self-compassion, they'll say, "Well, I won't get up and do it if I don't beat myself up." Is that you? Maybe I should ask that question. Does that resonate with you? Like, "I won't get to the gym. I won't exercise. I won't do the exposure unless I beat myself up. That's the only form of transportation to get myself to do the thing." If that's the case, please make today the day that you start trying something else. I'll tell you why real quick and then I'm going to finish up. Yes, there are times when being self-critical gets you to do the thing. And if that's what it takes, it's up to you. You get to choose. I'm not going to tell you what's wrong. I'm not going to tell you you are wrong. I don't want you to feel judgment about that from yourself or from me because we're all doing the very best we can with what we have. So, that's totally fine. But if you use that as your only way, the chances are, eventually, it's going to burn you out. You're going to start to feel so bad about yourself that you will give up. We've got all the research and science to back it. So, it's only short-lived. This is only going to work for a certain amount of time until it stops working. So, let's use today to try something different. Let's put eggs in different baskets. Let's practice compassionate accountability. Again, I'll say it, compassionate accountability is doing the thing that you set out to do, because you love yourself and you love your goals so much that you're willing to do the hard thing. That's it. That's it, friends. That's all I got to say. All right. I love you. Have a wonderful day. I just love you. I'm squeezing my fist. I just love you guys. Thank you for being a part of my community. Thank you for supporting me. I totally understand you have gazillions of options for podcasts and gazillions of people who are probably doing great things. Thank you for letting me be a part of your journey. It's an honor. Really it is. Have a wonderful day.

Aug 5, 2022

In This Episode: The importance of having a specific recovery goal Why you need a recovery goal in order to gain traction with OCD and other anxiety disorders What does your "recovery dream" look like? What is getting in the way of your recovery goal? Learn to live your life "as if" you had already reached your recovery goal. Links To Things I Talk About: https://www.cbtschool.com/overcominganxiety ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 296. Welcome back, everybody. I am so fired up for this episode. Oh, I just love this stuff. I love it. I love it. I love it. Okay. Let's get started. First of all, let's do an "I did a hard thing." This one is epic. This one is from Fisher and they said: "I have OCD, health anxiety, and panic disorder. And last year, I was diagnosed with POTS," which is postural orthostatic tachycardia syndrome. That is the chronic illness that I have also. And they've said: "This was very overwhelming for me. I was petrified of exercising because of the exercise intolerance that comes with POTS and worrying that it was a life-threatening cardiac issue." Oh, I am with you, Fisher. So, for those of you who don't know what exercise intolerance is, it's like it's almost impossible to do exercise. When you stand up, you pass out. And when I've been triggered by POTS, it's hard to even do a block around, walk around the block of my house. "My doctor did all the cardiac tests to rule out any underlying issues before diagnosing me with POTS and recommended cardiac reconditioning to help me get started with recovery. My first barrier to overcome this was to trust in my physician and their diagnosis and follow their recommendation for exercise therapy. My second barrier was facing my fear of exercising. I can now say that I'm in my last week of the program after going twice a week for three months, along with exercising on my own at home. It's been a struggle. There are some days where I flare up." I hear you, Fisher. I totally get you. "And it seems impossible, but accessing self-compassion, budgeting spoon usage for the day, and moving things around to allow myself to rest have been invaluable tools to help me with the experience. A wise person told me after my diagnosis, the only predictable thing about living with a chronic illness is that it is unpredictable. So, I try to accept that uncertainty as a part of my life, living with anxiety and POTS." Fisher, I just love you. You're killing it here. "I have a lot of work to do in learning to live with my chronic illness and my OCD and health anxiety recovery, but I make a little progress each and every day. P.S. Would you consider doing an episode on coping with chronic illness that mirror anxiety symptoms like POTS? I'd love to hear the skills that have helped you and some of you recommend coping strategies. Thanks for all the hard work that you do on this podcast." Fisher, I would love to have you on the podcast. I am going to write it in my notes to reach out to you because I think this is such an important topic, one that I myself have gone through, and thank you for writing this. You are doing badass, amazing hard work. So, yay. Thank you. You will hear from me. If you don't hear from me, reach out, because I think that would be wonderful. Okay. Let's take a breath because that brought up a lot for me. I just feel such deep compassion for Fisher and all of you who are just doing the hard thing. So, so cool. All right. Quickly, review of the week from Mosley23. They said: "I've been listening for several years and can say that this podcast has helped immensely to understand my OCD and anxiety. Kim and her guests have provided very helpful ideas, strategies, and encouragement that have been so key in helping me to get to a good place with my mental health. Could not recommend it more highly if you or someone you love have an anxiety disorder." Thank you so much, Mosley23. Your reviews mean the world to me. The world really. Really, it's so helpful. And again, if you give a review, and I know specifically what episode you're talking about or what specific thing, it means then I can do more of that and help more people. So, yay. All right. Let's talk about recovery. It's taking all of my energy not to bang my hands down on the table and be like, "Let's do it." All right. So, I take walks every morning and I often listen to podcasts or audiobooks. I'm a big self-help, non-fiction kind of gal. And I'm often listening to these most motivating speakers and it gets me so fired up. This morning, I got so fired up because this is such a part of the work of being a clinician. We get trained on all the theory and the statistics and the diagnoses, but we don't get taught very well how to help a client identify what is your recovery goal. What are you here for? And so, even though you, listener, loving beautiful person, human friend – even though you're not here for therapy, because this is not therapy, I want you to be really intentional about your recovery goals. Why is that important? Because, when you're dealing with a mental health issue, you've already got a full-time job. You're working your butt off to manage that. And sometimes we can put our attention so much on the disorder instead of making time and carving time and having a mindset towards, what do I want life to look like once I recover and how can I use that recovery goal to fuel the work I'm doing now while I'm in the trenches? So, what I'm not saying here is, list off 20 magical things that will happen to you in the future when you get rid of your anxiety disorder, because that just means now you have an additional list of things to check off and it's overwhelming and anxiety producing. So, I'm not talking about just lists. I'm talking about getting clear on what you want life to be like, even if anxiety is there. So, let me ask you. You guys know, I love questions. First question, what does your recovery dream look like? What do you wish it looked like? So, often when I ask that to clients, their first response is, they put their hand on the buzzer and they're like, "Pick me." I don't want anxiety and I don't want that to be your goal. So, the absence of an emotion is not a recovery goal. We need anxiety. If you didn't have anxiety, you'd put your hand on the hot plate. You'd jam your hand in the door. We need anxiety. So, try not to make that your goal. I'm talking about specifically, zoom in and imagine that you are the ring camera on your house. What would be happening in your house, around your house, around your life? How would you be interacting with the world? That's the stuff I'm really interested in knowing. So, for me it's like, okay, if I was in my fullest recovery, I would be with my kids. I would be helping my clients and my listeners and my followers. I would be a connected wife. I would be a wife that shows up for my husband, even when it's tough and we've got stuff to work out. I'd be someone who still has good days and bad days. But the bad days I just keep showing up, like it's a beautiful day to do hard things. I'd be that person. I'd embody "it's a beautiful day to do hard things." That's what recovery would look like for me. It might not be that for you. And please don't just use mine because mine is just for me. Make it specific for you and look at that, write it down. Because in those answers, in those questions and answers is all of the details in which you can start to implement today. So, example being, if that was my recovery goal, what can I do today? I can get down on the floor and I can play with my kids, even if anxiety is there. I can go to my husband and say, "How are you? How are you really?" And practice staying in the moment and practice listening instead of letting my anxiety do all the talking. I still do the talking, but I'm listening to my partner, not to my anxiety. I'm practicing this and it's not perfect. I might even suck at it. That's fine. But I'm already working towards the recovery that I want, the life that I want, the dream that I want. While I have anxiety, and if it's there, I'm also going to bring myself into intention that my goal was to help people, to be of service, to show up for you guys and have a couple of giggles and be myself because that's a huge goal for me, to be more myself, which means I have to share a few layers of professionalism and just show up as Kimberley, the imperfect, giggly, silly, goofy, all-over-the-place Kimberley. So, I'm working towards that, whether anxiety is there or not. And by practicing that, I'm already 20 steps towards the recovery goal because I got down-dropped into what was it that I was looking for? So, this is the work, guys. Don't use this recovery list as a list of expectations that you tell you, you won't ever get to. Instead, use it as a way to implement it today. Now, what I just said is the perfect segue into identifying the next question I had in my prep for this. Are you living according to old stories or your recovery goal? Because often, if we've made mistakes in the past or we've struggled in the past or we have messed up in the past, as we're engaging with our goals, we're telling ourselves a story. What's the point? Look at that, what I wrote down. Like, I want to show up for my followers and listeners. I want to be a wife that's engaged and connected. I want to be a mom that's on the floor playing with their kids. I want to be a therapist that is just pouring my heart into the people. So, that's my list. But if I'm living according to old stories, I'd go, "Yeah, that's not going to happen because you totally screwed up with that one client that time, and you totally said something inappropriate to that one person and offended them and harmed them." And so, you're just, "Nah." You think you don't deserve to have that recovery or it's just not possible for you, Kimberley. That's what we call a fixed mindset. You're living off of old stories. "No, I couldn't do it in the past. I tried. So, there's no point. There's my recovery list. I'll never get there." That's old stories. And the whole point of me talking with you every week on doing the "I did a hard thing" segment isn't just because-- well, yes, it's because I love it. I ain't going to lie. I love it so much. But the whole point I do that is so that you guys can see baby steps lead to medium size steps, leads to large steps. And you mess up and you totally screw up. I've done whole episodes about this in the past. Just recently actually. You mess up and then you go, "Okay, I'm going to just do one more." It's going to try one more time, and one more time. The whole AA approach, if you have an addiction, if you go to alcoholics anonymous is one more day. And there's some research around that model because it helps you just to stay in the short term, doing today, not looking at the long term, and changing the story. The next question I have is, are you really clear of what recovery will look like, and does that line up with your values? The reason I ask that, and that's the final question of this episode, is when I ask my patients like, "Okay, let's get a recovery plan together. What are your treatment goals? What do you want to look like once therapy is done? How would we define that?" Often, because they've been trained and conditioned from society to be this, they're like, "Okay, so I want to have a house and I want a car and I want to have 100,000 followers on Instagram and I want to be a size blobbidy blah." And it's just like, whoa, whoa, whoa, whoa, whoa. Is that what society told you or is that actually what you want? Do you actually value those things? Are they coming from a place of getting other people's approval or are they coming from a place of what really feels good to you, really feels good? What feels true to your values? Because yeah, it's easy to say, "I want to have this many dollars in the bank," or "I want to have achieved a certain thing." That's fine. I'm not against that. In fact, I love that kind of thing. I love goals. But I first want you to ask yourself, why? Why do you want that goal? Is it because you want approval or is it because you want to prove you're worth? Because if it's any of those two things, it's probably going to be a painful process. Because, number one, you won't get approval from other people that's long-lasting because that depends on their mood and their values themselves, and you won't get up to a place where you feel worthy because you've based that on a conditional relationship. The only way we can actually build self-worth is to drop all the conditions and recognize that you're worthy right now, whether you reach this goal, this recovery goal or not. It's not a condition. The thing to remember here is your worth doesn't go up if you reach these goals. Please remember that. Your worth is the same whether you reach them or not. You're a valuable, important human being that deserves love and kindness. So, just keep an eye on that. I'm sorry, I'm going on a little tangent there, but it's so important as you embark on getting really clear. And I really want you to be really, really clear. I really do. I'll use a really ridiculous example, and mind me, I understand that this is a very privileged example, but my daughter is going off to middle school. She's going to a school that's very far away. And so, I have to engage in a carpool. We have a four-wheel-drive that we use to do all of the outdoor stuff that we do. So, I need a bigger car to fit seven people. And so, I'm trying to get really clear on values as I buy this car. I understand this is a ridiculous example, but let's use it as an example. As I go to buy a car, what do I want to feel when I get in the car? What are the things that matter to me? Is it the brand? Do I have to drive a Mercedes Benz or is it the functions? Is it the way it makes me feel? Is it the color? Is it the way my kids feel? That will help me to make a decision. So, I drop down into, really what do I want? What's important to me? Is it important for me to have technology or is it important for me to have ease? Is it important for me to have technology or pay less for this car? And so, it's asking questions. Don't go overboard here, but asking questions so I get really clear on what matters to me, what values matter in this decision. So, again, I get the ridiculous privilege of that whole question, but they're the questions I want you to ask about you, because you deserve that. When you make decisions about your recovery and your life, you want to ask the questions that are detailed so that you can pivot in those areas. It doesn't have to be perfect, but get clear on what you want recovery to look like. Because if you don't, you'll probably find that you're wavering around feeling directionless, not sure why you're doing all these hard things, feeling like, what's the point really? But when you know exactly what the outcome you want is, you'll know exactly the point. Okay. I love you. I love you. I love you. I love you. Thank you for being here. It is a beautiful day to do hard things. I hope that was helpful. I will talk to you guys next week, and have a wonderful, wonderful, wonderful, wonderful, wonderful day. By the time you hear this, I'll be back in the United States from my trip. If you want to go back and listen to the old episodes, I encourage you to do that. All the goodness is right there in those early ones. Have a wonderful day, everybody. Talk to you soon.

Jul 29, 2022

Jul 29, 2022

SUMMARY: Today we talk all about how to manage when your fears appear in your dreams. This was a heavily requested topic, so I hope it was helpful for you. In This Episode: Why our fears and obsessions show up in our dreams What to do when your fears appear in your dreams How to manage the distress when dreams feel "real" Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 295. Welcome back, everybody. It is Episode 295, which sounds like a whole lot of episodes. It really, really does. Actually, it shocked me when I saw that number. Today, we are talking about when your fears show up in your dreams. I would say quite regularly, actually, a client, particularly morning clients will often say like-- I'll be like, "How are you? How was your week?" And they'll say, "Well, I'm just feeling really overwhelmed. I had the most bizarre dream last night and it's hard to shake it off." And so, I'm wondering, I'm guessing. I've had this experience, I'm guessing you have too. And I wanted to talk this episode about how we might respond to that situation and what we need to look out for when we have this situation, particularly if you have anxiety. That's really the specific group of humans we're speaking to today. And I'll share a little bit more about that as we get going. All right, before we do that, let's do the review of the week. This one is from FullWalrus and they said: "I found this podcast by Googling an issue I was having, and this just popped up." FullWalrus, this makes me so happy. Thank you so much for Googling this and finding me because that means we're doing a good job at being on the internet and helping people in that way. "I had kept away from podcasts about mental health in fear of being triggered or being told I was crazy after all, and that didn't happen obviously. Kimberley is a gifted presenter and a therapist who introduced me to Buddhism and mindfulness in a way I'd never thought of before. For the first time, I feel like I actually have the tools to help me manage OCD , and this show is sure a beautiful compliment to any therapy you should be currently undergoing because we all need therapy. Thank you for everything, Kimberley. My life is forever changed and I am forever grateful." Thank you, FullWalrus. What a wonderful, wonderful review. I just love hearing how I'm helpful. I love hearing what episodes are helpful and it's really cool that I'm a really-- I love Buddhism. I find it to be exactly what I need every time I'm in a hard time. So, I'm so glad that I'm bringing that in a way that isn't overwhelming or overpowering. So wonderful, wonderful, wonderful. This week's "I did a hard thing" is coming to you from Holly. Holly says: "Last week, I went to court to obtain full custody of my son since his father has become a threat to him. This was extremely difficult seeing as we have been in an abusive past. My anxiety was the highest it's been in a very long time, but ultimately, I knew I had to take action. I did my hard thing and I couldn't be more proud of standing my ground and not succumbing to so many fears." Holly, sending you so much love. This is 100% doing the hard thing. It's so hard, because often we're talking about irrational fears and so forth, but I love that you brought like I'm doing this real thing. This real thing. And I love when you guys share with me both you're facing your fears related to your disorder, but also just facing fear about showing up and living according to your values and showing up for your family. And Holly, just so good. Thank you so much for submitting that "I did a hard thing" for our "I did a hard thing" segment. Okay. Let's talk about dreams. So, again, often people will bring to my attention like, what do I do if my fears show up in my dreams, or even fears you didn't have right. Like fears that you never considered during the day, but once you go to sleep, it gives it to you, sucks it to you, and whatnot. So, what do we do in this situation? Most people will report they wake up in a massive ball of sweat, high heart rate. It feels so real. It feels like it actually happened. And it takes some time for that to burn off. It really, really does. Some people say it even takes the whole day to burn off. And so, if that's the case for you, you're definitely not alone. Now, one thing to think about when we're thinking about dreams is we've been fed this belief that dreams are like windows into our soul and that they must mean something, and that some people interpret dreams. In fact, I'll tell you a story. I'm a clinician, I'm a CBT therapist. I use science-based treatment methods. And I do remember looking for a therapist several years ago actually and asking some colleagues. And one colleague, who knew me really well, referred me to this dream analyst. And I went for the first session. I was like, "This is not going to work for me," mainly because of exactly what I'm going to tell you. Now, if you like dream analysis, 100% no judgment. The reason that I had a strong reaction to it is I was going through a very, very anxious time, and I knew that if I engaged in that behavior, it was going to trigger me in ways that I'll share here very soon. The way I understand and the way I was trained and the way I've researched dreams is dreams, are just thoughts you have at night. So, if you've listened to this podcast, you'll know that during the day, if you have a thought, I'm probably going to tell you, thoughts are thoughts. Don't give them your attention. Don't give them too much kudos. And so, dreams are no different. They're just thoughts that you have while you're asleep, and do your best not to give them a ton of importance, a ton of weight, a ton of value, because when you do that, you can get in trouble, particularly if they're anxious thoughts. Now, let me say here, I am notorious for having the weirdest dreams. My husband often, when we first got married, would sit up in the morning and be like, "Tell me everything you dreamed," because I dream about like, I once had this dream about turtles and we went scuba diving together. And me and these turtles, they were like cartoon turtles. We're like going through these tunnels together. Ridiculous stuff. I've had dreams of going hot air ballooning with a giraffe, and I have had this dream many, many, many times. I would say tens of times. And so, yeah, sometimes dreams are just silly and crazy. But where they've got fear attached or danger attached or catastrophes attached, it can be really hard for us to not get caught up in them. So, the next question is, is it effective to interpret our dreams? My opinion is there's nothing wrong with it, but here are the things to look out for. If you have a dream and it's attached to your obsession and you're interpreting your dream, it's a chance that you're doing compulsions to try and get certainty around that obsession. So, if you've already got the fear and the obsession, interpreting the dream actually maybe just reinforcing the fear, giving it too much importance, giving it too much value, and therefore feeding you back into a cycle where you're going to keep having more of them, and you're going to keep having anxiety about them, because you're responding to them as if they're important and dangerous. If they're just random like you wake up, often people say, "I had a dream that a loved one died," or "I had a dream that a loved one was in an accident or it was my fault or so forth." If you have that, what I would encourage you to do is look at it curiously. For me, it's either like a really silly cartoon style dream or it's that I'm responsible for something, which just is a sort of, if I'm curious about that, I'm like, yeah, that makes sense. I tend to be hyper-responsible. I tend to take responsibility very seriously. So, that makes sense. But I'm not going to go and dig around more than that because now I'm digging around in the content of my fears and giving those fears way, way, way, way too much attention. Way too much attention. So, is it effective to interpret your dream? It depends. And I will say really clearly, if it is around your obsession, I strongly discourage you from doing it with one caveat, with one exception, which is unless it's for the purpose of actually doing an exposure that's scary. So, that would be the one time I would say, yes, it's cool to interpret your dream. If you're doing it on purpose in effort to actually induce the actual obsession and fear that you have so that you can practice tolerating the uncertainty and you can practice writing that wave of discomfort. We can and we do do exposures to the content of your dreams. So, again, if a client has a dream or you have a dream and it's triggering you, whether it was a part of your old obsession or just a new one, you can choose if it's really bothering you to do an exposure. You could do an exposure with imaginal exposures. We cover imaginal exposures in ERP School , which you can go and find out about at CBTSchool.com if you're interested. ERP School is our online course that teaches you how to apply ERP to your obsessions. So, you could do an imaginal exposure where you write a story about your worst fear coming true and the consequences of that, and you read it over and over and over and you just allow the anxiety to rise and fall. You could do that. Or let's say if it's a fear like, not long ago, I had a dream about this one area of the corner of my kid's school. It was like this really bad thing happened. So, if it's really bothering me and I'm struggling with reducing my mental compulsions about that. Yeah, I might go into that corner and just sit there and read a book or just wait there for my kids or whatnot. So, yes, you can do exposures to the content of your dreams, particularly again, if they're really strong, repetitious, and they seem to be persistent. What we can do in addition to that is apply a ton of mindfulness to the dream content itself. So, this is what this would look like. You wake up, whether it's from the morning or from a nap. You've had a dream. It's really overwhelming. It feels really real. It might even feel like you're actually in the moment of this catastrophe or this event. And even though it feels real, we're actually just going to be mindful of that. Now, what does mindfulness mean? Let's do a quick recap. Mindfulness is being present with what's actually happening. So, within that moment, what's actually happening is things feel unreal, things feel strange, things feel scary. Your heart might be beating faster. You might be sweating. You might have a tummy ache. So, that's what's happening. We're present with that, but we're also present with what else is happening. Oh, the birds are chirping. I feel my pajamas against my skin. This is the taste of the coffee I'm drinking. I can smell the coffee as well. We're just being very mindful of what else is happening, and we're doing all of that nonjudgmentally. Key point: We're doing all of this. We're having the weird feeling. We're having the anxiety. We're smelling the coffee. We're feeling our feet against the floor and we're practicing not judging these things as good or bad, even though they might be uncomfortable. When we are acknowledging that they're here, we're allowing them. We're being willing to experience them, not pushing them away, and we're practicing being non-judgmental. Now you may need to do this, and this is often our clients will say, "Yeah, I did that, and then it kept bothering me." And I'll say, "Well, did you do it again? Could you do it a little longer?" And they'll go, "Yeah, I did. But then it kept bothering me." And I'll joke with them. I try never to be condescending, but I'll say, "But did you then do it again? Did you keep going?" And that's the key to mindfulness. Mindfulness , we don't do these behaviors to make the discomfort go away. We do them moment by moment, minute by minute, 10 seconds by 10 seconds, just to practice being in the presence of this discomfort and giving the discomfort zero of our tension. Now, the other thing we may want to do here is activate a behavior. So, if you're feeling totally overwhelmed, totally anxious, everything feels like it really actually happened. A lot of clients will say somebody died in their dream and they actually cry and they're experiencing grief as if it actually happened. That's true too. That often happens. We would engage in behavioral activation of going, "If I didn't have this feeling, what would I be doing?" Such a good question. If I didn't have this experience, what would I be doing? And go and do that thing. So, if I didn't have this dream, I'd be getting up and I'd probably go for a walk or I'd sit down and check my emails or whatever it may be. Make sure you do those things and try not to divert away from the behaviors you would've done had you not had this dream. That's the response prevention piece. If you didn't have this dream, would you be giving this content your attention? So, let's say I had a dream about my child dying, which is devastating, the idea of it. So, when we say I wake up and I feel like it actually happened, my body is telling me it actually happened, even though maybe my child is right in front of me. Then how do I engage with the rest of the day? Am I ruminating about ways to prevent that from happening? Am I actually implementing behaviors to prevent it from happening? Because if I'm doing those things, I'm actually doing compulsions. I'm trying to solve a thought that I had, not an actual thing. And so, this is why this is so important that we understand that dreams are just thoughts you have at night or during sleep. That doesn't mean that they're important and they need to be analyzed and that it's a sign of something to come, because we wouldn't do that with an intrusive thought. We're learning not to do that. So, when we have a thought, we're learning not to go, "Oh my gosh, that must mean it's a sign." We're learning to undo that reaction and going, "Yeah, thoughts are thoughts." So, this is how I want you to maybe consider changing your response to dreams, especially scary dreams. Again, let me be really clear. If you love analyzing dreams and you find it helpful and you don't find it loops you back into the anxious cycle, wonderful. No problem. I'm definitely not against dream analysis. But for those folks who were anxious, I just want you to know this information, keep it in your back pocket, or maybe even your front pocket for the times when you catch yourself engaging in behaviors that become ineffective. My word of 2022 is "effective." I have it written everywhere. It's a huge part of the decisions I make every day, every minute. Does this keep me in being effective? And so, it's such a great question when we ask ourselves, is this behavior effective? It won't always be, you don't always have to be effective. But sometimes again, when you catch trends that are getting you to be ineffective, we want to see if we can make a change. Okay? So, that's Episode 295: When your fears show up in your dreams. I hope it was helpful. Do not forget, it is a beautiful day to do hard things. This work is not easy, friends. This work is actually-- let's just be real. This work sucks. It really, really does. It's exhausting. It's hard. It's taxing. It beats you down. So, please be gentle. It is a beautiful day to do hard things. Please remind yourself of how brave and strong you are because you're stronger than you think. And I will see you next week. Have a wonderful day.

Jul 22, 2022

SUMMARY: Correcting thoughts can but a very helpful tool to use when you notice that you have lots of thought errors. However, in some cases, correcting thoughts can become a compulsion. In this episode, ask the question, "Can correcting thoughts become a compulsion?" And review what you can do to make sure you are not engaging too much in the content of your thoughts. In This Episode: How to correct your thoughts and how this can help people who have errors in their thinking How to determine when it is helpful to correct your thoughts How to determine when correcting thoughts is becoming a compulsion Links To Things I Talk About: Overcoming Anxiety and Panic https://www.cbtschool.com/overcominganxiety ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 294. Welcome back, everybody. What a special treat to have you here with me today. Today, we are talking about when correcting your thoughts, we call it cognitive restructuring in therapy – when you correct your thoughts, when does that become compulsive? Or we could also say problematic. And so, we're actually going to go into this today, and then I'm going to let you decide for yourself what is helpful and what's not. But I hope today is really helpful. It's a very, very, very important topic. It's often one of the biggest mistakes therapists make, particularly those who are not trained in anxiety disorders and OCD, and ERP. It's probably one of the biggest mistakes that they make. So, I want to really review this so that you can have the information in your back pocket and you can make the decisions for yourself. Before we do that, let's first do the review of the week. This is from Cynthia Safell and Cynthia said: "I first was introduced to Kimberley's clear and compassionate teaching style when I took the ERP school course for therapists." This is wonderful, Cynthia. So, for those of you who don't know, we have ERP School, which is a course where I teach you exactly how I would do ERP if you were my client. And then it turned out that a lot of therapists were taking this course. And so, we duplicated the course and I added a whole bunch of modules for therapists, so they can become excellent therapists for people with OCD as well. So, I am so delighted that Cynthia has written this review. She goes on to say: "In the past 3 weeks since taking the course, I recommended both the course and podcasts to my clients. So helpful. Thank you, Kimberley." Wow, Cynthia, literally, that is the biggest compliment. Really, it is. If a therapist can trust me so much that they would recommend it to their clients, that is the biggest gift to me. And thank you so much for telling me that, because it just brings me so much joy and so much pride. So, thank you so much, Cynthia, for that amazing review. Alright, before we move on to the bulk of the content of this episode, we also want to do the "I did our hard thing" segment. This is from Abby and Abby is over here doing some hard things. So cool. Let's go. It says: "I have come on holiday. I'm terrified of flying. My anxiety was high. My thoughts were racing, but I did it." So good, Abby. "I got on the plane and I got on holiday. It was scary, but I did it and I'm proud. Now to commit to the holiday first two days have been hard, but sitting with it and not letting it ruin my time." Abby, this is so good. Not only did you get on a plane, but you're doing all the hard things in addition, and that's so good. What a treat for you. What a reward for you. You did the hard thing and now you're on vacation. Isn't that so cool? Thank you so much, Abby. And thank you so much, Cynthia, for being an amazing part of our community. Alright. So, let's get down to it, shall we? So, I am a cognitive behavioral therapist. I love cognitive behavioral therapy. If you haven't heard what that is, I'm assuming you have, but basically what that means is there is a cognitive component to treatment, which is focusing on your thoughts, and there is a behavioral component to treatment, which is where we focus on changing behaviors. Now, in some disorders, we spend a little more time on cognitions and a little less time on behaviors. And in other disorders, we spend a little more time on behaviors and much less time on cognitions. So, I think it's important for you to know that it depends on your disorder on how much cognitive restructuring or changing and thinking we do. And so, the whole point of today is to explore, is your cognitive restructuring, is changing and challenging your thoughts helpful for you and your set of symptoms? And you get to make that decision. I'm not here to tell you what's right or wrong, but I do want to give you some guidance. So, first of all, the big question that my staff bring to me when we're in supervision, and this was actually inspired by a conversation we had during supervision, was what is the role of correcting distorted thoughts in treatment? So, if someone presents to me a distorted thought, a statement, they might say, "I'm an idiot," or "What's the point? I only ruin it and mess it up anyway," or "I always make mistakes. I never do anything right." I as the clinician and them as the client may benefit by pausing the session and checking in with them in how true is that statement. Is it really true that you never do anything right? Is it true that you are an idiot? Could we challenge that and could we start to have you practice changing the words you use towards yourself? I am a massive, massive advocate for cognitive work because I think that in general, we walk around and we say a whole bunch of stuff that's not true. I do it too. I actually have put-- in the last 18 months, I have put in massive amounts of time and energy into catching because I was finding I was saying a lot of sweeping generalizations like, "I feel terrible today." Even though I didn't feel well, it's like, okay, I'm saying these words, "I'm so tired." That was another big one I used to say every day. My husband would ask, "How are you, Kimberley?" "I'm so tired." And it's not that that thought was wrong or not true. I was really tired. But I had to check, is it helpful for me to keep saying this? Is there another way that I could maybe reframe this or present this or look at this? So, yes, there's definitely a role in challenging and correcting errors in our thinking. And so, it's important that we first look at what is a thought distortion or a cognitive distortion, or a thought error. It's usually any thought that's, number one, not true or not helpful, or keeps you responding in a way that isn't beneficial. So, again, the thought for me is "I'm so tired." It's true. Is it helpful? No. Does saying that actually make me feel a little bombed and a little down? Yes. Could I maybe replace it with something else? That's up to me. There's no right or wrong. I want to be really clear here in that when we talk about correcting thoughts, we are not saying toxic positivity, like, "Oh, I'm supposed to tell myself I feel fabulous because I don't." That's not what this is about. We don't do that kind of thing. We just make small little shifts depending on what feels helpful to you. So, let's go through a couple of scenarios. Does correcting thoughts help with depression? Now, based on the research, the treatment for depression is actually really balanced in terms of doing 50% cognitive work and 50% behavioral work. These numbers I'm throwing out aren't science-based, but just in general, I want you to think about like, yeah, you have to do both. You have to look at correcting the lies that depression tells you, but you also have to look at your behaviors and how can you engage in behaviors that actually make you more fulfilled and happy and not feeling down. So, yeah, with depression, we look at a lot of thoughts that are very critical, sweeping generalizations, we look at a lot of thoughts that discount the positive. I thought that's like discounting the positive like, "Well, yeah, even though I got an A in that test, still, I'm probably going to fail my last year of college." So, they discount the positive thing and they make another sweeping statement. So, we really want to make sure we're correcting thoughts when it comes to depression. It's really important because depression lies. Do we correct thoughts when it comes to generalized anxiety? Well, yes, we can. But this is where this topic is so important, is you want to be careful. If you're spending a lot of time correcting thoughts, there's always room to correct your thoughts about things. But if you find that you're trying to correct your thoughts just to reduce or remove your uncertainty, then it's likely that it's going to get you stuck in a loop where you have to keep doing that thought correction in a somewhat compulsive way to feel good. And so, what we want to do here is, yeah, we want to be mindful of our thoughts, and then we may choose whether we want to correct it or not, or whether we just want to observe that I'm having a thought. This goes for depression as well because mindfulness-based cognitive therapy is a huge, huge science-based treatment for depression. So, you're going to see a trend happening here. So, we always want to observe the thought because it helps us to diffuse from the thought and see it in perspective. And then we can choose to correct it if it's helpful in that moment. Maybe if you've never corrected it before, if it's a new thought that it's helpful for you to do a little thought work with. And then again, you'd still do the behavioral piece with generalized anxiety. So, if you're having a lot of anxiety, you still want to work on not avoiding things and not seeking reassurance and not doing any self-critical behaviors, and so forth. So, yes, what I would say is there is some benefit to correcting thoughts. The main thing with this is as long as it's not the only tool you're using, because if it's the only tool you're using, you're going to be putting in a lot of work, a lot of time of the day correcting thoughts, and that's probably going to take you away from living the life you want. Several episodes I did a podcast about your recovery plan and what's getting in the way. The truth is, if you can identify the things you want to be doing when you're recovered, once you've done that, you can start implementing that right away. So, I often will check in with myself because I've been doing a lot of work too. Okay, I could correct the thought right now, or I could just immediately throw myself into the behavior I want to live by. That's according to my values. And then I make a decision. What would be most helpful? Should I explore this thought? Or would this be a wonderful time to do my paint by numbers? PS, I love Paint By Numbers. It literally got me through COVID. You have to try it. It's the coolest thing and it's so fun. But I ask myself like, do I want to just allow the thought to be there and go do the thing I love? Or would it be helpful for me to correct it? There's no right answer. But if I'm trying to correct things that I've already corrected and that I already know the answer to, yeah, I probably am going to choose to do the Paint By Number, if I'm completely honest. I think that's a more effective route. You are going to have to think about it and do a little cost-benefit analysis for yourself. Then we are going to move over here, and this is very similar. Does correcting thoughts help with obsessive-compulsive disorder? You can see a progression here with depression. Yeah, we do quite a bit of it. Generalized anxiety, a little less because it can sometimes be very repetitive. When it comes to obsessive-compulsive disorder, guys, you have to be very careful about correcting thoughts. Because if you're correcting thoughts to try and reduce or remove your uncertainty, it will most likely, and I would probably go as far to say, definitely turn into a compulsion that will keep you stuck. Because remember, the treatment of OCD and obsessive-compulsive disorder often involves leaning into discomfort, leaning into uncertainty, leaning into doubt, leaning into tolerating whatever experience of uncertainty and discomfort that you have. So, here is what I say to my clients, and this is exactly what I said to my staff. One of my staff had said, "Okay, when do we correct thoughts and when don't we then?" And here is the thing. If somebody is coming to me and they're saying something that's an error in thinking around their ability to cope with discomfort, I would 100% correct that. So, an example would be, if a client says to me, "I can't handle my discomfort," I will probably have them challenge that. I might even say, "How do you know? Could this be the first time that you actually do tolerate this discomfort or cope with this pain?" So, I would 100% challenge and correct thoughts around their coping. But if someone has a thought, "What if I have a panic attack?" the truth is, trying to correct that is uncertain anyway. You're not going to be able-- you can't say, "No, I won't," because you don't know that. You can't say, "Yes, I will," because you don't know that. So, only correct thoughts around your struggle to cope. Never correct thoughts where you're trying to reduce or remove your uncertainty. That would be my best advice to you. Another point here is, if you find you're correcting the same thought repetitively, chances are, it's a compulsion or will turn into a compulsion. The reason that I push this so heavily is you're going to-- here is where I really struggle the most, is you're going to-- if you're on Instagram, a lot of you come, listen, you follow me on Instagram. We have an Instagram account called Your Anxiety Toolkit. There are hundreds of accounts that tell you to correct every single thought you have, and I don't agree with that. I do not agree with that. I think that that is terrible advice. Because number one, you could spend your whole day doing that, particularly if you've got bad anxiety or depression. Number two, you could spend your whole day doing the exact same behaviors you did last yesterday and last week that obviously didn't reduce or remove your discomfort. And the third thing to remember here is we have scientific evidence specifically for obsessive-compulsive disorder, but also for generalized anxiety disorder, that most people who have these disorders, there is a certain set of things happening in their brain where cognitive restructuring just doesn't stick. The part of their brain that allows them to correct things, there's a weakness there or there's this bad connection there, which means if this were to work, it would've worked already and they probably wouldn't suffer because they would go, "Oh yeah, you're right. That doesn't make any sense." And off they go. It's really frustrating because I know a lot of you see your partner or your friend who can quickly correct a thought or quickly do a quick Google search, quickly get reassurance and they're fine. They get to move on. But the brain of an anxiety disorder is different, specifically the brain of someone with obsessive-compulsive disorder is different. And so, for you, you might get a moment of relief, but then you find the thought comes right back. And so, again, there's no real point you can. Doing it is like whack-a-mole. If you do it,then discomfort goes away and then it comes back and you do it again. And now you're just stuck, like weeding weeds that keep growing. So, these are the things I want you to think about for yourself. I'm definitely not telling you what you have to do. Again, this is not therapy. But I want you to do a little inventory for yourself and just ask yourself what would be helpful and what's not. The last question I have here for myself is, when does correcting thoughts help in recovery? Just like I said before, if it helps you in terms of reducing your self-criticism, increasing your sense of mastery over a task, or increases your ability to feel like you can cope, well then, I think it's a helpful tool. I'll give you an example of that. I personally hate running payroll. Every month, I have these beautiful 10 and 11 staff. It's actually more like 13, 14 beautiful staff who work for me. And at the first of every month, I have to run all this payroll stuff. And guys, to be honest, I suck at it. I'm terrible with numbers. I get all the numbers mixed up. It takes me twice as long as it would, but I really do value the importance of me knowing what's happening in my business. So, I do it. I'm doing it. While I'm doing it, I have a lot of thoughts like, "I can't do this, I don't want to do this," and a lot of like, "Ah, this is too hard" thoughts. So, in that situation, I'm correcting my thoughts so that I can embody a sense of like, "No, I'm a really good boss and I'm trying to run a business that helps other people with their life." And so, I correct my thoughts so that I can embody like, "No, this is important. I want and I'm choosing to do this. This is important for my staff. It's important for me to get it right. And it's worth the time." So, in that situation, correcting the thoughts is really helpful because it helps me with that degree of anxiety. However, if I was having thoughts like, "What if you make a mistake? What if you make a mistake? What if you make a mistake?" correcting my thoughts to like, "You won't make a mistake or that's not even true. So, it's not going to be helpful." So, again, let's go back. When it will help is when it's around your coping, when it's around your capabilities. So, if you're having a lot of thoughts like you suck and you can't and you're not good enough, you're not strong enough, you're not wise enough, you're not courageous enough, yeah, you can correct that into more encouraging statements. But we don't do it around uncertainties. We don't do it around uncertainties. That will keep you stuck. Now the last thing I will say here before we wrap up is, is there a difference between education, reassurance, and assurance? So, let's just break that down. If a client comes to me and they say, "Oh my gosh, I keep having these horrible intrusive thoughts. Something must be wrong with me," through the lens of education, I might educate them and say, "Listen, everyone has intrusive thoughts. You're just like everybody else and you shouldn't be ashamed. And I really want you to understand that having intrusive thoughts is a normal part of having a really healthy working brain." I consider that education. And you deserve to get education around things. So, if you have, let's say, a new illness, it's okay to go and get educated about the new illness. That's not a compulsion. Now, there will be times where you educate yourself and you need to tweak what you know or learn something new, and that is also fine. The thing I would have you as we leave for this episode just continue to think about is the thing that we want to look out for is when it's called reassurance, which is repetitive over and over attempts to reduce or remove a thought specifically related to your anxiety or your uncertainty. So, that's the real thing I want you to think about and look out for. Take note. And the other thing I want you to remember is, please don't beat yourself up if there are days when you do a lot of thought correction and it turns out to be a compulsion. You're just a human being. There is no right or wrong. Often, I'll say to a client, they'll be like, "But what if I do correct a thought?" I'll say, "You know what, you're going to have ups and downs. So, try not to get too perfectionistic about this practice." There's just these general ideas and you'll know in your body if you're doing it compulsively. A great and easy way to know if you're doing something compulsively is, are you doing it with urgency? Are you doing it with an experience of resisting discomfort in your body? Are you doing it to reduce or remove a thought that you're having? And are you doing it repetitively? Those are things where if you're doing those things, you will know you're probably doing a compulsion. And in fact, I encourage you to get really good at catching those things because then you will be one step closer to recovery. Alright, my loves, that ends the episode on whether correcting thoughts is a compulsion or not. I'm going to let you really come to a conclusion on your own, or you can go and speak with your clinician and get to the bottom of that for yourself. Have a wonderful, wonderful day. It is a beautiful day to do hard things, and I will talk to you very, very soon, aka, next week. Have a good one, everyone.

Jul 15, 2022

This is Your Anxiety Toolkit - Episode 293. You guys, I've totally screwed up. Oh my God, it's going to be one of those episodes where I laugh a lot. Maybe not. Who knows? Alright, I totally screwed up. It's funny because I have for months been thinking about doing an episode and reminding you guys mostly so I could remind myself that I'm a human being, that I'm going to make mistakes, and it's one of the biggest lessons that I have had to learn over and over and over and over again. It's really frustrating, you guys. I'm so frustrated by this fact that humans make mistakes. I don't like it. It makes me mad. If only we could figure out a way where we don't and we don't disappoint people and we don't screw up. If anyone has figured this out, let me know. Just shoot me an email, tell me your special secret, because I haven't figured it out yet. So funny. Okay. Before we get into it, this is actually pretty much a coincidence and I love when big coincidences happen, but the review of the week is actually from Flashcork. They're writing a specific review on Episode 193, which I think is really cool because this is by coincidence 293. And they said: "This episode 193 is just what I needed to hear today. I'm stressed and anxious about my upcoming trip and experiencing racing thoughts. This will help me to manage those feelings and practice by shortening the leash." Now, if you haven't listened to this episode, it is probably one of my most favorite episodes. A lot of my patients and clients have said that this concept has helped them a lot. And so, really go back and listen to 193. If you want to practice being able to be in a place where you can manage those thoughts a little better, go back and check that out. It's just a metaphor. Flashcork says: "It makes sense because it has worked for me walking Sally, my Golden Retriever." I make a reference to thoughts being like a dog on a leash. So, you can go back and listen to that anytime. That's the review of the week. Thank you, Flashcork. So happy to have you join us. The "I did a hard thing" is from Allison. Allison says: "I'm going to go on a job interview next week after applying to a different job, going through the grueling interviewing process and at the end not being successful. I'm working really hard to believe in myself, screw up my courage to attend this interview and be open-hearted about the new possibilities. It's hard to pick yourself up and try again, but I'm doing the hard thing of trying again. I'm scared, but I'm proud of myself." Allison, you are doing the work. And I'm actually going to take your advice today, Allison, because this is so perfect for the topic of today, which is like, yeah, sometimes we do screw up and we just have to get up and we have to try again. It's so important. I'm so, so I'm impressed. I'm just so impressed with your courage and thank you so much for sharing that because I think we've all experienced it. So, Allison, let me tell you my hard thing. I want to preface this with, I think in my-- if I'm being completely authentic with you guys, I think that I've somehow, for many years of my adulthood, without me realizing, and in not a super severe way either, it was a very secret underlying compulsion I think I've been doing for years that I didn't even know I was doing until the last couple of years is I was trying to find a way, constantly striving to find a way that I could live in a world where I didn't make a mistake. Now I understand I'm a human. I don't think I'm a superwoman. But in my mind, I think I've had-- well, I know I have, let's be honest. I think in my effort to control my emotions that I've engaged in these little nuanced secretive behaviors of constantly trying to find the formula where I don't upset people and I don't screw up. Let's just take a minute because it's funny for me to say that because how many times during the week with my clients and with you guys and everything I do is about self-compassion and letting go of control. And all along there was this nuanced little secret slither going through my life. And I think that number one, a part of this is true for a lot of people who have anxiety and are high functioning. Because I spoke to a couple of friends about this and they were like, "Yeah, to be--" when you have anxiety, to be high functioning, you have to put in place systems and procedures and routines to keep you going. And it makes sense that we often engage in other little behaviors that make us feel like we're getting control when we don't. Everybody knows, I even spoke about it a couple of sessions ago, that I am so in love with calendaring. My life has changed since I've been more intentional about my calendar. I'm not compulsive about it at all. Because I'm managing two children and two businesses and a chronic illness, if I can be really intentional and effective with my schedule, I can go into the day. I never worry about what I have to get done anymore. Really, I don't. It was the best change I ever made because I have a system where I write down what I need to do and I throw that list out because I immediately calendar the times that I'm going to do it. So, I know it's going to get done because it's in the calendar. And if I don't get it done, I'll reschedule it. And I know I'll get it done. And through the process, I've actually built such trust with myself. I know. I know I used to worry that I won't get things done. I never worry about that anymore because I've gotten really good at this process. You guys know what's going. This week is literally the only week of the year where the things on my calendar cannot be rescheduled because my beautiful daughter, who is a delight, she's growing up to be this absolutely gorgeous human. I wish you could all meet her. She's just so good. I know I'm biased, but she is just so wonderful. It's her graduation. She's graduating elementary school, you guys, and I'm going to have a middle schooler next year. So, the one thing this year-- because I'm my own boss. I can schedule what I want. The one thing I can't miss is her graduation. And last week, you know what's going to happen here I was prepping to present at this conference and I got on the call and then we were doing this rehearsal and she said, "Okay, great. I'll see you next Friday." And I was like, "No, no, no, no. It's the week after." And she said, "No, no, no it's next Friday." And I'm like, "No, no, it's not. And I'm always right. It's in my calendar." And she's like, "No, it's really not. It's next Friday. You agreed to it on this date." And I realized she's right. Now, I said to her, literally, "I cannot do it with this whole thing. I can't do it. I've totally screwed up. This is not something I can reschedule." And she was like, "Oh, okay." So, she had to basically message a whole foundation. They had to change everything. They had to try and figure it out. This is where it was so humiliating, is they had to reach out to the person who was going after me, who is a very, very, very well-known person in the OCD community who I respect and don't know. So, it's like I have a relationship and had to ask him to reschedule his entire day because I screwed up. Now, I know this is not a huge disaster. This is in the grand scheme of things. This is not a huge problem, but I felt so bad. Oh my God, it was so painful. I was in this meeting and to see their faces of just pure annoyance and frustration and anger of like, "What? You got the date wrong?" They were very kind, but I could tell they were annoyed. And so, my question to you, because I love questions, is what do we do when we screw up? What do you do when you screwed up? Now you might be thinking this isn't a big deal. I want you to think about a time when you did screw up that's a big deal for you, and I want you to ask yourself, what did you do when you screw up? Immediately for me, this is the reason I wanted to really do this episode, is there was this interesting shift in me this time where-- because I haven't screwed up this big in a couple of years. This was a pretty huge screw-up. I looked like a complete fall in something that was organized months ago, we've been talking about it, emailing back and forth. How did I miss this? I don't know. But what was fascinating to me is, once upon a time, I would've said some very mean things to myself. Really, really mean. And I probably would've-- now that I'm noticing it is I would've responded, not just with self-criticism, but I would've tightened my belt even more with checking behaviors, rechecking, more controlling calendar, like compulsive calendaring. I would've overcorrected because I have been known to overcorrect. If you ask my partner, he'll tell you I often used to overcorrect pretty bad. If I make a mistake, I would-- if I upset someone, I would go overboard trying to get them to like me again. Or I remember I used to-- if I was worried I offended someone, I would like to apologize over and over and over again. I don't know if you've done any of these behaviors. You might want to gently say, "Kimberley, you're not alone." I'm kidding. But this time what? I notice this shift in me where I was like-- what I say to my son all the time is, "Oh my gosh, I'm such a ding-dong." I'll say you're such a ding-dong and he'll say you're such a ding-dong. It's a funny thing. It's lighthearted and it's not critical. It's just like, "Ding-dong. You're such ding-dong." And what was interesting is I responded by went, "Oh my gosh, I'm such a ding-dong," but it wasn't-- I said things that sounded critical, but it wasn't. There was this giggle to it. There was this acceptance of my humanness to it. It was so playful in my response. And I mean, this is a big deal for me because I very much value the respect of the people in my field and I work really hard to get their respect. Not in a people-pleasing way, but it's a very big value for me. And it was funny. I just went, "Oh my gosh, I'm so sorry. I'm a ding-dong." And then I said, "What can we do to fix it?" It was just a very transactional thing. Whereas before I would've, "Oh my God. I'm so sorry. I'm such an idiot. I can't believe I did this. You should fire me." I would just go overcorrect. So, let's come here to the questions because I love the questions. If you're driving, don't do this. But if you're not driving, I'd love for you to actually sit down with a notepad and just journal some of this out. So, when you screw up, what do you do? The second question is, is it okay for you? Because it was fine for me, and I want you to actually check-in, is it okay for you to make jokes about yourself? Answer it honestly. If it's a yes, that's okay. It can be giggly, nothing too harsh. If no, take that and really follow that out when you do make a mistake. Number three, is it helpful to apologize? Yes, of course. When we screw up, we should apologize. But how many times? And how do we apologize? Do we say it in a way that's very factual, "I'm so sorry, this is a huge inconvenience for you"? Or do we say, "I'm sorry, I'm such a mess, screwed up person. I've ruined your day," and make up a whole story about it? Because a lot of us do that when we screw up. Do you apologize over and over and over? Catch how do you respond to try and make it up to them. And that's a really big one. Because if you find that you're trying to make it up to them that's okay. But are you doing it because it equals the degree in which you screwed up or are you doing it just to remove the discomfort you feel about the fact that you're a human being? Make sure it's in proportion. So, if you, let's say, forgot to text somebody about something, you wouldn't need to buy them a $100 gift card. That's going overboard. Maybe it depends on the situation, but we're just making an assumption here. If you forgot someone's birthday. Well, yeah, you probably need to take them out for dinner and do make a big deal about it. But do you need to do that four times this month or throw them a party that puts you out of pocket? No. Don't try to make it up to people in a way that actually takes away from your well-being. This is the next thing, is-- once I did this, I was really proud of myself. I'm not going to lie. I handled it pretty well, I think, and I was like, "Wow, I've made some pretty big growth in here obviously." What was interesting is, once I hung up from them and I was like, "Oh dear." I have all of these emotions, which I'll talk to you here in a second about, I had to ask myself. The next question is, how long am I going to be on the hook for this, meaning from myself? How long am I going to hold myself on the hook? When am I going to let this one go? Because what I could have done is I could have said, "Okay, I made a mistake. It was not a good mistake there." Obviously, I need to make some changes, but I'm going to beat myself up for the rest of the day. I'm going to ask yourself, how effective is that and is it in proportion with what happened, and is it effective? Really, does it make it less likely that you'll do it again? The truth is, if I beat myself up all day, it's not going to reduce the chances of this happening again, because it was a human mistake. And then the last question is, what can I do to resolve this if anything? But let me come back to the emotions because those questions are very much related to these emotions. When you make a mistake and whether-- let me pose a couple of things to you. It could be something you do to somebody else. It could be something you do to yourself. Meaning if you do a ton of compulsions and you are up all night and now, you're exhausted, or it's any mistake you make. You had a huge panic attack and you left the party of your best friend and she's really mad at you because you left her birthday party. It could be that you were depressed and you just couldn't show up for your friend this day. So, there are so many ways in which this plays out. It doesn't just have to be with scheduling. When we upset other people or our behaviors impact other people, it's normal to feel strong emotions. That's normal. Often what we do is when we feel those strong emotions, we respond to them as if we need to squash them immediately, because we've told ourselves we can't tolerate them. Guilt is probably one of the most common, shame being the second. There may be some anxiety related to it as well, or maybe some other emotions as well. But let's take a look at those emotions and just quickly review how they may actually impact you. So, when we feel guilt, guilt is usually you've done something wrong, and I had done something wrong. So, guilt was an appropriate emotion. But I always think of guilt-- I've done episodes on this in the past. I think of guilt as just a stop sign to ask you, is there anything I can do to fix this now or in the future? Again, just really logical. In this situation, yeah, I can reschedule. I can be honest. I can do what I can to apologize. But beyond that, there isn't anything else. And so, any residual guilt I feel from there, I must just tolerate. I must compassionately ride the wave of guilt. Often, I see my clients, and I've done this myself, is if guilt is here, I'm going to beat myself up for it. No matter what, that's the conditions. If guilt is present, I will beat myself up. And I want to invite you to have guilt and just be kind and let it ride. It'll burn off like a candle. It'll burn itself out and it'll slowly dwindle away. Guilt is "I did something bad." Shame is "I am bad." If you do something and you screw up, and you feel shame, your job is to check-in and recognize that mistakes don't make you bad. Literally, no mistake. There is not a mistake you could tell me of that makes you bad. Even if there was an absolute catastrophe that happened, mistakes don't make you bad. You're a human being. You're going to make them. And I know, like I said to you, if you figured out how not to be human, please email me. I'll happily take your email into my inbox and I'll apply your rules. But the truth is, I know none of you are going to email me because it's not possible and we have to accept it. We have to accept it. I'm just joking really about the email. And so, there is really no place for shame. If you feel shame, same as guilt, write it out compassionately. Give it very little of your attention. Don't get into the content of what your shame is saying. Write it out and let it go. Meaning, like I said to you, there's really no point in me dwelling on this because it's done and I can't do anything about it. All I can do is be kind to the feelings I'm feeling. Now, a lot of people will say, "Oh my gosh, I wrote this response on an email or call or I presented, or I was in a party, and now I feel nothing but anxiety because I totally made a mistake." I've had people even say like, "Oh, I was at a party and I passed gas," or "I said something stupid." I mean, I could tell you some absolutely ridiculous stories. Actually, let me tell you a quick, funny story, because I'll come back to this, is recently, I attended this creative writing course, but it was actually a writing course for people who are business owners, and they were talking about getting really clear about you and the message you want to give and how to tell stories about it and so forth. And he was asking these questions about, who are you? And what's something that the people closest to you would say? And I was thinking about it and I don't think you guys know this about me, but I have, not in my professional life, but in my personal life, I have a way of the most bizarre things happening to me, like silly things. I always find myself in these situations where everyone is like, "Oh, only Kimberley would get put in that situation." So ridiculous. I can't even-- one day I think if I really let go, I'll tell you some ridiculous stories. But if something really bizarre is going to happen, it always happens to me. And so, I just wanted to tell you that, because I want you guys to know that as the podcast is where I get a little more personal and bizarre things totally happen to me all the time. But let me go back. So, let's say you have anxiety. You're having anxiety about something that happened, and you're thinking like, "Oh my God." And your brain is just telling you catastrophe after catastrophe, after catastrophe, all of the worst-case scenarios. The truth is, that's your brain's job. Its job is to tell you of all the catastrophes, but it doesn't mean you need to respond as if they're all true and happening. And so, again, we go back to these core questions, is how can I stay with the facts that it happened? How can I acknowledge that it is what it is and that I can't solve it, I can't make it go away? And how can I act in a way that doesn't overcorrect again, not over-apologizing, not asking for reassurance, not avoiding those people, not saying too many jokes, and so forth? So, we want to catch that. We want to catch how we go into anxiety and respond in that compulsive way. As I said to you at the beginning of this episode, I think that I was for many years doing this very nuanced compulsion of over-checking schedules and even being super neutral and kind to people so that I would never offend them. Stripping my personality down just so I would never harm them or never hurt them, which is not me being authentic, and I can see that now. So, these are the things I want you to think about. And then once you identify these strong emotions – again, we've looked at guilt, we've looked at shame, we're now looking at anxiety – the job is to ride them out, let the anxiety burn out on its own. We don't need to tend to it. It happened because we're human and we're going to allow it to rise and fall on our own. So, here is where I want you now to, number one, give yourself permission to be a human. Humans screw up. It's a fact. It's something we have to accept. How can we be in these situations and change the way we react so that we are not beating ourselves up and we're not overcorrecting for the future? The only last thing I'll say here is, if you're trying to control what people think about you, you're never going to win because what they think is a reflection of them. So, here is the last point. I screwed up. It's just a fact. I put other people out. My mistake is probably going to interrupt some people's time next week. I don't like that. That doesn't line up with my values, but it is what it is. There's not a lot I can do. But what they think about me is completely a reflection of them. So, if let's say this one person goes, "Oh my gosh, she is such an unorganized person and is horrible," that really shows the degree in which they're judgmental. Meaning they haven't allowed me to show them that I'm more complex than that, that I have many other qualities, and so forth. If they were to say, "Oh my God, you're fired, you're terrible," again, that's not a fact either. And that's a reflection of them and their struggle to be flexible and find solutions and so forth. Not that they're bad, it's just it's more of a reflection on them because, in this situation, the people were very kind and they said, "We'll work it out. We'll see if we can reschedule you to be later on in the day," and that it really was a reflection of how flexible they are. So, I want you to really remember here that you making a mistake doesn't make you good or bad. Their judgments about you doesn't define whether you're good or bad or that they're good or bad. It's just we're doing the best we can and it's just it is what it is. So, that's it, guys. We make mistakes. It's terrible. I know it's hard. It's really painful, but can we hold space for the pain and the emotions associated and ride them out without beating ourselves up? That's the real question. Have a wonderful day, everybody.

Jul 8, 2022

SUMMARY: In this episode, we explore how to manage uncomfortable sensations. Many people do not struggle with intrusive thoughts and intrusive images, but instead, struggle to manage intrusive sensations. My hope is that this will give you some tools to manage these uncomfortable sensations and help you reduce how many compulsions you do to reduce or remove these feelings. In This Episode: What is an intrusive sensation? What is the difference between an uncomfortable sensation and an intrusive sensation. How to manage uncomfortable sensations such as rapid heartbeat, tingling limbs, numbness, lightheadedness, chest pain, etc. Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 292. Welcome back, everybody. Today, we are talking about something that I very rarely talk about that I should be talking about more because it's like 20% of the conversations I have with clients. And I'll explain to you why in just a second. First, I'm going to do the review of the week. This one is from Linelulu. And they said: "Grateful. I am so grateful that I stumbled onto your podcasts. Your soothing voice enhances your messages as I am trying to understand more about anxiety, and panic attacks to be a better support for someone very close to me. Thank you!" You are so welcome, Linelulu. Thank you for that beautiful review. Please, I know I ask you every single episode. If you benefit from this podcast, this is one way that you can help me. So, if for any reason you feel like you have a few spare minutes, please do go and leave a review. The last thing before we get talking about sensations is to do the "I did a hard thing" of the week, and this one is from Camille. Camille says: "I've been managing my dermatillomania ," which we also know is compulsive skin picking, "very well. However, I had a very stressful day and picked my skin pretty bad, in my opinion. I had a party to go to that night with a bunch of people. I didn't know. And I almost didn't go. But I pushed myself to go and no one said one thing about my skin. I'm so glad I went and got over the fact that my skin needs to be perfect in that instance." Camille, this is so good on so many levels, that you showed up and you did the thing that you wanted to do. And ugh, it's so good. And how wonderful that you had supportive friends. Again, we sometimes were really hard on ourselves and we think people notice everything about us, every flow, but how wonderful that they embraced you and no one said anything. So, thank you so much for Camille for putting in that "I did a hard thing." I just love hearing you guys doing all the hard things. Now, why do we do this segment? Let's just go back and look at that. So, most of you know that the thing I say all the time is "It's a beautiful day to do hard things." Our brains naturally default to this idea of like, "No, I shouldn't do the hard thing. I should do the easy thing." Marketing keeps telling us don't do the hard thing, do the easy thing. Commercial advertising is always sharing the easy five-step way to do something. And we want to flip the script because while it's good to have things be easy, when it comes to anxiety and these kind of conditions that we're often talking about, it's often important that you stare that scary, hard thing in the face. Now, that is the perfect segue into this week's episode about sensations. Now, at the beginning of the episode, I said it's crazy that I haven't done a lot of these episodes because sensations is 20% of the work. Now, why did I say that? In total, the clients that I see and that my staff see in our private practice, they're coming to us for one of five reasons usually. They either have an intrusive thought that they don't know what to do with, they have an intrusive feeling that they don't know what to do with, they have an intrusive urge that they don't know what to do with, they have an intrusive image that they don't know what to do with, or they have an intrusive sensation that they don't know what to do with. Five things. 99.9% of our patients and of the people that we help come with one of those five problems. It doesn't matter what you call it. They're coming with, "This is the experience that I'm having." That's so overwhelming and difficult and hard that then they go on to do behaviors to try and manage it, and we teach them how to manage those five things in a way that doesn't require them to do the behaviors that cause them trouble. So, let me give you a little more information about that. So, when we're talking about sensations, we're talking about-- let's first get a definition. What is a sensation? A sensation is a physical feeling or a perception resulting from something that happens or that comes into contact with the body. So, really what we're saying is a sensation is an experience you have in your body and it's very specific. So often when I'll say to a client, "Okay, how can I help?" they'll say, "Well, I'm anxious." And I'll say, "Okay, tell me about your anxiety." And they'll then usually go on to say, "Well, I'm having these thoughts," or "I'm having these feelings," or "I'm having these urges. I'm having these images," or "I'm having these sensations, and I don't like it. They make me uncomfortable." And when I have them, I do these again, like I said, behaviors that kept me into a ton of trouble. Meaning they've got big consequences. So, often a sensation we consider to be an obsession, just like an intrusive thought, is an obsession. It's as relevant. And it's important if someone has anxiety for us to go, "Okay." This is a common question. If you were my client, this is a common question I ask. I'll say, "Imagine that I'm an alien and I've never, ever once in my life experienced anxiety, and I want you to tell me what it feels like because it doesn't make any sense to me." And often clients will struggle with this because they'll be like, "Well, I just have anxiety." And I'll say, "No, we need to understand what specifically, how do you specifically know you're anxious?" "Oh, I have tightening in my chest or I have shortness of breath, or I have a lump in my throat or I have these butterflies in my tummy." So, immediately, once we get that, we're like, "Okay, now we know what we're dealing with. Okay, now we have specific sensations and now we can develop tools around them so that when you have them, you don't either engage in avoidant compulsions or physical compulsions or mental rumination or reassurance or self-punishment." So important. Now, let's slow down here a little and look at what that looks like for many of my patients and many of you. So, this is not scientific, what I'm about to tell you. This is really just coming off of my stream of consciousness and my experience as a clinician, is I've broken them down into four main sensations that my patients report to me. Again, this is not a clinical list. So, I want to preface. I don't want to ever mislead you into thinking this is scientific. But often one of the sensations that people will feel are physical experiences of anxiety, like I listed. It could be butterflies in your tummy, tightness in your chest, as I just said, and I've listed them off. The next one is specific sensations around what we call depersonalization and derealization. I've done full episodes on those in the past. So, go back and check them out. But this is the experience of this weird feeling. The sensation is like, everything feels strange. I feel like distorted, like I'm in a daydream. It feels very hazy and strange, or I feel like I'm outside of my body. Now while we have words to describe derealization and depersonalization, they are also at their most basic form of sensation, a basic sensation. So, I put that in its own category. The next one is similar to anxiety and derealization and to personalization, but I've put them under the category of panic. Now, the reason that it's so important for us to talk about sensations is, people who have panic disorder are very sensitive to the sensations that they have because panic is such a 10 out of 10 anxiety. So, it's like can't breathe, racing thoughts, major overwhelmed, dizzy, sweating. These are all sensations. These are all things that we perceive or we experience in our body. And then the last one is physical pain. This is a sensation too. When you physically have pain, a tummy ache, that's also a sensation. Now, let's talk about why I separated those, because I'll give you a really perfect example of how this gets messy. Most of you know that I have postural orthostatic tachycardia syndrome, which is symptoms of dizziness, lightheadedness, headaches, stomach troubles. And often if you stand for too long, you faint. Now, what does that sound very similar to? You guys are probably laughing at me already. Anxiety. It looks exactly like anxiety except the fainting piece, dizziness, lightheadedness, stomach aches, headaches. So similar. And so, when we have, and this is where it gets difficult, when we have a chronic illness or if we have health anxiety, when we experience a sensation, sometimes we can't figure out whether it's real pain and real threat or if it's anxiety. The thing to remember here is the response needs to be similar. So, for me, when I had dizziness and lightheadedness, yes, of course, I'm not going to push myself to a place where I pass out, but I'm going to first stop and go, "Hmm, let me try to dip into these sensations. Instead of catastrophizing them as this is terrible and bad things are going to happen, I wonder what would happen if I just labeled them as a sensation." The thing here is, when we have sensations, and you're having them right now, believe it or not. It could be an itch. It could be a muscle that's sore from a workout you had, it could be a stomach ache because you just ate an amazing dinner and you just had a little more than you wish you had, or you're having anxiety. We all have them. Where we often get into trouble is when we label them as good or bad. So, that's the main point here first. Are you labeling your sensations as good or bad? When I would have my POTS symptoms, I get dizzy. At the beginning, I go, "This is bad, this is bad. Bad things are happening," which would then give me anxiety, which would make it worse. And now I've got this hot mess. Massive hot mess. Same for people with health anxiety. They have tightness in the chest and they go, "Oh my God, I'm dying. I'm having a stroke," or "I'm having a heart attack." And when we label it as bad, we get more anxiety, which makes it worse, and now we're in a cycle. If you're having a panic disorder and you're starting to notice that small little tingle of anxiety coming up, this like whoosh of anxiety that whooshes over you when we have a panic attack, and you label this as, "Oh, this is bad, this is terrible. I got to get it to go away," you can bet your bottom dollar, it's actually going to feed you more anxiety. So, question whether you are labeling your sensations as good or bad. Now I'm guessing some of you are thinking, "Well, Kimberley, of course, I'm going to label it as bad. It is bad. It's terrible. I don't like it." And I get you. But we're here to learn. We're here to grow. We're here to recover. So, I want you to think beyond that judgment and look at first the judgment doesn't help you. Whether it's true or not, it's not helpful. It makes it worse. So, let's work at being nonjudgmental about the sensations that we have. The response we have to your sensations can determine whether you get stuck in a cycle of having more discomfort. Let me rephrase that in a different way to make an even bigger point. The response you have to your sensations can determine whether you have anxiety about them in the future. Because if you treat the sensations today like they're dangerous and harmful and they require immediate emergency, you're training your brain to perceive those sensations as scary and bad and dangerous. And so next time you have them, your brain is going to send out a whole bunch more anxiety. So important. I've had my share of panic attacks in my life, but when I have them and if I'm like, "Oh, dear God, please don't," I know my brain is going, "What, what, what? What's wrong, Kimberley? Why are you telling me this is terrible? Okay, it is terrible. I'll keep sending out anxiety." But when I can respond by going, "Good one, brain. It's cool. There's no amount of sensations I can't tolerate. It's fine. I'm going to ride it out." Again, we don't know how to bypass it with positivity by going, "It's great. I love it." We're not saying that. But we are saying if we can reframe the sensation as tolerable and manageable, you're less likely to have anxiety about the sensation tomorrow. Now, I know a lot of you may be asking, "But how do I know when it's something to just be uncertain and nonjudgmental about or when I should rush to the hospital and so forth?" Number one, you'll know. But the other piece, I don't want to discard you on that one because that's hard to say, especially if you have anxiety, especially OCD and health anxiety . But the other thing is, for me, if I'm having it and I'll use me as an example, if I'm having dizziness and lightheadedness, which could be anxiety or it could be my POTS, I just keep on the deferring. I keep on deferring like, "Okay, can I just stay with it nonjudgmental for another few minutes?" If I'm getting to feel really horrible, of course, I'm going to sit down and take a rest. I'm not going to push through and be unkind. But I just keep being curious. Could I it do a little longer? Could I have a little more? Could I be nonjudgmental for another few minutes? It's so important because when it comes to anxiety, the way in which we respond to the sensations is as important as how we respond to intrusive thoughts. Particularly like I said, if you've got depersonalization, derealization, panic disorder, physical pain, generalized anxiety, health anxiety, so important. If it's social anxiety, it's a big one because a lot of people with social anxiety have an aversion to the sensation of being flushed in their cheeks. But if you respond to your cheeks flushed as bad, you're probably going to get more of it. It's paradoxical. Now, here is one other point I want to make before we finish up, which is there is no sensation you can't ride out. This was a huge one for me because I've had anxiety and I've had some pretty bad chronic illnesses. If I go into the day telling myself, "I won't be able to handle it," I usually have anxiety about the day. Have you noticed that? I know you can't answer back, but I really want you to consider the question. Do you notice that in your experience? When you tell yourself "I can't handle things," does that actually then create more anxiety for you? And sometimes more depression too, if I can be completely honest. Last week, we did a whole episode on depression. I think it's really important to recognize that. Even I should say other sensations are like depression , that's that sinking, dark, gray sensation that goes with having depression. I should put that there as the fifth type because that's a sensation that can be scary too. Grief can be an experience that-- there are sensations associated with grief that feel intolerable. But when we tell ourselves we can't tolerate them, we actually then create more anxiety and depression. So, these are things to think about when it comes to sensations. Now, if you were in an office with me or one of my staff, we are most likely to say, at the end of the day, you're going to have to say, "Bring it on." Once you identify the sensation, it really comes to, do you avoid it or do you say it's a beautiful day to do this hard thing, to experience this hard thing? And so, we would say, "Bring it on." Now, in ERP School, we talk about this. I probably should do an episode on this. Let me just actually write myself a note to episode on this. If someone really comes to our office with a stronger aversion to certain sensations, we do what we call interoceptive exposures. We talk about this in ERP School. It's an online course. But an interoceptive exposure is where we purposely expose you to the sensation that you're avoiding. So, examples might be, if you really don't like dizziness and you're doing things to avoid dizziness, we would sit you in our chair and we would spin you around 30 times and then we'd walk the hallway ways with you while you're dizzy. If you're afraid of shortness of breath, we would give you a very small straw. One of those straws that you use to stir your coffee with, and we would have you practice breathing through that so that you, on purpose, tolerate the feeling of having shortness of breath. If you really don't like the feeling of shortness of breath, like tightness in your chest, we might wrap a bandage around your chest, so tight that it feels like you can't breathe, just for a few minutes. We're not here to torture you. But these are examples of interoceptive exposures that we do because not only are we like "Bring it on," we're like, "Let's have more of it." Let's practice doing it so we can practice nonjudgment, we can practice non-aversion. We can practice saying I can handle this and learning that we can handle this is cool. So, so cool. That's the thing. So, depending on where you are and how severe you are in your aversion to sensations, there are multiple ways you can respond. I want you just to use this episode as an opportunity for you to check in, where are you in respect to your experience with sensations? Do you have aversion to them? How willing are you to feel them? Questions are my favorite, you guys. You know this about me. So, ask yourself these questions. So important. All right. That is it for sensations. I hope that is helpful. I know I took you on a couple of meandering tangents there, but I hope you stayed with me. I love talking to you about this stuff and I hope that that did give you some clarity on how you may handle it in the future. All right. I will see you next week. Have a wonderful, wonderful day, and don't forget, it's a beautiful day to do hard things. I'll talk to you later.

Jul 1, 2022

SUMMARY: A few months ago, I posted on social media and asked "What are your best tips for depression" and the response was incredible. Hundreds of people weighed in and shared their best tips for managing depression with OCD and other anxiety disorders. In This Episode: Hundreds of people with depression shared what skills they use to manage OCD and depression What skills can become compulsions How to manage day-to-day depression when you are feeling hopeless (OCD hopelessness) Links To Things I Talk About: Kimberley's Instagram Page https://www.instagram.com/youranxietytoolkit ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit Episode 291. Welcome back, everybody. So, I want to set the scene here because things are shifting. Things have shifted. So, I am right now sitting in my office, which is in Southern California, in the United States. But as this launches and goes live, I will be in Australia for the summer. I think I've talked to you guys about this in previous episodes, but my husband and I made a decision that the children and I will go to Australia to see our family for the entire summer. Oh my goodness, what a huge undertaking, but we're doing it and I am so excited. So, really, I've had to batch 10 episodes ahead of time. Now, what I've done is I've done my best to make these the best episodes I can batch for you, like the things that seem to be coming up the most for my clients, the questions my staff seem to be asking the most, and the things that everyone seem to be really, really liking and appreciating on social media. And so, in preparation for today, I was thinking about what's one of the most helpful, most enjoyed, and engaged posts on social media, because I do spend a lot of time over on Instagram. And by far, interestingly by far, my most popular post I have ever made in the whole history of me being on social media is tips on managing depression. What? I'm an OCD and an Anxiety Specialist, but yet my most popular post in the whole time I've been there is on managing depression. So, that's what we're talking about today. Now, in order for me to do 10 posts, 10 podcasts, excuse me, in order, I've had to manage my time down to the minute because right now we are leaving in 18-- no, what is it? Not 18 days. It's like 15 days. So, we're leaving in 15 days. I have all of this in addition to the work because I usually just do these here and there. I've had to manage my time, and what I have relied on the most is managing my time using what we call "calendaring." I talk a lot about this on my online course. If you go to CBT School, we have a whole course on managing time. But the reason I also share that with you is as we talk about skills today, we're going to be talking about cognitive skills and behavioral skills. And if you have depression, I strongly encourage you to go and sign up for that course. It's not an expensive course. It's jam-packed with how to schedule your time so that you can lessen the heavy load that you're carrying or the time about the lists of things you have to do and get done. So, I do recommend you go check that out. Go to CBTSchool.com and I think it's /time management. Yes, it is. We're about to get into the show. First of all, let's do the "I did a hard thing." This one is from Anonymous and it says: "I stopped driving and spending time with children because of OCD. But yesterday, I drove my little sister to school. I was scared, but I'm so proud of myself. Thank you, Kimberley." This is so good. I can't tell you how many people when they're anxious, they stop driving. It's actually a really common question I get on social media. It actually surprised me at first in that how common it is. It's one of the first things people stop doing, is driving. So, Anonymous, amazing. You are just all for the correct courage and all for the bravery and I'm celebrating you right now. That is so, so amazing. Great, great job. And one more thing, let's do quickly a review of the week. This is from Robin. Robin says: "I'm not sure how to condense all of my happiness and thanks, but I'll try. Was recommended to listen to your podcast by my therapist (who is just superb and I'm grateful she exists) and I instantly fell in love with your genuine desire to help which seeps through the sound waves. I am hooked on the real-life stories that I can connect to my own experience and have gotten my sister hooked as well who struggles with anxiety as I do. Thank you for your tools and support!" Thank you, Robin, for that amazing review. Please do go over. And if you listen to the podcast, leave a review. It does help me help other people and more than ever, that is my biggest mission. Tips to Manage Depression (From Hundreds Who Have Been There) All right, let's do it. So, let me just give you a little bit deeper context here. So, what I did is I did a poll on social media. So, just to give you some context, I have around 75,000 followers on social media. So, I posted: "Please just give me your best tips for managing depression." Hundreds of people wrote in and the reason-- I don't give you the numbers because I'm bragging. I want you to know this is not just from me. This is from hundreds of people who weighed in, who've been there, who've had depression and they shared little nuggets of what has helped them. And I want to-- in fact, we actually had to split this post into two because there was just so many submissions that we couldn't fit them all in one post. So, here we go. The number one tip for managing depression and these aren't in order, by the way, this is not the one that was most popular. This is just as we went through, these were the ones that seemed to be really coming up for the same a lot of people. The first one is-- this is going to be a fun one for you, is many people reported that having a dog or a cat or a pet helped them to feel like they had a purpose in the world, that they were there to take care of someone, and that that pet gave them an incredible amount of love. I loved this one. What was interesting, I'll give you feedback right away, is there was a little controversy and feedback around this. A lot of people were saying, "Please don't encourage people to get a pet just because they're depressed. Taking on a pet is a huge responsibility." There was a little controversy, a little backlash, I would say, over that point. But I really do agree that those who do have a pet and can commit to taking on a pet have found that that's really helpful for their mental health. Most people said having a pet is the most mindful they are in the day when they're petting their pet, feeding their pet, cuddling with their pet, listening to their pet, and so forth. So, that I thought was an amazing, amazing tip or thing you could practice. Number two, probably again, one of the most important from a clinical perspective is exercise . Now, yes, I know, it's hard to exercise when you're depressed, but we do have a ton of research to show that exercise is in fact as effective as an SSRI. Not to say you shouldn't be on an SSRI. I actually am on all four meds. But exercise is an additional benefit. And so, I strongly encourage everyone to at least get out. It doesn't have to be strenuous, but around 25 minutes was what most people who have depression said, that was the ideal amount. If you get to that point, you actually get more benefit, which I thought was really cool. The next one is: Practice mindfulness . Now again, so helpful. If you have depression, usually, I'm going to guess, your mind tells you a lot of lies, a lot of horrible lies, a lot of absolute painful lies. And a big part of managing it is using what we call mindful-based cognitive therapy. And so, what we mean by that is, first, we are aware and we just observe thoughts as thoughts. We don't take thoughts as facts. And then the cognitive therapy side is once we identify that we've had a thought, we may actually stop to correct it. So, if your brain says, there's no point, you're a waste of space or the future is going to be nothing but terrible or my life is nothing but terrible – when it tells us these lies, we can actually stop and go, "Okay, now, number one, that's a thought and I'm going to observe that thought nonjudgmentally." And then you can also go, "Okay, let's actually check the evidence for that depressive thought. Hmm, do I bring purpose into the world? Is the world going to be terrible?" and look for maybe some holes in this theory and start to be curious about whether that's in fact correct. It's so important. Mindfulness . I personally think these two, the exercise and the mindfulness, are key, are major keys to managing depression. The next one that was suggested by a lot of people was to talk to family and friends, even if they don't fully understand . And I loved that little caveat to go on. As much as depression makes you want to isolate and shut down, make sure that you are going and you're just connecting with them. You're talking with them, you're sharing what you're going through, even if they don't understand, because the truth is they won't. Even if they've been through what you've been through, they won't fully get it. They're not the ones getting fed the lies of depression like you are. Or if you're a family member, I want you to understand it's really not helpful to say to someone with depression, "I totally get what you're going through," because the chances are you don't. But that doesn't mean that we can't relate on some level. That doesn't mean we can't connect and support each other. So, important. So, so important. This one was an interesting one. And I want to-- some of these surprised me, but lots of people reported that attending couples therapy, couples counseling , if you're in a relationship, was helpful for their depression. Now, I wonder if that is because maybe their relationship was a part of what's very difficult for them, but I can see the benefit in that. I don't talk about this very often, but I personally love couples counseling. I have no problem admitting that we've been to couples counseling before. It is thebomb.com. It is such a beautiful thing to do with your partner. Is it hard? Yes. Is it bumpy? Yes. But there's something really cool about knowing that you're showing up to the same place every week with the same goal, which is to strengthen your relationship. That in and of itself is just really, really cool. And a lot of people responded saying that that was really helpful for their depression, which I thought was really cool. Next one, you guys aren't going to be shocked by this, and I definitely wasn't, which was to practice self-compassion . You guys, depression is nasty. It tells you nasty. I'm doing everything I can not to swear here, but it's like BS. It tells you such nasty BS. And one of the best insurance policies against that, or one of the best defenders against that, or I should say offense, the offense against that is to practice compassion for yourself, to practice being kind and respectful and being tender to the suffering that you're experiencing. Because believe me, I do know, I've experienced depression throughout different parts of my life. It's horrible and it feels-- the only way I can explain it is you can't understand it when you're in depression because you're in depression. But once you're out of the depression, for me, it felt like someone had pulled this gray veil off my head that I didn't even know was there until I'd come out of a depression by going to a lot of therapy and so forth. And I was like, "Whoa, I had no idea everything was under a gray veil until the gray veil was lifted." So, that compassion piece is really important because I didn't know the depression was there until the depression had lifted, if that makes any sense. And had I known it, I probably would've been much, much, much kinder to myself. Next point, I love this. It's very similar to what we talked about before, but it says, no matter how much you don't want to, get up and move your body . Now, I could have easily put this under the category of exercise. But a lot of the comments weren't-- this wasn't talking about exercise. It was saying, stand up and stretch was one of them. Just stand up and swing your body around, move it around, get into the flow, let the blood flow around your body. And they were saying that that is a shift in mentality. It's a shift in mindset. I know even today as I'm recording all these episodes, I'm going to need to practice this, because if I just stay here and I stare into this microphone and I'm looking at the screen, my brain is going to get a little distorted and strange. I'm going to have to go upstairs, shake it off, get a cup of tea, move around. And so, I love that they distinguish this separate from exercise. Next point, oh my gosh, this is gold right here. It says, do something you used to enjoy . Now, when we're depressed, often nothing feels enjoyable. Even food isn't enjoyable anymore, or company might not be enjoyable. The things you used to love, the vibe is gone. But what a lot of people were saying, and this is again from people who've had depression and managed it, is they were saying, whether or not you enjoy it now, continue to do the things you used to enjoy, but also spread out. This is one thing I didn't mention here, is a lot of people said, be curious about little things that you used to enjoy that you never really developed as a hobby. So, an example would be, I think somebody said something to the likes of like, I used to love hopscotch. Of course, they loved it when they were very, very little. So, as they got older, of course, they stopped playing hopscotch into their adulthood. But they were like, "I literally wrote down a list of everything I used to enjoy and I just did it, whether I've done it for 40 years or not." So, little things. It doesn't have to be grand things. It doesn't have to be hobbies. It could be going, "I remember as a kid, I used to love boba or whatever." Go and get some. Do the things you used to enjoy, even if they're teeny tiny. Another huge group of people said sunlight . Sunlight is a huge part of managing depression. Now, thank goodness for these, my community, because if I was putting together a podcast or managing depression, I would've completely forgotten about the people who have seasonal affective depression because I live in California and I wouldn't have thought of that. But so many of my followers are from all around the world and hundreds of people responded saying, you have to get sunlight. You have to get exposure, UV lights. There are all these really cool exposure lights that you can talk to your doctor about getting. So, thank you to everyone who wrote this in because I would've forgotten that. And for me too, what I will say is I work indoors a lot. I work at my desk a lot. Most of you know I am running two separate businesses at once. My private practice and CBT School. So, the days where I don't just-- even if it's go outside and sit in the sun while I have a cup of tea for 10 minutes, I do notice a shift in my mood. Again, don't do too much. We don't want you to get sunburn. We don't want you to have too many exposures to UV rays. But I do believe there's such a benefit for mental health. Okay, next one. This one is amazing. So, many people wrote some variation of this, but we pulled it into this one point, which is write a list of "I can" statements . Meaning, when you're depressed, depression will tell you can't. "You can't do that. You can't do this. What's the point of doing that? You can't. Don't do it. You won't do it. Don't do it." And so, a lot of people were talking about writing a list of either your strengths or your characteristics or things that you can do. And I think that that is such an amazing shift – to write a list of I can's. I can work out. I can call my friend. I can get some sun today. I can go to therapy. I can play with my dog. It's very similar to the term "should." That simple move of saying "I should exercise" to "I could exercise" like "I should be kinder to myself," or you could say, "I could be kinder to myself," those small shifts in sentences can make such a difference. So, I like either of those. Next one, appreciate the little things you do for yourself . You might start to see a trend here. When you're depressed, the big stuff feels really hard. So, you got to zoom in on the little stuff. And they were saying, appreciate the little things you do for yourself. So, an example might be, "It's really nice that you made yourself a cup of tea before you recorded these podcasts, Kimberley," or "Wow, it was kind of you that you bathed today. Great job. Making sure you ate breakfast. Great job. Getting out of bed today." Often with depression, we go, "Oh, that's stupid. Why would I celebrate getting out of bed? Everyone gets out of bed. I'm such a loser because I can't get out of bed." I mean, that's the mindset of someone with depression. And so, we want to shift that away from such critical voices and going, "Good job you got out of bed. That's a big deal when you're depressed. Good job on brushing your teeth when you're depressed. That's a big deal. Good job on saying no to that thing you didn't want to do. That's a big deal." Really, really important. I have three left. The third last one is, take your medication . Hundreds of people wrote this in and I just loved it. It filled me with joy because whether you choose to take medication or not is entirely your decision. But 10 years ago, I remember when I was-- 15 years ago when I was starting to do my internship, there was this article. I think it was like a USA Today article or something, and it was talking like, let's take the stigma out of medication. And so, great. We're starting to have those conversations. But to see now how the response was of like, "Just take your medication," it just really made me feel joyful that maybe that means there's a little less stigma about it, and I really hope that I help you to take the stigma out. There's absolutely nothing wrong with taking medication. In fact, I'll tell you a quick story about myself, when I-- you'll probably remember I went through a period in 2019 and 2020 where I was very, very sick and I had severe depression alongside it. And I remember the doctor saying, "Okay, we'll prescribe you such and such for this condition and such and such. And we'll prescribe you an SSRI for your depression." And he didn't really even ask if I was depressed, he just prescribed it. And I was like, "What? You didn't even ask me if I was depressed." And he goes, "No, no. Most people who have POTS," I have pots, "they get depressed." And I was like, "Huh, that's interesting." And I thought to myself, okay, I don't-- for a second, I thought, no, I don't really need it. But then I was like, "You know what? What a gift to give myself the help. If it's going to help, I'm going to do it. What a gift." Not that I'm at all encouraging you to take medication, but I just want to share with you my experience. I could have seen it as like, "Oh, I'm so bad. That's weak and that's lazy and I should try without it." But I was like, "You know what? I'm really not well. I'm going to take all the help. And if one form of the help is to take a pill, I'm going to take a pill." I'm not going to tell myself a story that that's lazy. In fact, I'm going to say that's pretty badass, that I would accept the help. I'll get going. Sorry, I had to tell you that really important story from my perspective. All right. Two to go. Second last one: Surround yourself with people who help keep sight of what's important . This is important. If you're depressed and you're surrounded by people, whether it's physically or on social media, people who are very materialistic or they are striving towards things that actually make your depression worse, find different people. You want to find yourself around people who strive for similar things that are aligned with your recovery. I'll tell you again a different story. As a business person, I love business. I really do. I love being a therapist, but if I wasn't a therapist, I'd go to business school because I just love it. But I notice that if I'm hanging around with other people who are business-minded, it can get really icky and the messages can get really gross. And I can find myself falling into this trap of winning and wanting more. I was finding that I was starting to be hard on myself until I caught this and was like, "Whoa, I need to unfollow these people because this is not good for my mental health. I need to surround myself with people who have the same goals, like what's important as their goal." And that was really, really monumental for me. So, do an inventory of your friends, your family, your social media, your colleagues, and try to only surround yourself with people who support your recovery. Last one is, when you're having this feeling, don't numb it out . I'm leaving this at the end. I probably should have put it at the front, but don't numb it out. It's okay. Sometimes you will need to turn your brain off and watch some TV. But if that's all you're doing to manage your depression, the chances are you're going to get more depressed. That's why I keep talking about scheduling and calendaring. Because often when we're depressed, we want to just stay in bed and numb the feeling out. Sleep all day, watch TV just to numb the depression. But that only makes it worse. And this is the behavioral piece of managing depression, which is one of the gold standard treatments for depression is what we call time blocking or activity scheduling so that you schedule your day. Nothing heavy, nothing crazy. But you do that so that in doing that, you actually reduce your depression because you feel accomplished and you don't feel like the day was a complete waste. Again, there's a balance. You don't want to overschedule, but you do want to engage in the day. You want to make sure that you've got things planned. So, don't numb. Try to activity schedule. If you need help with that, head over to CBTSchool/-- sorry, you'll go to products and then there'll be time management there, or CBTSchool/timemanagement . You can learn that in that course. It's a really pretty cheap course and it's pretty quick. It's like a two-hour course and I walk you through exactly how I do it. All right. So, that's it. There are tips for managing depression. There's like 12, maybe 15 of them. They're from hundreds of people who have been there. I just love this community so much. If you haven't followed me on social media, head over to Instagram under Your anxiety Toolkit, and I'll be there. Thank you. All right. Have a wonderful day. I will see you next week. Next week, we're talking about sensations and anxiety and panic. So, I'll see you there. Have a good one, everyone.

Jun 24, 2022

In This Episode, we discuss: Is it important that you stop doing all your compulsions? How can I practice Self-Compassion as you move through recovery? How can you balance facing fears and also being gentle on yourself? Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 290. Welcome back, everybody. 290, that sounds like a lot of podcast episodes. It's funny. Sometimes I don't think of it. If you have asked me on the street, I'd say, "Yeah, I'd have about maybe 110 in the can." But 290, that is a lot of episodes. I do encourage you to go back and listen to them, especially the earlier ones. They're my favorite. But no, go back, play around, check out the ones that you love. There's probably some things there that you could probably go back and have a good giggle at. All right. We today are talking about a question that came from a student in one of my courses. I've found this question to be so important. I wanted to bring it in and have it be a podcast episode because I think this is a very important question and I think it's something we can all ponder for ourselves. Now, before we go into it, I would like to give you the "I did a hard thing." This is a segment where someone shares a hard thing that they've done. And I love the "I did a hard thing" segment probably as much as anything. This one is from anonymous and they said: "I have contamination OCD. And one thing I've avoided for a very long time is raw meat and eggs. Over the winter, I discovered that ERP is so much EASIER (and I use this term very loosely in capital letters) if my exposures are value-based." This is so good, Anonymous. "So I decided that I wanted to be the mom that baked with her kids, anxiety be darned. I wanted my kids to have warm memories baking in the kitchen with their mom as the snow fell. So each week over the winter, we picked a new recipe, and over the weekend we made it as a family. The first time I cracked an egg, my husband took out his phone and took a picture. He was so proud. The exposure was still hard and I didn't feel calmer at least while baking, but I tried my best to present and enjoy the time with my kiddos. Later, my son brought home A Joy Is book made at his school. Each page had something on it that brought him joy – fishing with dad, some are vacations. And there on the page." Oh my God, Anonymous, I'm getting goosebumps. "There on a page was 'making cookies from scratch with mom.'" Oh my God, I think I'm crying. Oh my goodness. I have goosebumps everywhere. "It is so hard to measure success with ERP sometimes, but that gets real, tangible evidence that I had accomplished something and it felt so good." Holy my stars, Anonymous. This is incredible. Wow. This is what it's all about, you guys. This is what it's all about. For those of you who are listening, I don't read these before the episode. I literally read them as just I pull them up and I read them. This one has taken my breath away. I just need a second. Oh my goodness, that is so beautiful. So beautiful. Thank you for sharing that. Oh my gosh, that is so perfect for this week's episode. All right, here we go. This week's episode is about a question, like I said, is it okay to keep doing some of my compulsions? Again, this came from one of the courses that we have. We have two signature courses for OCD. One is ERP School, and then the other one is this Mindfulness School for OCD that teaches mindfulness skills . Now, the reason I love this question is, they're asking me as if I am the expert of all things, OCD. And I want to let you in on a little truth here – I am not. You're probably like, "What is happening? She's been telling us that she's an OCD specialist all this time. And now she's telling me she's not the expert." I am not the expert of you. And I want to really make sure that is clear. Anytime someone says, "What should I do? What's the right thing to do for me?" I try my best not to tell them that is best for them because I'm only telling them what I think is best for them. That doesn't mean it's the facts. So, I want to be very clear. I am not the expert in you. You are. You do get to make choices of your own. That being said-- and I'll talk more about that here in a second. But that being said, let's look at the question and just look at it from a perspective of just general concepts of OCD. Now, in the beginning of ERP School, we have a whole module that explains the cycle of obsessions and compulsions. I draw it out on a big sheet of paper, like this huge sticky note. And it's actually really funny because I'm trying to squeeze myself into the frame of the video with this huge sticky note. When I think back to it, it makes me giggle. But here let's take a look. The thing to remember here regarding this question is, if you have a fear and the fear is what we call egodystonic, meaning it doesn't line up with your values, you know it's a fear, and you know it's probably irrational. If you have this fear and you respond to the fear as if it is dangerous and important and urgent, you actually are keeping your brain afraid of the fear. And you're continually keeping your brain stuck in a cycle where your brain will set off the metaphorical fire alarm every time it has that fear. When you have fear and it doesn't line up with your values and you have the insight to see that it's irrational or that it's keeping you stuck and it's not effective for you and not responding anymore, your job is to practice changing your behaviors and your reaction to that thought so that you can train your brain not to set the fire alarm off next time. It may take several times or many times. But again, if you have a fear and you respond to it like it's important, your brain is going to keep thinking it's important. If you have a fear or an obsession and you keep responding to it with urgency, your brain is going to keep interpreting that fear as urgent, serious, dangerous, scary things. So, I'm always going to encourage my patients and my students to always check in on this one golden question, which is, what would the non-anxious me do? Or what would I do if I weren't afraid of this thought? Or another question is, am I responding from a place of fear, generally? And if that's the case, then I would encourage my patient to really work at reducing that compulsion because the compulsion keeps the cycle going. Now, that being said, still, again, I'm going to say, under no circumstances do I get to tell you what to do. Only you will know what's right for you. And I have had clients, I will say, I've had clients where they've written out their hierarchy. They've gone all the way to the top. And there's several things at the top where they're like, "No, I'm actually going to keep these ones. These ones are ones that don't interfere with my life too much. I'm comfortable. I'm not ready to face them yet. And so, no, I'm going to keep doing them." And I respect that. Again. I am not the expert on everybody. Everyone gets to make their own value-based decisions. That's entirely okay. I always say to them, going to the top of your hierarchy and cutting back on all of the compulsions is, think of it like an insurance policy on your recovery. It's not going to completely promise you and guarantee that you won't have obsessions in the future or you won't have a relapse here or there. No. And that's okay. That will happen. We're going to actually have a conversation about that here in the next few weeks on the podcast. But you can help train your brain by marking off all those compulsions. So, what I'm going to leave you here with-- this is actually not going to be a long podcast, but what I'm going to leave you with is the actual answer to the question. Is it okay if I keep doing some of my compulsions? Yes, it's okay. You don't have to be perfect. You don't have to win all the challenges. And for reasons that are yours, you get to make those decisions. And really that's your personal decision as well, and-- we don't say "buy," we say "and." And just keep in mind the nature of compulsions. Compulsions keep the cycle going. Just keep that in mind gently, in a tender place. Put it in your back pocket. And here is the question I'm going to leave you on, is ponder why you don't want to stop this compulsion. What's getting in the way? If you're really honest with yourself, what's the reason you want to keep doing it? Does doing it keep you aligned with your values? Is there a way to be creative and strategic in this situation where you can slowly reduce the compulsion, even if it's a baby step? It's so important just to be pondering and asking yourself questions. I have to always stop and say like, "Okay, Kimberley--" I call myself KQ. Everyone calls me KQ. "KQ, let's get real. What's really happening here.?" And I'm not doing it in a mean way. I'm having a heart-to-heart. What's really happening? What's really getting in the way? Are you being honest with yourself? And sometimes you have to have really honest conversations to be like, "Oh, I know. I'm totally giving myself stuck here." And it might take some time before you're ready, and that's okay too. Okay? So, I want you to think about those things. Maybe even write the questions down. Go back and listen, or you can go to the transcript of this podcast. Write those questions down and go back and review them every now and then, because those are questions I ask my patients every single day. Every single day. And the questions I ask myself and the questions I ask my patients are often what defines how successful they are because we're questioning the status quo. And that's what gets them better. Before we finish up, let's do the review of the week. This is from Robyncox and they said: "Thank you, Kimberley. I'm not sure how to condense all of my happiness and thanks but I'll try. I was recommended to listen to your podcast by my therapist (who is just superb and I'm grateful she exists) and I instantly fell in love with your genuine desire to help which seeps through the sound waves." I love that. "I am hooked on the real-life stories that I can connect to my own experience and have gotten my sister hooked as well who struggles with anxiety as I do. Thank you for your tools and support!" Thank you, Robin. Again, I love hearing your reviews and I just love hearing that I can be of service and help you and be a part of your day. I love knowing that people are like taking walks, listening to me and we get to have chats together. It's beautiful. It's really, really such an honor. All right. That's it for Episode 290. That's a lot of episodes, but I think we're doing well. I will see you next week for Episode 291 and we will go from there. Oh, one thing to note. By the time you talk to me next time, I will be in Australia. We are going to spend the summer there this year and I could not be more excited. I'll send you my love from there. Have a great day.

Jun 17, 2022

In This Episode: What is whack-a-mole obsessions? Why do my obsessions keep changing? What is the treatment for fears that keep changing? Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 289. Welcome back, everybody. I am so happy to be with you again. I won't lie. I'm still on a high (that rhymed) from the managing mental compulsion series. Oh my gosh, you guys, I am so proud of that series, that six-part series. If you didn't listen to it, please do go back. I'll probably tell you that for the next several podcasts, just because I am really still floating on the coattails of how amazingly, so wonderful that was. And it really seemed to help a ton of people, which is so fulfilling. I do love-- it's not because of the ego piece of it, I just do love when I know I'm making an impact. It's really quite helpful to feel like you're making an impact. And sometimes when I'm putting out episodes, I really don't know whether they're helpful or not. That's the thing about podcasts compared to social media, is with social media, if you follow me on Instagram @youranxietytoolkit or Facebook, I can get a feel based on how many comments or how many likes or how many shares. But with podcast, it's hard to know how helpful it is. And the feedback has been amazing. Thank you, everyone who's left reviews. What a joy, what a joy. What the cool thing is, since then, it's actually created this really wonderful conversation between me and my therapist. So, for those of you who don't know, in addition to me owning CBT School , I also own a private practice where myself and nine of my therapists were actually, now 10 extra therapists, in the process of hiring a new person. We meet once a week or more to discuss cases. And the cool thing about the mental compulsion series is it brought the coolest questions and conversations and pondering, what would this help this client? How would it help that client? These are the struggles my clients are having. Because as I kept saying, not every tool is for everybody. Some you'll be like, "Yes, this is exactly what I needed," and there'll be other things where they might not resonate with you. And that's totally fine. It doesn't mean anything is wrong. That's because we're all different. But it's really brought up a lot of questions. And so, now I'm actually going to hopefully answer some of those questions in the upcoming podcasts. Today, we're actually talking about what to do when your obsessions keep changing. Because we're talking about mental compulsions and reducing those, and that's actually the response prevention part of treatment, what's hard to know, like what exposures do you do for somebody whose obsessions keep changing or their fears keep flip flopping from one to the other? One week, it's this. Next week, it's that. And then it's funny because a lot of clients will say, "What was a 10 out of 10 for me last week is nothing now. And now all I can think about is this other thing. I was really worried about what I said to this one person. Now, all I can think about is this rash on my arm. And the week before that, I was really upset that maybe I had sinned," or there was another obsession. Again, it's just what we call Whack-A-Mole. We're going to talk about that today. But before we do that, we are going to do the "I did a hard thing" segment. This one is from Marisa. And Marisa is at the @renewpodcast. I think that might be her Instagram or their Instagram. Marisa said: "Last week I submitted my dietetic internship applications. It was a long, stressful process and anxiety definitely came up during it. And I was able to move through and do the hard thing. I kept reminding myself that the short-term discomfort of submitting the application was worth the long-term reward of hopefully getting a step closer to my goal of becoming a registered dietician through completing the internship. Even though there is still uncertainty and the outcome that I have to sit with while I wait to find out the results of my application, I have learned through my ERP work that I can sit with the discomfort and uncertainty. Thank you, Kimberley, for reminding me that it is a beautiful day to do hard things." Marisa, I hope that you get in. I hope that you get all of the things that you're applying for. This is so exciting. And yeah, you really walked the walk. This is exactly what we're talking about when we do the "I did a hard thing" segment. It doesn't have to be OCD-related or anxiety-related. It could be just hard things because life is hard for everyone. I love this. Thank you so much, Marisa. If you want to submit your "I did a hard thing," you may go to my-- it's actually my private practice website where I host the podcast. If you go to KimberleyQuinlan-lmft.com and you go to the podcast link, right there, there is a link that says "I did a hard thing." It's actually KimberleyQuinlan-lmft.com/i-did-a-hard-thing/ okay? But it's easier just to go, and I will try to remember to put this in a link in the podcast. All right. One more piece of housekeeping before we get going is, let's do the review of the week. This is from Sass, and Sass said: "I have had an eating disorder for many years and I spent my adult life trying to understand my compulsions and obsessions. When I found your podcast last summer, everything started to make sense to me. You have given me an understanding and acceptance I couldn't get anywhere else. I look forward to your weekly podcast and enjoy going back and listening to the earlier podcasts as well. Thank you for all you do." Sass, I get you. I was exactly in that position when I had my eating disorder. I didn't understand it. I didn't feel like people explained it in a way that made sense to me. And the obsessive and compulsive cycle really made sense to me. So, I am so grateful to have you, and I'm so grateful to be on this journey with you. Really, really, I am. Thank you for leaving that review. Okay, let's do it. Today, we are talking about Whack-A-Mole obsessions. Now, Whack-A-Mole obsessions is not a clinical term. Let's just get that out of the way. There is nothing in the DSM or there's no-- it's not a clinical scientific term, but it is a term we use in the OCD community. But I think it's true of the anxiety disorder community. Maybe even the eating disorder community as well, where the fears flip flop from one thing to the other. This may be true too if you have health anxiety. It might be true if you have generalized anxiety, social anxiety, where one day everything, it just feels like this fear is so intense and it's so important and it must be solved today. It's so painful. And then for no reason, it goes. And then it gets overshadowed by a different fear or obsession or topic. And what can happen in treatment is you can start to treat one, doing exposure. This was actually one of the questions that came up through ERP School, which is our online course that teaches you how to create a plan for yourself to manage OCD . Some people will say, "Oh, I created a hierarchy. I followed the steps in ERP School. I started working on it and I did a few exposures and I did a few marginals. And boom, it just went away and then a new one came or the volume got turned down." It could be that you addressed it a small amount, and then it went away and got replaced by another. Or it could be that you didn't even get time to address it and it just went to a different topic. And this is really, really distressing for people, I'm not going to lie, because you're just constantly whack-a-moling. You know the Whack-A-Mole game? You're whack-a-moling things that feel super important, super scary, super urgent. And so, what I want to do first is just validate and recognize this is not an uncommon situation. If this is happening for you, you are definitely not alone. And it doesn't mean in any respect that you can't get better. In fact, there's a really cool tool, and I'm going to teach it to you here in a second, that you can use. We use it with any obsession. This is not special to Whack-A-Mole obsessions, but you can use it with any exceptions or if things keep changing. But first of all, I just want to recognize it is normal and it's still treatable. What do you do? The thing to remember here is, when you zoom out, and this is what we do as clinicians, our job as clinicians, and I say this to my staff all the time, is to find trends in the person's behaviors and thinking. And what you will find is, when you're having Whack-A-Mole obsessions, while the content may be different, when you zoom out, the process is exactly the same. You have a thought, a feeling, a sensation, or an urge that is repetitive, that is uncomfortable, that creates a lot of distress in your life. And of course, naturally, you don't want that distress. That's scary. And so, what you do is you do a compulsion to make it go away. It doesn't matter what the content is. It doesn't matter what the specific theory is. This is the same trend. And so, when we zoom out, we can see the trend, and then we can go, "Aha. Even though the content is the same, I can still intervene at the same point." When we talk about this in ERP School, is the intervention point is at the compulsion. And so, the work here is the content doesn't matter. Your job is to catch and be aware, like we've talked a lot about mindfulness, is to be aware and identify, "Oh, I'm in the trend. I'm in the cycle." While the one content has changed, the same behaviors are playing out. So, you catch that. You then practice being willing to be uncomfortable and uncertain about the content, because that's the same too. The same cycle is happening. The thought and the fear create some anxiety, some sensations, and so forth. And then we have an aversion to that. And then our job is to work at not engaging in that compulsion. So, that compulsion might be mental rumination . It might be doing certain behaviors, physical behaviors. It might be reassurance seeking. It might be avoidance. It might be self-punishment. It might be self-criticism. And your job is actually to go, "Okay, it really doesn't matter." And I really want to keep saying that to you. If the fear is, what if I have cancer? What if I'm going to hurt someone? What if I'm aroused by this? What if I have sinned? What if things are asymmetrical? What if I got some contaminant? What if I don't love him enough? It doesn't matter. What if it is not perfect? What if I fail? It doesn't matter. I've just listed some, but if I didn't list your obsession, please don't worry. It's for every one of these. The content for all of them are equally as important. Sometimes what we do is we go, "Oh, that one is okay. But this one is really serious, and we have to pay attention to it." And so, we have to catch that and go, "No, it's all content. It's all--" you could say, some people say it's all spam, like the spam folder. Because when we get an email, we have emails that we really need to see – events, meetings coming up. And then we always have spam, the stuff that's like, "Please send me money for Bitcoin," or something. So, we put that in the spam folder. And so, your job is to catch the trends here, the patterns, and learn how to put those obsessions in the spam folder, no matter what the content. Now, this does require, and here's the caveat, or I would say this is the deal-breaker, is it does require a degree of mindfulness in your part to be aware of what's going on. And this is a practice, like a muscle that you grow. So, what it requires is you have to be able to catch that you are in the content. You have to be able to catch that you are in the cycle that keeps you stuck. And that does require you to be mindful again. And I get it. I'm not saying that you'll ever be perfect at this because I don't know anyone who is. There will be times when you're so caught up in the content and you've been doing compulsions for an hour, two hours, two days, two months and you haven't caught it. And you're like, "Oops, wait. Oops, I didn't catch that one." That's okay. We don't beat ourselves up. Then we just go, "All right, I'm at the point where at least I've caught it. I'm aware that I'm in the content. I'm aware how this is playing out exactly the way that it played out yesterday, but with a different obsession." And then you just move on from there. Don't beat yourself up. But it does require you to strengthen the muscle of being able to catch that you're in the content. And it's what we call insight. It's having the insight to recognize. Now, insight is something we can strengthen with practice. It's not just one and done. It's practice. It's repetition. I have to do this all the time for myself. While I don't have OCD, I do have anxiety and I will catch myself going down the rabbit hole with something until I'm like, "Wait, wait, wait, wait, wait, you've been here before. It looks exactly like what you did on Tuesday where you're trying to figure out something that's not in your control. Kimberley, this is not in your control. You're trying to control something that isn't even your business." And I've seen that trend in me. And so, my job is to catch it. Once I can catch it, then I know the steps. I know, "Okay, I got to let this one go. I got to accept the discomfort on this one. I'm going to have to ride this wave of discomfort. I'm going to have to radically be kind to myself." We know the steps. And once we can get those steps down, it's about catching it. But this is what we do when the obsessions do keep changing. Now, I'm not going to say this is easy because it's not. And if you require help doing this, reach out to an OCD therapist or an anxiety specialist who knows ERP . Remember here, and I'm telling you this with the deepest, most absolute degree of love, is CBT School, the whole mission of CBT School is to provide you tools and resources for those who don't have tools and resources. So, if you haven't got a therapist and you're finding this really, really helpful, but you're still struggling, don't be afraid. It doesn't mean anything is wrong with you. It just means maybe you need some more professional help. Maybe you have a therapist and you're listening into this just to get extra tools. Great. Take what you learn and then take what struggles you have and figure that out. I really want to stress here, and the reason I bring that up is, when I say this, it isn't as easy as it sounds and it does require sometimes having somebody else, this is why I go to therapy myself, is even though I know the tools, it's really nice to have a second set of ears just going, "Wait a second. Sounds like you're caught up in the content." If it's not a therapist, maybe you could have a loved one or even journaling I have found is really helpful in that when you journal it down, and I do this regularly, I then read it, not to judge it, but just to see what trends. And I get a highlighter and I just highlight like, where are the trends? Where am I seeing the same patterns playing out? And that's where we intervene. So, that's Whack-A-Mole obsessions. That is what to do when your obsessions keep changing. I do hope that that was helpful, not just to validate you, but to give you some skills moving forward. I am so grateful to have you here. Don't be afraid to let me know what you think. I love, again, getting your feedback via reviews. I urge you to join the newsletter. That will then allow you to reply and give me feedback that way. I love hearing from you all. All right. I'm going to sign off and I'll talk to you very, very soon.

Jun 10, 2022

SUMMARY: Today, I share what to do when you get "bad" news. This episode will share a recent situation I got into where I had to use all of my mindfulness and self-compassion tools. Check it out! Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 288. Welcome back, everybody. We literally just finished the six-week series on managing mental compulsions. My heart is full, as full as full can be. I am sitting here looking into my microphone and I just have a big, fat smile on my face. I'm just so excited for what we did together, and I felt like it was so huge. I have so many ideas of how I want to do something similar in the future with different areas. And I will. Thank you so much for your feedback and your reviews. I hope it was as helpful as it was for me, even as a clinician. I found it to be incredibly helpful, even as a supervisor, supervising my staff. I have nine incredible staff who are therapists, who help treat my clients and we constantly keep referring back during supervision of like, "Do you remember what Lisa said? Do you remember what Reid said? Listen, let's consider what Jon said or Jon Hershfield said, or Shala Nicely said." It was just so beautiful. I'm so grateful. If you haven't listened, go back and listen to it. It's a six-week series and ugh, it was just so wonderful. I keep saying it was just so wonderful. So, if you go back, I did an introduction, Episode 282. And then from there, it was these amazing, amazing experts who just dropped amazing truth bomb after amazing truth bomb. So, that's that. Today, I am going back to the roots of this podcast. And I'm sharing with you-- for those of you who have been listening for a while, we usually start the episode with a segment called the "I did a hard thing" segment. This is where people write in and tell me a hard thing that they've done. If you go to my website, which is KimberleyQuinlan-lmft.com. There on the podcast page is a place to submit your "I did a hard thing." And today's "I did a hard thing" is from yours truly. I just had to share this story with you. I feel like it's an important story to tell you guys, and I wanted to share with you that I'm not just talking the talk over here, I'm walking the walk. So, today's episode is called When You Get Bad News. I'm just going to leave it at that. Before we get started, I would love to leave you and share with you the review of the week. This is from hannabanana3131, and they said: "Fantastic mental health podcast. Such an amazing podcast. I have learned so many useful tools for dealing with my anxiety and OCD. And Kimberley is such a loving, compassionate coach - I feel like she's rooting for me every step of my healing journey," and she's left a heart emoji. Thank you so much, hannabanana. I love, love, love getting your reviews. It does help me so much. So, if you have a moment of time and the podcasts are helpful for you, that is the most helpful thing you can do back. When we get reviews, then when people who are new come over and see it, it actually makes them feel like they can trust the information we're giving. And in today's world, trust is important. There is so much noise and so many people talking about OCD and anxiety, and it's easy to get caught up in nonsense stuff. And so, I really want to build a trust factor with the listeners that I have. So, thank you so much for doing that. Okay. It's funny that hannabanana says, "I feel like she's rooting for me," because the "I did hard thing" is me talking about my recent experience of having a root canal. Worse than a root canal. So, let me tell you a story now. I'm not just telling you this story to tell you a story. I'm telling you this story because I want to sometimes-- when we do the "I did a hard thing" segment, it's usually very, very short and to the point, but I'd actually like to walk you through how I got through getting some really bad news. So, let's talk about it. And I'll share. I'm not perfect. So, there were times when I was doing well and there was times when I won't. So, for those of you who don't know, which I'm guessing is all of you, I have very bad gums. My gums, I inherited bad gums. It comes in my family. I go in every three months for a gum routine where they do a deep cleaning or they really check my gums to make sure there's not receding too much. And because of that, I take really good care of my teeth. And because of that, I usually have very little dental issues. I never had a cavity. I've never had any cracks or any terrible swollen problems. That just isn't my problem. My problem is gums and it's an ongoing issue that I have to keep handling. So this time, I go in, I get my x-rays, and the doctor comes in. And I have this really hilarious dentist who has not got the best bedside manner, but I do love him and he has been with me through some really tough times that when I found out I have a lesion on my brain, I fully broke down in front of him and he was so kind and gave me his cell phone number. He was just so lovely. But he comes in and he rubs his hands together and says, "What are we doing here today, Kimberley?" And he looks at the x-rays and I kid you not, he says, "Holy crap!" Literally, that was his response, which is pretty funny, I think. From there, I proceed to go into some version of a panic attack. I'm like, "What? What's wrong? What do you see? What happened?" And I think that was pretty appropriate for me to do that. So, I want to validate you. When you get big news, it's normal to go into a fight or flight, like what's going on, you're hypervigilant, you're looking around. Now, he waited about 45 seconds to answer my question. I just sat there in a state of panic while he stared at the x-rays on the wall. And these 45 seconds, I think, was the longest 45 seconds of my life because he wouldn't answer me. And I was just like, "Tell me what's wrong. What's wrong?" So, he turns around and he says, "Kimberley, you have a dead tooth." And I'm like, "What? A dead tooth? What does that even mean?" And he says, "You have a tooth infection that is dormant. Do you have any pain? Do you have a headache? What's going on?" And I'm like, "Nothing, nothing. I'm fine. Everything is fine." And so, he proceeds to immediately in this urgent, panicky way, call in his nurses, "Bring me this, bring me that, bring me this, bring me that. Bring me this tool, bring me this chemical or medicine or whatever." And they're all poking at me and prodding at me and they're trying to figure it out. And he's like, "I cannot figure out what this is and why it's here." So, bad news. Just straight-up bad news. Now, the interesting thing about this is, it's hard to be in communication with someone, particularly when they're your doctor and they appear to be confused and panicking. Not that he was panicking, but he was acting in this urgent way. That's a hard position to be in. And if you've ever been in a position like that, I want to first validate you. That's scary. It is a scary moment that your trusted person is also panicking. Just like when you're on an airplane and it's really bumpy. But if you see that the air hostesses are giggling and laughing, you're like, "Okay, it's all good." But when you see their faces looking a little nervous, that's a scary moment. So, first of all, if you've been in that position, that's really, really hard. What he then proceeded to tell me is, "Kimberley, this tooth has to come out. It has to come out immediately. We cannot wait. It's going to cost a god-awful amount of money. And this has to happen right away." Now in my mind, you guys know me, I am really, really strict about scheduling. I have a schedule. I'm not compulsive about it, but I run two businesses. I have a podcast, I have two children. I have a medical illness. I have to manage my mental illnesses all the time. So, I have to be really intentional with my calendar. So, this idea that immediately, everything has to change was a little alarming to me. But what I remember thinking, and this is one of the tools I want to offer you for today, is being emotionally flexible is a skill. And what we want to do in those moments, and this is what I practiced was, "Okay, Kimberley, this is one of those moments where your skills come in handy. Thank God for them." How can you be flexible here? Because my mind wanted to go, "You got to pick up the kids and you've got to do this and you've got to a meeting tomorrow and you've got clients and you can't do this. This can't happen this week." But my mind was like, "I'm going to practice flexibility." In addition to that, when things change really quickly, we tend to beat ourselves up like, "Such and such is going to hate me. They're going to be mad at me. They're going to think I'm a loser for having to change the schedule." And I just gently said to myself, "Kimberley, we're going to be emotionally flexible here and we're going to let everybody have their emotions about it." So, the kids get to have their emotions about everything changing and my clients get to have their emotions about it too. And having to cancel the meetings, they get to have their emotions. Everyone's allowed to have their emotions about the fact that many, many things are going to be canceled in the next few days. And that has been such a work of art for me, but it has been so beautiful for me to say, instead of me going, "No, no, no, I can't do this," because I don't want them to have feelings and I don't want them to think this about me, now I'm just like, everyone gets to have their feelings. They get to feel disappointed. They get to feel angry. They get to feel annoyed. They get to feel irritated. They get to feel sad. Everybody gets to feel their feelings about it because that's a part of being a human. That's one of the tools I want you to think about. Just play with these ideas. You've just come off the six-week series. These are some more ideas to play with. But then from there, I had about 36 hours where I had to wait for this surgery. And during that time, I had to have an x-ray where I was told, and this is the real bad news, is this infection, actually, this is gross. So, trigger warning, guys. The infection actually ate through a part of my jaw bone. I know. Isn't that crazy? The infection was so bad and it was right at this area where I guess nerves come out of your jaw. There's this tiny hole right at the front, around the sides where the nerves come out of your jaw and up into your lips and the infection spread and was all over that area. I know that is gross, but it's also really scary. So, not only did I have to think about all of the changes, but he, the doctor, the dentist had made me very aware that this surgery has to go really well, and that if he pushes too hard or he pulls too hard with a tooth or he had to put in a-- there's these words I don't even know, but like a canal, like some kind of fixture so that he can create a new tooth because I had to have a tooth completely pulled out. He was like, "If I push it in too far, I actually may hit this nerve, which could be very, very bad." So, this uncertainty felt horrible to me. And of course, I'm going to have these intrusive thoughts like, "What if I never get to speak again? What if I lose a feeling in my gums and what if he pushes hard and this is terminal? What if, what if, what if, what if?" And so, my skill here, and we've learnt this from managing mental compulsions, is bring it back to the present. Until there's a problem, we don't solve them. So, that's what I kept doing. "It's not happening now. Kimberley, it's not happening now. It's not happening now," even though it's a real threat, even though it's going to be something I have to face, because sometimes our fears are like, "What if something happens?" But it's just a what-if. There's no actual event that you know for certain is going to happen. This was like, "Yeah, you're going to do this in literally 30 hours and all of these risks are here." You guys have probably got stories like this, where you've gone in for some brain surgery or any surgery where there's a risk, but this risk was pretty huge. He was very concerned. I think appropriately concerned. So, here I am for 30 hours, managing this stuff where I'm like, "Okay, this could go really well or this could go really bad, like really, really bad." I giggle just because it makes me nervous just to think about it. That's a nervous giggle that you just heard me. I don't know. I often giggle when I'm nervous. But it's a big deal. So, I, in these moments, had to weigh up, go back to what Lisa Coyne was talking about. I was like, "Okay, values versus fear. Which one do I consult with?" I had reached out to the dentist to say, "You know what, let's just not do this. I'm not in any pain. Let's just keep it there. Let's just not." And his response was like, "That's not even an option. If you've already got this much damage, this could get worse and be very, very problematic." So, I didn't even have the option to back out. I had to do this. And so, as I proceeded forward, I had to keep being aware like what Jon Hershfield talked about and Dr. Grayson and Dr. Reid Wilson, and Shala. I had to really allow all the intrusive thoughts to come like, "Yup. Possible. Yup, that's possible too. Yup, that's possible too. Maybe it does. Maybe it will. Not going to give it my attention right now. I see you're back again. Good one, bro. Hi there, I see you. I fully accept the uncertainty." That was me for l30 hours, literally bringing in every tool I have. The cool thing is it was a hugely busy week. And because I have been really doubling down on my mindfulness skills over the last few months, that actually really helped. Every time I noticed that I was getting anxious, I was like, "Okay, what does the keyboard feel under my fingers?" I have these fiddles that I play with and I'm like, "Okay, what does this feel like? This rubber feel like, or this metal feel like, and so forth?" So, that was really helpful. The day of the surgery, I go in and I'm fully anxious. I'm going to the bathroom. I'm needing to pee. I feel dizzy. I'm not allowed to be on my medication. Oh, and that's the other thing, is this maybe the-- what do you call it? The silver lining. Just a little update for you guys, is there is a small chance, because this infection has been here for a long time and we haven't actually detected it yet, that it may be the reason for all my POTS symptoms. As some of you may know, I have postural orthostatic tachycardia syndrome. It is a chronic illness related to dysautonomia. It causes me to faint and have headaches and nausea and dizziness and blood pooling and it's the worst. And there is a chance that that might be why. So, I'm half scared and half excited all day, which is a lot to handle. But as the day is moving forward, I'm getting more and more nervous and I start to feel the urge to start to seek reassurance. I start to observe the urge to Google. I start to observe the urge to ask the doctors many, many, many, many questions. And when I say it, I'm saying that very intentionally. I observed the urge, which is I didn't do those behaviors. I just noticed the urge that kept showing up. "Ooh, let's try and get this anxiety to go away. Ooh, let's try and get that anxiety to go away." Knowing that when it's my turn to sit in that chair, I will ask specific questions. So, I'm not saying you can't ask your doctors questions, but that was key for me, was to observe the urge to seek reassurance, observe the urge to go into avoidance. I'm not going to make this story too much longer, but what I will say, I want to tell you the funniest part of this story. I'm in the doctor's office because I had to go in for this very fancy x-ray that does all your nerves because he was afraid he was going to hit one. He's showing me the x-ray and I'm literally looking at it. He's showing me cross-sections of my jaw. And you guys, it was so scary. You can see the hole that it's created. You can see the infection and how it's deteriorated the bone. It was so scary. And so, he puts his hand on my-- and I'm like, at that point, "Is there any way we could get away with not doing this? Because this is really scary." He puts his hand on my hand, he says, "I'm going to go and take care of all of these last patients I have so I can give you 100% of my attention and I will be back." You guys, this is the funniest thing ever. So, the dental nurse is there watching me. My heart is through the roof. My blood pressure is all over the place. She stands in front of me and she says, "Miss Kimberley, don't be worried. We've watched all the YouTube videos." And I swear to you, every piece of panic that I had went out the window for that small second and I laughed so hard. She said, "In fact, that's where the doctor is right now. He's just going to watch the YouTube video one more time." And I just died laughing. Now for some of you, that may have actually been really anxiety-provoking. But for me, it was exactly what I needed. I needed someone to make this so funny. And it was so funny. I swear to you, every time I think of it, the way she says it in her accent was the most hilarious thing ever. It was so perfectly timed. The delivery was perfect and I burst out laughing. He comes back in-- this is the end of the story. I'm not going to drag it out for too much longer. I promise. But he comes back in, and I just wanted to share with you, because I know last week with Lisa, I had a really emotional moment, and I think it was really tied to this. As he was putting in the IV – because I had to be knocked out. He said he couldn't take a risk of me moving. So, he knocked me out for the surgery – tears just rolled out of my eyes. And I wasn't going to be ashamed of it. And what came up for me was, I said, "Please, sir." I said "Sir," which I think is so funny, because I know him by his first name. "Please, sir. Please just take care of me." And for me, tears were rolling down my face, but that was an act of compassion for myself. Instead of me saying-- because I know two years ago, or even six months ago, I probably would've said, "Please, don't kill me," or "Promise me nothing bad would happen." But there was this act of compassion that just flowed out of me, which was like, "Please, sir. Please take care of me." And it was coming from this deep place of finally in my life, being able to ask to be taken care of. And I've been working on this, you guys, for about a year, is having the ability to actually ask for help has been something I've really sucked at and it's something I've worked so hard at. And for me, that was groundbreaking, to ask for help. Now you could say it was me pleading with him, but it wasn't. It was me. It was an act of compassion. It was an act of saying, "I'm scared. I'm not asking you to take my fear away. I'm just asking you to hold me in a place of kindness and compassion and nurturing and care." And that for me was profound. So, I just wanted to share that with you. I know that it might not be as skills-based as some of the other episodes, but I love sharing with you hard things and I love sharing with you that I'm a human, messy human who's doing the best they can and is imperfect too. But I just wanted to give you a step-by-step one. It's okay if it's hard and there are skills that you can use and we can get through hard things. It's a beautiful day to do hard things, I always say that. And so, I wanted to just record this and share with you the ups and the downs of my week and help you maybe if there's a time where you've gotten bad news on ways that you might manage it. Now, what I do want to end here with is, I understand my privilege here. I understand my privilege of getting bad news and being able to get medical care and have a lovely dentist and a lovely nurse who makes funny jokes. And sometimes the news doesn't end well, and I get that. I want to honor you that there is no right way to get bad news. And the grief process of getting bad news is different for everybody. This was more of an anxiety process, but I want to honor to you that if you're going through some hard thing in your life where you've gotten bad news, I want to also offer you the opportunity to grieve that and I want to honor that this is really, really a hard thing to go through. So, I really want to make sure I make space for you with that because my experience is not your experience, I'm sure. So, that's it, guys. That's what to do when you get bad news. That's my experience of getting bad news and I hope it's been helpful. We are embarking on some shifts here with the podcast. I am so inspired to be more focused on just delivering the tools to you and being a safe place for you and being a bright, shiny light for you. And so, I'm doing a lot of exploring on how I can do that. So, if you ever-- again, please do feel-- if you want to give some thoughts, please do reach out, send me an email. If you're not on my newsletter list, please do go and sign up. I'll leave you a link in the show notes, or you can go to CBTSchool.com and sign up for the newsletter and you can reply there as well or you can leave a review. All right. I love you guys. Have a wonderful day. It is a beautiful day to get bad news and do the hard thing. I love you. Have a great day.

Jun 3, 2022

SUMMARY: In this episode, we talk with Lisa Coyne about ACT For mental compulsions. Lisa Coyne addressed how to use Acceptance and Commitment therapy for overcoming mental compulsions. We cover how to identify your values using a fun little trick! In This Episode: How to use Acceptance & Commitment Therapy to manage mental compulsions How to practice Willingness in regards to reducing mental rituals and mental rumination A fun little Value Based tool for identifying your values. How to be curious instead of thinking in a limited way. Links To Things I Talk About: Stuff thats Loud Stop Avoiding Stuff https://www.newenglandocd.org/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 287. Welcome back, everybody. I am so excited. We are at Episode 6 of this six-part series of how to manage mental compulsions. You guys, we could not end this series with anyone better than Dr. Lisa Coyne. I don't know if you've heard of Lisa Coyne. I bet you, you probably have. She is the most wonderful human being. I have met Lisa, Dr. Lisa Coyne multiple times online, never in person, and just loved her. And this was my first time of actually getting to spend some really precious time with her. And, oh my gosh, my heart exploded like a million times. And you will hear in this episode, you will hear my heart exploding at some point, I'm sure. I am so honored to finish out the six-part series with Lisa. This series, let me just share with you how joyful it has felt to be able to deliver this as a series, as a back-to-back piece of hope. I'm hoping it has been a piece of hope for you in managing something really, really difficult, which is managing mental compulsions. Now, as we finish this series up, I may or may not want to do a recap. I'm not sure yet. I'm going to just see where my heart falls, but I want to just really first, as we move into this final part of the series, to remind you, take what you need. You've been given literally back-to-back some of the best advice I have ever heard in regards to managing mental compulsions. We've got world-renowned experts on this series. You might have either found it so, so educational and so, so helpful while also feeling sometimes a little bit like, "Oh my goodness, there's so many tools, which one do I use?" And I really want to emphasize to you, as we finish this out, again, so beautiful. What a beautiful ending. I almost feel like crying. As we finish it out, I really want to remind you, take what you need, take what's helpful, or – well, I should say and – try all of them out. Practice with each of the skills and the concepts and the tools. See what happens when you do. Use them as little experiments. Just keep plugging away with these skills and tools. Because number one, they're all evidence-based. I very carefully picked the experts on this series to make sure that we are bringing you evidence-based, really gold standard treatment. So, that's been a priority. Just practice with them. Don't be hard on yourself as you practice them. Remind yourself, this is a long-term journey. These are skills I still practice. I'm sure everyone who's come on the show, they are still practicing them. And so, I really want to send you off with a sense of hope that you get to play around with these. Be playful with them. Some of them will be we've giggled and we've laughed and we've cried. So, I want you to just be gentle as you proceed and you practice and remind yourself this is a process and a journey. That being said, I am going to take you right into this next part of the six-part series with Dr. Lisa Coyne. This is where we bring it home and boy, does she bring it home. I feel like she beautifully ties it all up in a ribbon. And I hope it has been so helpful for you. Really, I do. I want this to be a resource that you share with other people who are struggling. I want to be a resource that you return to when you're struggling. I want it to be a place where you feel understood and validated. And so, thank you so much for being a part of this amazing series. That being said, let's get over onto the show, and here is Dr. Lisa Coyne. ------ Kimberley: I literally feel like I'm almost in tears because I know this is going to be the last of the series and I'm so excited. I had just said this is going to bring it home. I'm so excited to have Dr. Lisa Coyne. Welcome. Lisa: Thank you. It's so nice to be here with you, Kim. Hi, everyone. What is a Mental Compulsion? Do you call it a Mental Compulsion or a Mental Ritual? Kimberley: Yes. So, first of all, the question I've asked everybody, and I really am loving the response is, this is a series on managing mental compulsions, but do you call them mental compulsions, mental rituals, rumination? How do you conceptualize this whole concept? Lisa: I would say, it depends on the person and it depends on what they're doing. I call them any number of things. But I think the most important thing, at least for me in how I think about this, is that we come at it from a very behavioral perspective, where we really understand that-- and this is true for probably all humans, but especially so for OCD. I have a little bit of it myself, where I get caught up in the ruminations. But there's a triggering thought. You might call it a trigger like a recurrent intrusive thought that pops up or antecedent is another word that we think of when we think of behavior analysis. But after that thought comes up, what happens is the person engages in an on-purpose thing, whatever it is that they do in their mind. It could be replacing it with a good thought. It could be an argument with yourself. It could be, "I just need to go over it one more time." It could be, "I'm going to worry about this so I can solve it in advance." And that part is the part that we think of as the compulsion. So, it's a thing we're doing on purpose in our minds to somehow give us some relief or safety from that initial thought. Now the tricky part is this. It doesn't always feel like it's something we're doing on purpose. It might feel so second nature that it too feels automatic. So, part of, I think, the work is really noticing, what does it feel like when you're engaging in this activity? So, for me, if I'm worrying about something, and worry is an example of this kind of doing in your mind, it comes with a sense of urgency or tightness or "I just have to figure it out," or "What if I--" and it's all about reducing uncertainty really. So, the trick that I do when I notice it in me is I'll be like, "Okay, I'm noticing that urgency, that tension, that distress. What am I up to in my head? Am I solving something? Is that--" and then I'll step back and notice what I'm up to. So, that's one of my little tricks that I teach my clients. Kimberley: I love this. Would you say your predominant modality is acceptance and commitment therapy? What would you say predominantly you-- I mean, I know you're skilled in so many things, but what would you-- Lisa: I would say, it's funny because, yeah, I guess you would. I mean, I'm pretty skilled in that. I'm an ACT trainer. Although I did start with CBT and I would say that for OCD, I really stick to ERP. I think of it as the heart of the intervention, but we do it within the context of ACT. ACT for Mental Compulsions Kimberley: Can you tell me what that would look like? I'm just so interested to understand it from that conceptualization. So, you're talking about this idea. We've talked a lot about like, it's how you respond to your thoughts and how you respond and so forth. And then, of course, you respond with ERP. What does ACT look like in that experience? I'd love to hear right from your mouth. Lisa: Okay. All right. So, I'm going to do my best here to just say it and then we'll see if it sounds more like ACT or it sounds more like ERP. And then you'll see what I mean when I say I do both of them. So, when you think about OCD, when you think about anxiety, or even maybe depression where you're stuck in rumination, somebody is having an experience. We call it a private event like feeling, thought, belief that hurts, whatever it is. And what they're doing is everything that they can to get away from that. So, if it's OCD, there's a scary thought or feeling, and then there's a ritual that you do. So, to fix that, it's all about learning to turn towards and approach that thing that's hard. And there's different ways you can do that. You can do that in a way where you're dialing it in and you're like, "Yeah, I'm going to do the thing," but you're doing everything that you can to not feel while you're doing that. And I think that's sometimes where people get stuck doing straight-up exposure and response prevention. It's also hard. When I was a little kid, I was really scared to go off the high dive. I tell my clients and my team the story sometimes where it was like a three-meter dive. And I was that kid where I would be like, "I'm going to do it. All the other kids are doing it." And I would climb up, I'd walk to the end of the board, freak out, walk back, climb down. And I did this so many times one day, and there's a long line of other kids waiting to get in the water. And they were pissed. So, I got up and I walked out to the end of the board and I was like, "I can't." And I turned around to go back. And there was my swim coach at the other side of the board with his arms crossed. I was like, "Oh no." Kimberley: "This is not the way I planned." How do you apply Acceptance & Commitment Therapy for OCD and Mental Compulsions? Lisa: And he is like, "No, you're going." And I went, which was amazing. And sometimes you do need that push. But the point is that it's really hard to get yourself to do those really hard things sometimes when it matters. So, to me, ACT brings two pieces to the table that are really, really important here. You can divide ACT into two sets of processes. There's your acceptance and mindfulness processes, and then there's your commitment and valuing processes, which are the engine of ACT, how do we get there? So, for the first part, mindfulness is really paying attention on purpose. And if you want to really learn from an exposure, you have to be in your body, you have to be noticing, you have to be willing to allow all of the thoughts and sensations and whatever shows up to show up. And so, ACT is ideal at shaping that skillset for when you're in the exposure. So, that's how we think of it that way. And then the valuing and commitment is, how do you get yourself off that diving board? There has to be something much more important, bigger, much bigger than your fear to help motivate you for why to do this hard thing. And I think that the valuing piece and really connecting with the things that we most deeply care about is part of what helps with that too. So, I think those two bookends are really, really important. There's other ways to think about it, but those are the two primary ways that we do ERP, but we do it within an ACT framework. Using Values to manage Mental Compulsions Kimberley: Okay. I love this. So, you're talking about we know what we need to do. We know that rumination isn't helpful. We know that it creates pain. We know that it keeps us stuck. And we also know, let's jump to like, we know we have to drop it ultimately. What might be an example of values or commitments that people make specifically for rumination, the solving? Do you have any examples that might be helpful? Lisa: Yeah. I'm just thinking of-- there's a bunch of them, but for example, let's take, for example, ROCD, relationship OCD. So, let's say someone's in a relationship with a partner and they're not sure if the right partner is. Are they cheating on me? Are they not? Blah, blah, blah, blah. And it's this like, "But I have to solve if this is the right person or not. Am I going to be safe?" or whatever the particular worry is. And so, one of the things that you can do is once folks notice, they're trying to solve that. Notice, what's the effect of that on your actual relationship? How is that actually working? So, there's this stepping back where an ACT, we would call that diffusion or taking perspective self-as-context, which is another ACT, acceptance, and mindfulness piece. And first of all, notice that. Second of all, pause. Notice what you're up to. Is the intent here to build a strong relationship, or is the intent to make this uncertainty go away? And then choose. Do I want to work on uncertainty or do I want to work on being a loving partner and seeing what happens? Because there's so much we're not in charge of, including what we're thinking and feeling. But we are in charge of what we choose to do. And so, choosing to be present and see where it goes, and embracing that uncertainty. But the joyfulness of it, I think, is really, really important. So, that would be one example. Kimberley: I love that example. Actually, as you were saying, I was thinking about an experience of my own. When your own fears come up around relationship, even you're ruminating about a conversation or something, you've got to stop and be like, "Is this getting in the way here of the actual thing?" It's so true. Tell me about this joy piece, because it's not very often you hear the word joy in a conversation about mental compulsions. Tell me about it. Lisa: Well, when you start really noticing how this is working, and if you're willing to step back from it, let it be, and stay where you are in that uncertainty, all sorts of new things show up. Stuff you never could have imagined or never could have dreamed. Your whole life could be just popping up all of these possibilities. In that moment you stop engaging with those compulsions, you could go in a hundred different directions if you're willing to let the uncertainty be there. And I think that that's really important. I want to tell a story, but I have to change the details in my head just for confidentiality. But I'm thinking of a person who I have worked with, who would be stuck and ruminating about, is this the right thing? I could make decisions and how do I-- for example, how do I do this lecture? My slides need to be perfect and ruminating, ruminating, ruminating about how it works. And one day they decided, "Okay, I'm just going to be present and I'm just going to teach." And they taught with a partner. And the person themself noticed like, "Wow, I felt so much more connected to my students. This was amazing." And the partner teaching with them was like, "I've never seen you so on. That was amazing." They contacted this joy and like, "This is what it could be like." And it's like this freedom shows up for you. And it's something that we think we know. And OCD loves to know, and it loves to tell you, it knows the whole story about everything. And it's more what you get back when you stop doing the compulsions if you really, really choose that. It's so much more than just, "Oh, I'm okay. I noticed that thought." it's so much more than that. It's like, yes, and you get to do all this amazing stuff. Kimberley: Right. I mean, it's funny. I always have my clients in my head. When someone says something, I'm imagining my client going, "But like, but like..." What's the buts that are coming? Lisa: And notice that process. But see, that's it. That's your mind, that's their minds jumping back in being like, "See, there it is again." Kimberley: Yeah. Lisa: And what if we just don't know? Using Curiosity to Stop Mental Compulsions Kimberley: And this is what I love about this. I agree with you. There have been so many times when I've dropped myself out of-- I call it being heady and I drop into my body and you get this experience of being like, "Wow." For me, I can get really simple on like, "Isn't it crazy that water is clear?" I can go to that place. "Water is clear. That is incredible." You know what I mean? It's there to go to that degree. But then, that's the joy in it for me. It's like, "Wow, somebody literally figured out how to make this pen work." That still blows my mind. Lisa: I had a moment. I started horseback riding again for the first time in literally-- I've ridden on and off once a year or something, but really riding. And actually, it was taking classes and stuff for the first time in 30 years. And they put me in this class and I didn't know what level it was. I just thought we were just going to walk around and trot and all that stuff. Plus, she starts setting up jumps. And I was like, "Oh my God, this is old body now. This is not going to bounce the way it might have been." It's what means all these 15-year-olds in the class. Kimberley: Wow. Lisa: I'm third in line and I'm just on the horse absolutely panicking and ruminating like, "Oh my God, am I going to die? Should I do this? What am I going to do? Should I tell her no? But I want it and I don't know what I'm going to--" and my head was just so loud. And so, the two girls in front of me go. And then I look at the teacher and I go, "Are you sure?" It's literally the first time I've ever done in 30 years. She just went-- she just looked at me. And I noticed that my legs squeezed the horse with all of the stuff rolling around in my head. And I went over the jump and it was, I didn't die. It was really messy and terrifying. Oh my God, it was so exciting and joyful. And I was so proud of myself. That's what you get-- Kimberley: And I've heard that from so many clients too. Lisa: It's so awesome. Kimberley: I always say it's like base jumping. It's like you've got to jump. And then once you've jumped, you just got to be there. And that is true. There is so much exhilaration and sphere that comes from that. So, I love that. What about those who base jump or squeeze the horse and they're dropping into discomfort that they haven't even experienced before, like 10 out 10 stuff. Can you walk me through-- is it just the same? Is it the same concept? What would you advise there? Lisa: So, I think it's important to notice that when that happens, people are not just experiencing physical sensations and emotions, but it's also whatever their mind is telling them about it. And I think this is another place where ACT is super helpful to just notice, like your mind is saying, this is 10 out of 10. What does that mean to you? That means like, oh my gosh. And just noticing that and holding it lightly while you're in that 10 out of 10 moment, I think, is really, really helpful. So, for example, I have a really intense fear of heights where I actually freeze. I can't actually move when I'm on the edge of something. And I had a young client who I've worked with for a while. And as an exposure for her, but also for me as her clinician to model, we decided. She wanted me to go rock climbing with her, which is not something I've ever done, ever, and also fear of heights. So, I kept telling myself, "Fear of heights, this is going to suck. This is going to be terrible. This is going to be terrible." And there was also another part of me interested and curious. And so, what I would say when you're in that 10 out of 10 moment, you can always be curious. So, when you're like, "Oh my gosh, I'm really scared," the moment you're unwilling to feel that is the moment it's going to overwhelm you. And if you can notice it as a thought, "I'm having the thought, I don't think I can handle this. I don't think I'm going to survive this," and notice it and be curious, let's see what happens. And so, for me, I noticed interestingly, even though I'm terrified of heights, I wasn't actually scared at all. And that was a shocker, because I was full sure it was going to be the worst thing ever. And so, notice the stories your mind tells you about what an experience is going to be and stay curious. You can always be curious. And that's going to be, I think, your number one tool for finding your way through and how to handle those really big, unexpected, and inevitable surprising moments that happen in life that are really scary for all of us. Kimberley: Right. And when you say curious, I'm not trying to get too nitpicky on terms, but for me, curiosity is, let's experiment. I always think of it like life is a science experiment, like let's see if my hypothesis is true about this rock climbing. Is there a way that you explain curiosity? Lisa: Yeah. Well, that's part of it, but it's also part like what you were describing. Isn't water cool? It's more than, is this true or not true? That's so narrow. You want, "No, really? What does this taste like?" And that's the mindfulness piece. Really notice all of it. There's so much. And when you start doing that, you'll find-- even if you do it outside of exposure, for example, as practice, you start to notice that the present moment is a little bit like Hermione's purse in Harry Potter, where you think it's this one thing, and then when you start to expand your awareness, you notice there's tons of cool stuff. So, in these big, scary moments, what you might see is a sense of purpose or a sense of, "Holy crap, I'm handling this and I didn't think I could. Wow, this is amazing," or "I'm really terrified. Oh my gosh, my nose itches." It could be anything at all. But the bottom line is, our bodies were meant to feel and they were meant to experience all the emotions. And so, there is no amount of emotion or fear or anything that we are not built to handle. Emotions are information. And to stay in the storm when it's such a big storm, when OCD is ramping you up, it teaches the OCD, "Actually, I guess I get to stand down here eventually, I guess I don't need to freak out about this so much. Huh, interesting. I had no idea." I don't know if that's helpful or not. Kimberley: No, it's so helpful. It is so helpful because I think if you have practiced curiosity, it makes sense. But for someone who maybe has been in mental compulsions for so long, they haven't really strengthened that curiosity muscle. Mindfulness for Mental Compulsions Lisa: That's so true. So, start small. Don't start in the storm. Start with waking up in the morning and noticing before you open your eyes, what do you hear? How do the covers feel? Do you hear the birds outside your window? Start with that. And start in little moments, just practicing during the day. Start a conversation with someone you care about, and notice what your mind is saying in response to them, what it's like to notice their face. Start small, build it up, and then start practicing with little tiny, other kinds of discomfort. Sometimes we'll tell people like impatience. When you're waiting in line or in hunger or tiredness, any of those, to just bring your full awareness to that and be like, "What is it like inside this moment right now?" And then you can extend that to, "Okay. So, what if we choose to approach this scary thing? What if we choose to just for a few seconds, notice what it feels like in this uncertain space?" And that's how you might begin to bring it to rumination, be curious about what was the triggering thought. And then before you start ruminating or before you start doing mental rituals, just notice the first thought, and then you don't have to answer that question. And there's different ways to handle that, but curiosity is the beginning. And then stopping the compulsion is ultimately, or undoing it or undermining it in some way is going to be the other important piece. Kimberley: I'd love to hear more about commitment. I always loved-- when I have multiple clients, we joke about this all the time. They'll say, "I had these mental compulsions and you would be so proud. I was so proud. I was able to catch it and pull myself back into the present. And yes, it was such a win. And then I had another thought and you'd be so proud of me. I did the same thing. And then I had another thought and..." Lisa: You're like, "Was that the show that you just did right there?" It's sneaky, huh. Kimberley: And so, I'd love to hear what you're-- and maybe bring it from an ACT perspective or however you would. It's like you're chugging away. "I'm doing good. Look at me go." But OCD can be so persistent. Lisa: It's so tricky. Kimberley: And so, is that the commitment piece, do you think? What is that? How would you address that? Lisa: So, if I'm getting your question right, you're asking about, what do we do when OCD hijacks something that you should do and turns it into a ritual? Is that what you're asking? Kimberley: Yes. Or it just is OCD turns up the volume as like, "No, no, no, no. You are going to have to tend to me or I'm not going to stop," kind of thing. Lisa: Yes. That is a commitment piece. And it's funny because there's different ways that I think about this, but it's almost like a little child who has a tantrum. If you keep saying yes, every time they make the tantrum bigger, it's going to end up being a pretty big tantrum. And OCD loves nothing more than a good tantrum. Kimberley: So true. Lisa: And so, the thing you have to do is plan for that and go, "Yeah, it's going to get loud. Yeah, it's going to say whatever it needs to say, and it's going to say the worst thing I can think of." And I have had my clients call this all sorts of different things like first-order thoughts, second-order thoughts, just different variations on the theme where it's going to ramp up to hook you in. And so, really staying very mindful of that and making a promise to yourself. One of my clients who helped us a lot in teaching but also in writing stuff that's loud, Ethan, I think said it in this really elegant way. He said, make a promise to yourself. That really matters, even if it's small. It doesn't matter how big it is. But one of his first ones was, under no circumstances, am I going to do X the compulsion? And keep that promise to yourself because if you-- anybody who ever woke up and didn't want to get out of the bed in the morning because, "Ah, too tired, it's too early. I don't really want to go to the gym." If you know you're in that conversation with yourself about, "Well, maybe just one more minute," you've already lost. And so, this is a good place again for that ACT piece of diffusion. Noticing your mind or your OCD or your anxiety is pulling you into, "Ah, let's just see if we can string you along here." And so, what needs to happen is just move your feet and put them on the floor. Don't get into that conversation with yourself. And having that commitment piece, that promise to myself with the added value piece, that really matters. And one other thing that's sometimes helpful that I have-- I'll use this myself, but I also teach my clients, remembering this question: If this is a step towards whatever it is that's really important, am I willing to allow myself to feel these things? Am I willing? And remembering that as a cue. We're not here. It's never about this one exposure. It's about, this is a step towards this other life that you are fighting for. And every single step is an investment in that other life where you're getting closer and you're making it more possible, and just remembering that. I think that that's a really important piece. A Values Tool YOU NEED! Kimberley: Yeah. It actually perfectly answered the question I had, which is, you're making a commitment, but what to? And it is that long-term version of you that you're moving towards or the value that you want to be living by. Would you suggest-- and I've done a little bit of work on the podcast about values. Maybe one day we can have you back on and you can share more about that, but would you suggest people pick one value, three values? How might someone-- of course, we all have these values and sometimes OCD can take things from us, or anxiety can take those things from us. How would you encourage someone to move in that direction? Lisa: Well, actually, do you want to do a fun thing? Kimberley: I do. Lisa: Okay. So, let's do-- Kimberley: I never would say no to that. I would love to. I'm really curious about this fun thing. Lisa: All right. So, do you like coffee or are you a tea person or neither? Kimberley: Let's go tea. I'm an Australian. If I didn't say tea, I would be a terrible Aussie. Lisa: They'll kick you off. All right. So, Kim, think about in your life a perfect cup of tea, not just a taste, but a moment with someone maybe you cared about or somewhere that was beautiful or after something big or before something big, or just think about what was a really, really amazing important cup of tea that you've had in your life. Kimberley: Oh, it's so easy. Do I tell you out loud? Lisa: Yeah. If you want to, that'd be great. Kimberley: I'll paint you guys a picture. So, I live in America, but my parents live in Australia and they have this beautiful house on a huge ranch. I grew up on a farm. And we're sitting at their bay window and you're overlooking green. It's just rolling hills. And my mom is on my left and my dad is on my right. And it's like milky and there's cookies. Well, they call them biscuits. So, yeah. That's my happy place right there. Lisa: And I could see it in your face when you're talking about it. So, where do you-- does that tell you something about what's really important to you? Kimberley: Yes. Lisa: What does it tell you? Kimberley: Family and pleasure and just savoring goodness, just slowing down. It's not about winning a race, it's just about this savoring. And I think there's a lot-- maybe something there that I think is important is the green, the nature, the calm of that. Lisa: Yeah. So, as you talk about that, what are you noticing feeling? Kimberley: Oh my God, my heart just exploded 12 times. My heart is filled. That was the funnest thing I've ever done in my whole life. Funnest is not a word. Lisa: What if you could build your life around moments like that? Would that be a well of life for you? Kimberley: I think about that nearly every time I make tea, actually. Lisa: That's how you would help your clients, and that's one way to think about values. Kimberley: Wow. That is so cool. I feel like you just did a spell on me or something. Lisa: You just connected with the stuff that's really important. So, when you think about if I had a hard thing to do, what if it was a step towards more of that in your life? Kimberley: Yeah. Lisa: You see? Kimberley: It's so powerful. I've never thought that. Oh my God, that was gold. And so, that's the example. Everyone would use that, coffee or tea. Lisa: There you go. Just think about it. And it's funny because we came up with this in our team, maybe three months ago. We keep piloting just new little values exercise, but it's so funny how compelling it is. just thinking about-- gosh. Anyway, I could tell you about mine, but you get the point. Kimberley: And you know what's so funny too and I will say, and this is completely off topic, there's a social media person that I follow on Instagram. And every time she does a live-- and for some reason, it's so funny that you mentioned this, I love what she talks about, but to be honest, I'm not there to watch her talk. The thing that I love the most is that she starts every live with a new tea and she'll pause the water in front of you. It's like a mindfulness exercise for me. To be honest, I find myself watching to see whether she's making tea. Not that this is about tea, but I think there's something very mindful about those things that where we slow down-- and the water example, she's pouring it and she's watching the tea. And for some reason, it's like a little mini-break in the day for me. Lisa: I totally agree. It's like the whole sky, the cloud, and the tea and the-- Kimberley: Like Thich Nhat Hanh. Lisa: Yes. I can't remember the quote, but exactly. Kimberley: Yeah. Oh my gosh, I love that example. So good. Well actually, if you don't mind, can you tell us your tea? Because I just would love to see if there's a variation. So, what would yours be? Lisa: It was funny because I think I did coffee the first time I did this, but then recently I just did a workshop in Virginia and I was like, "Oh my gosh, tea." And what came to mind was, when I took my 17-year-old daughter tracking in the Himalayas to Nepal, because I wanted her. She was graduating from high school and I wanted to show her that you could do anything and she really wanted to go. We both really wanted to go to Ever Space Camp. And every morning after trekking nine, 10, 11 hours a day where you're freezing cold, you're exhausted, everything's hurting, and it's also amazing and beautiful, the guides would knock at our door and there would be two of them. And one of them would have a tray of little metal cups. And then the other one would say, "Tea? Sugar? Would you like sugar?" And they would make you, they would bring you, and this was how you woke up every morning, a steaming cup of tea. Sometimes the rooms were 20 below zero. And you'd get out of bed and you'd be so grateful for that warm cup of tea. And that was the tea I remembered. Kimberley: Right. And then the values you pulled from that would be what? Lisa: That moment, it was about being with my daughter and it was about showing her, modeling courage and modeling willingness and just adventure and this love of being in nature and taking a journey and seeing, "Could we do this? And what would it be like?" And just sharing the experience with her. It's just beautiful. And the tea is right in the center of that. So, it's almost not even about the tea, but it's that moment. It's that time and that experience. So amazing. Kimberley: So amazing. Thank you. I'm deeply grateful. That just filled my heart. Lisa: I'm so glad. I feel so honored that you have had experience. I love that so much. Kimberley: I did. I always tell my clients or my kids or whoever is at-- when I was a kid, my mom, every afternoon when I came home from school, she'd say, "What's the one thing you learn at school today?" And so still, there's always one thing I learn and I always note it like that's the one thing I learned today and that was it. What an amazing moment. Lisa: I'm so glad. Kimberley: Okay. I love this. So, we've talked about mindfulness and we've talked about commitment. We've talked about values and we have talked about the acceptance piece, but if we could have just one more question around the acceptance piece. How does that fit into this model? I'm wondering. Lisa: It's funny because I always feel like that acceptance piece, the word, it means to so many people, I think, tolerance or coping or let's just make this okay. And it doesn't mean any of those things. And so, I've moved more into thinking of it and describing it as, it's like a willingness. What is under the hood of acceptance and am I willing? Because you cannot like something and not want something and also be willing to allow it. And it's almost like this-- again, it involves curiosity about it. It involves squeeze the horse with all the stuff. Get the feet on the floor, even though you're having an argument that's in your head. And so, sometimes people think about it as a feeling and sometimes it is, but a lot of times, it's willingness with your feet. When you think about moms and infants in the middle of the night, I don't think there was ever a moment when I was like, "Oh yeah, the baby's crying at 4:00 in the morning. I'm so excited to get up." I'm feeling in my heart, no. It's like you're exhausted and it's like the last thing you want to do and 100% you're willing to do it. You choose. And so, that's the difference. And so, I think people get tangled up, not just thinking of it as tolerance, but also waiting for a feeling of willingness to happen. And that's not it. It's a choice. Kimberley: It's gold. Lisa: Yeah, seriously. I mean, it's the same thing. I learn it every day. Trust me, when I fall out of my gym routine or my running routine and I'm off the willingness, and then I'm like, "Yeah, that's not it." And I have to come back to it. So, it's something we all struggle with. And I think that's really important to know too, but ultimately, it's a choice, not a feeling. Kimberley: Okay. That was perfect. And I'm so happy. Thank you, number one. This is just beautiful for me and I'm sure the gifts just keep going and flowing from this conversation. So, thank you. Lisa: Thank you for having me. Kimberley: Tell me where people can hear more about you and know your work? Lisa: Well, we're at the New England Center for OCD and Anxiety in Boston. We have recently opened in New York City and in Ireland. So, if anybody is in Ireland, call us, look us up. Kimberley: Wow. Lisa: Yeah. That's been really fun. And there's a few books we have. There's Stuff That's Loud written by Ben Sedley and myself. There's our newest book called Stop Avoiding Stuff with Matt Boone and Jen Gregg. And that's a fun little book. If anybody's interested in learning about ACT, it's really written-- the chapters are each standalone and they're written so that you could read them in about two minutes, and that was on purpose. We wanted something that was really pocket-sized and really simple with actionable skills that you could use right away. And then I have a new book coming out actually really soon. And no one knows this. Actually, I'm announcing this on your show. And I am writing it with my colleague, Sarah Cassidy-O'Connor in Ireland. We are just doing the art for it now and it's a book on ACT for kids with anxiety and OCD. Kimberley: When is this out? Lisa: Good question. I want to say within the year, but I don't remember when. Kimberley: That's okay. Lisa: But look for it and check out our website and check out Stuff That's Loud website. We'll post it there and let folks know. But yeah, we're really excited about it. And it'll be published by a UK publisher. So, it's really cute. So, I think the language will be much more like Australia, UK, Ireland for the US, which is really fun because I have a connection to Ireland too. But anyway, there you go. Kimberley: It's so exciting. Congratulations. So needed. It's funny because I just had a consultation with one of my staff and we were talking about books for kids. And there are some great ones, but this ACT work, I think as I keep saying, there's skills for life. Lisa: It really is. Kimberley: So important. How many times I've taught my child, even not related to anxiety, just the ACT skill, it's been so important. Lisa: Yeah. Mine too. I think they're so helpful. They were just really helpful with flexibility in so many different areas. Kimberley: Right. I agree. Okay. This is wonderful. Thank you for being on. Like I said, you brought it home. Lisa: We'll have our cups of tea now. Kimberley: We will Lisa: So nice to talk to you, Kim. Kimberley: Thank you. Lisa: Thank you.

May 27, 2022

SUMMARY: In this week's podcast, we talk with Dr. Reid Wilson. Reid discussed how to get the theme out of the way and play the moment-by moment game. Reid shares his specific strategies for managing mental compulsion. You are not going to want to miss one minute of this episode. Covered in This Episode: Getting your Theme out of the way The importance of shifting your additude Balancing "being aggressive" and implementing mindfulness and acceptance How to play the "moment by moment" game Using strategy to achieve success in recovery OCD and the 6-moment Game Other tactics for Mental compulsions Links To Things I Talk About: Reid's Website anxieties.com https://www.youtube.com/user/ReidWilsonPhD?app=desktop DOWNLOAD REID's WORKBOOK HERE Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 286. Welcome back, everybody. I am so excited. You guys, we are on number five of this six-part series, and this six-part series on Managing Mental Compulsions literally has been one of the highlights of my career. I am not just saying that. I'm just flooded with honor and pride and appreciation and excitement for you. All the feedback has been incredible. So many of you have emailed me or reached out to me on social media just to let me know that this is helping you. And to be honest with you, I can't thank you enough because this has been something I've wanted to do for so long and I've really felt that it's so needed. And it's just been so wonderful to get that feedback from you. So, thank you so much. The other plus people I want to be so grateful for are the guests. Each person has brought their special magic to how to manage mental compulsions. And you guys, the thing to remember here is managing mental compulsions is hard work, like the hardest of hard work. And I want to just honor that it is so hard and it is so confusing and it's such a difficult thing to navigate. And so, to have Jon talking about mental compulsions and mindfulness and Shala talking about her lived experience and flooding, and Dr. Jonathan Grayson talking about acceptance last week. And now, we have the amazing Reid Wilson coming on and sharing his amazing strategies and tools that he uses with his patients with mental rumination, mental compulsions, mental rituals. Literally, I can't even explain it. It's just joy. It's just pure joy that I get to do this with you and be on this journey with you. I'm going to do this quick. So, I'll just do a quick introduction. We do have Dr. Reid Wilson here. Now we've had Reid on before. Every single guest here, I just consider such a dear friend. You're going to love this episode. He brings the mic drops. I'm not going to lie. And so, I do hope that you squeeze every little bit of juice out of this episode. Bring your notepad, get your pen, you're going to need it, and enjoy. Again, have a beautiful day. As I always say, it is a beautiful day to do hard things. Let's get onto the show. Kimberley: I am thrilled to have you, Dr. Reid Wilson. Reid: Thanks. Glad to be here. Kimberley: Oh my goodness. Okay. I have been so excited to ask you these questions. I am just jumping out of my skin. I'm so really quite interested to hear your approach to mental compulsions. Before we get started, do you call them mental compulsions, mental rituals, mental rumination? How do you-- Reid: Sure. All of the above doesn't matter to me. I just don't call it "pure obsessions, pure obsessionals" because I think that's a misnomer, but we can't seem to get away from that. Kimberley: Can you maybe quickly share why you don't think we can get away from that? Do you want to maybe-- we'd love to hear your thoughts on that. We haven't addressed that yet in the podcast. Reid: Well, typically, we would call-- people write to me all the time and probably do that too, say, "I'm a pure obsessional." Well, that's ridiculous. Nobody's a pure obsessional. What it really is, is I have obsessions and then I have mental compulsions. And so, it's such a misnomer to be using that term. But what I mean is, how we can't get away from it is it's just gotten so completely in the lexicon that it would take a lot of effort to try to expel the term. Getting the theme out of the way Kimberley: Okay. Thank you for clearing that up, because that's like not something we've actually addressed up until this time. So, I'm so grateful you brought that up. So, I have read a bunch of your staff. I've had you on the show already and you're a very dear friend. I really want to get to all of the main points of your particular work. So, let's talk first about when we're managing mental compulsions. We'll always be talking about that as the main goal, but tell me a little bit about why the theme, we've got to get out of the way of that. Reid: Right. And my opinion is this is one of the most important things for us to do and the most difficult thing to accomplish. It's really the first thing that needs to be accomplished, which is we have to understand. And you're going to hear me say this again. This is a mental health disorder and it's a significant disorder. And if we don't get our minds straight about what's required to handle it, we're going to get beaten down left and right. So, of course, the disorder comes into the mind as something very specific. Focusing on the specific keeps us in the territory of the disorders control. So, we need to understand this is a disorder of uncertainty. This is a disorder of uncertainty that brings distress. So, we have that combination of two things. If we're going to treat the disorder, we cannot bring our focus on our theme. But the theme is very ingrained in everyone. I talk about signal versus noise, and this is how I want to help people make that transition, which is of course, for all of us in all humanity, every worry comes into the prefrontal cortex as a signal. And we very quickly go, "Oh yeah, well, that's not important. I don't need to pay attention to that." And we turn it over to noise and let go of it and keep going. With OCD, the theme, the topic, the checking, and all the mental rituals that we do are perceived and locked down as signals. And if we don't convert them into noise, we are stuck. What I want the client to do is to treat the theme as nothing, and that is a big ask. And not only do we have to treat the theme as nothing, we have to treat it as nothing while we are uncertain, whether it's nothing or not. So, in advance of an obsession popping up, we really need to dig down during a no problem time and get clear about this. And then we do want to figure out a way to lock that down, which includes "I'm going to act as though this is nothing," and it has to be accomplished like that. Go ahead. Kimberley: No. And would you do the same for people, let's say if they had social anxiety or health anxiety, generalized anxiety? Would you also take the theme out of it? Reid: Absolutely. But if the theme is in the way, then we need to problem-solve that. So, if we go to health anxiety, okay, I've got a new symptom, some pain in the back of my head that I've never had before. I have to decide, am I going to go into the physician and have it checked out or am I not? Or am I going to wait a few days and then do it? With that kind of anxiety and fear around health, we have to get closure around "I don't need to do anything about this." Sometimes I use something called "postponing." So, with social anxiety, it can-- I mean, with health anxiety, it can work really well to go, "Well, I'm having this new symptom, do I have to immediately go in and see the physician and get it checked out? Can I wait 24 hours? Yes, I can. I've already been diagnosed with health anxiety. So, I know I get confused about this stuff. So, I'm going to wait 24 hours." So, what does that give us then? Now I have 24 hours to treat the obsession as nothing because I don't need to focus on it. I've already decided, if I'm still worried tomorrow, I'm making an appointment, we're going in. That gives me the opportunity to work on this worry as an obsession because I've already figured it out. The reason we want to do that so diligently is we have to go up one level of abstraction up to the disorder itself. And that's why we have to get off of this to come up here and work on this. Kimberley: This is so good. And you would postpone, use that same skill for all the themes as well? I'm just wanting to make sure so people clarify. Reid: Well, sure. I mean, postponing is a tactic. I wouldn't say we can do postponing across the board because some people have-- it really depends on what the obsession is and what the thinking ritual is as to whether we can use it. But it's one of them that can be used. Shifting your attitude Kimberley: Amazing. Tell me about-- I mean, that requires a massive shift in attitude. Can you share a little bit about that? Reid: Yeah. And if you think about-- I use that term a lot around attitude, but we've got some synonyms in attitude. What is my disposition toward this? Have I mentioned mental health disorder? What do I want my orientation to be? How do I want to focus on it? And we want to think about really attitude as technique, as skill set. So, what we know is the disorder wants some very specific things from us. It wants us to be frightened by that topic. It wants us to have that urge to get rid of it and have that urge to get rid of it right now. And so, that begins to give us a sense of what is required to get better. And that again is up here. So, why do you do mental counting? Why do you do rehearsal mentally? Why do you try to neutralize through praying? When you look at some of those, the functions of some of those or compulsions and urge to do the compulsions, it is to fill my mind so I don't get distracted again, it is to reassure myself, it is to make sure everything is going to be okay. It is to get certain. And so, when we know that that is the drive of the disorder, we begin to see, what do we need to do broadly in general? And that is, I need to actually operate paradoxically. If it needs me to do this, feel this, think this, I'm going to do everything I can to manipulate that pattern and do the opposite. It wants me to take this theme seriously, I'm going to work on-- and really it has to be said like that. I'm going to work on not taking it seriously. So, that's the shift. If we can get a sense of the attitude and the principles that go along with all of that, then moment by moment, we'll know what to do in those moments. Do you need to be aggressive with OCD and intrusive thoughts? Kimberley: We've had guests talking about mindfulness and we will have Lisa Coyne talking about act and Jon Grayson talking about acceptance, and you really talk more about being aggressive. How do you feel about all of those and where do they come together, or where are they separate? How would you apply these different tools for someone with mental compulsions? Reid: Yeah, sure. Mindfulness is absolutely a skill set that we need to have. Absolutely. We are trying to get perspective. We're trying to get some distance. We would like to detach. That's what we're trying to do. But what are we trying to be mindful of? We're trying to be mindful of the belief that this topic is important. We're trying to be mindful of the need to ritualize that is created by the theme. So, the end game is mindfulness and detachment. That's where we're going. My opinion is, the opening gambits, the opening moves, it's very difficult to go from a frightened, terrified, scared, and slide over to neutral and detached. It's just difficult. And so, I think initially, we need to be thinking about a more aggressive approach, which is I'm going to go swing in this pendulum from, "I can't stand this, this is awful." I'm going to swing over right past mindfulness over to this more aggressive stance of, "I want this, let's get going. I'm taking this theme on." The aggressiveness is a determination of my commitment to do the work. And here's the paradox of it. I'm going to address on the disorder by sitting back. My action is to go, "I'm okay. This is all right." And that's a mindful place to get to. But you have to know we're going after this big, aggressive bully, and it requires an intense amount of determination and you have to access your determination over and over and over again. You don't just get determined and it's steady. So, we just got to keep getting back to that. "No, no, I want to do this work. I want to get my outcome picture. I want to have my mind back. I want to go back to school. I want to be able to connect with my family in a loving way, with having one-third of my mind distracted. I want that back very strongly. And therefore, If I have to go through this work to get there, I want to go through this work." We can maybe talk more about what that whole message of "I want this" means, but here it is, which is, "I want this" is a kind of determination that's going to help drive the work. Kimberley: Yeah. Let's go there because that is so important. So, tell me about "I want this." Tell me about why that is so important. So, you've talked about "I want to get better and I want to overcome this," and so forth. Tell me more about the "I want this comfort." Reid: Well, let's think about-- you really only have two choices in terms of your reaction to any present moment, either I want this moment, so I'm present to this moment, or I don't want this moment. It's very simple in that way. When I don't want this moment, I'm now resisting this present moment. And what that means practically speaking is, now I've taken part of my consciousness, part of my mind that is available for the treatment and I've parked it. I've taken it offline and actually provoking myself, sticking myself with, "Are you sure you want to do this? Is this really safe? Don't you think-- maybe we could do this later and not now." So, there's a big drive to resist that we need to be aware of. Have I mentioned this yet? This is a mental health disorder that is very tough to treat. I want 100% of my mental capacities available to do the treatment. I'll never have all of that because I'm always going to have some form of resistance, but I need to get that resistant part of me on the sideline not messing with me, and then let me go forward all like that. One of the confusions sometimes people get around this work when I talk about it is it's not, "Oh, I want to have another obsession right now," or "I want to have an urge to do my compulsion right now. I want that." No. What we're talking about is a present moment. So, if my obsession pops up, if it pops up, I want it. If I'm having that urge to do my compulsion, I want it. And why is that? Because we have to go through it to get to the other side. I have to be present to both the obsessions and the urges to do the compulsions in order to do the treatment. So, that's the aggressive piece. "Come on, bring it on. Let's get going. I'm scared of this." Of course, I don't want-- Kimberley: I'm just going to ask. Reid: I don't want to feel it. I don't want to, but I'm clear that to do the treatment, it requires me to go through the eye of the needle. If you're like I am, there's plenty of days when you don't want to go to the gym. You don't really want to work out or sometimes you don't even want to go to bed as early as you should, but if we want the outcome of that good rest, that workout, then we manifest that in the moment and get moving. We're disrupting a pattern. When I talked about postponing, it's a disruption of this major pattern. If we insert postponing into these obsessions and mental compulsions are impulsive, I have that obsession and I pretty immediately have that urge to do the compulsion. And then I begin doing my mental compulsion. If we slide something in there, that's what mindfulness does go, "Oh, there it is again. Oh, I'm doing it." Even if you can't sustain that, you've just modified for a few moments, the pattern that you've had no control over. So, that's where we want to be going. And you know how I sometimes say it is, my job is to-- as the client is to purposely choose voluntarily to go toward what scares the bejesus out of me. I don't know if you have bejesus over there in California, but in North Carolina, we got bejesus, and you got to go after it. Kimberley: I think in California, it's more of a non-kind word. Reid: Ah, yes. Okay. Well, we won't even spell it. The Moment By Moment Game Kimberley: That's okay. So, I have questions. I have so many. When you're talking about this moment, are you talking about your way of saying the moment-by-moment game? Is that what you're talking about? Tell me about the moment-to-moment game. Reid: Sure. I'm sure people hearing this the first time would go, "Well, don't be-- you've lost rapport with me now because you called it a game." But I've been doing this for 35 years, so it's not like I am not aware of the suffering that goes on here. The only reason to call it a game is simply to help structure our treatment approach. Kimberley: That's interesting, because I think of a game as like you're out to win. There's a score. That's what I think of when I-- Reid: That's what this is. That is actually what this is. OCD and the 6 Moment Game Kimberley: I don't think of it as a game like Ring A Rosie kind of stuff. I think of it as like let's pull our socks up kind of stuff. Is that what you're referring to? Reid: We've got this mental game that we are-- we've been playing this game and always losing. So, we're already engaged in it. We're just one down and on the losing end, on the victim end. So, when I talk about it as moment by moment, I want to have, like we've been talking about, this understanding of these sets of principles about what needs to happen. It wants me to do this, I'm going to do the opposite, this is paradoxical and so forth. And then we need to manifest it moment by moment. So, how do we do this? I will really talk about six moments and I'll quickly go through the first three because the first three moments are none of our business. We can't do anything about them. So, moment #1 is just an unconscious stimulus of the obsession, and that's all. That's all it is. Moment #2 is that obsession popping up. And moment #3 is my fear reaction to the obsession because obsessions are frightening by their construct. And so, now I've got those three moments. As I'm saying, we can't do anything about those three moments. These three moments are unconsciously mediated. They are built right on into the neurology. Now we've got in my view three more moments. So, moment #4 is really the foundation of what we do now, what we do next, which is a mindful response. And it is just stepping back in the moment. Suddenly the obsession comes up and I'm anxious and I'm worried about it and I'm having the urge to do the compulsion. And what I want to train myself to do, which can take a little time sometimes, is when I hear my obsession pop up. The way I just described it right there is already a stepping back. When I recognize that I've started to obsess and sometimes it takes a while to even recognize it, I want to step back in that moment and just name it. They have that expression, "Name it to tame it." So, it's the start of that. So, I'm stepping back in that moment going, "Oh, I'm doing it again," or, "Oh, there it is." Now, the way I think about it, if I can do that and just step back and name it, I just won that moment because I just inserted myself. I insinuated myself into the pattern. OCD doesn't want you anywhere near this at this moment. It doesn't want you to be labeling the obsession an obsession. It wants you to be naming the fearful topic of it. So, I'm going to step back in that moment. And if I can accomplish that, great, I've won that moment. If I can go further in that moment, of course, in the end, we want to be able to do that, moment #5 is taking the position of, "I'm treating this as nothing. There is my obsession. I'm treating it as nothing." And there's all kinds of things you can say to yourself that represent that. "This is none of my business. Oh, there it is trying to go after me. Not playing. I'm not playing this game." Because it really is a game that the disorder has created. And what we're saying is, "Look, I'm not playing your game anymore. I'm playing my game. And this is what my game looks like." I'm going to notice it when it pops up, the obsession and the urge to do my compulsion, and I'm going to go, "Not playing," whatever way I say it. And then moment #6, and this is a controversial moment for others. Moment #6, I'm going to turn away from it. I'm going to just redirect my attention, because this is nothing, but it's drawing my attention. I'm going to treat it as nothing by engaging in some other thought or action that I can find. And even if I can refocus my attention for eight seconds, even if it pops right back up again like, "Where are you going? This is important. You need to pay attention to it," even if I turn away for eight seconds, I've won that moment because I'm no longer responding to this over here. Now, why I say this is controversial for some folks is it sounds like distraction. It sounds like, "Oh, you're not doing exposure. You're just telling the person to distract themselves. And that's opposite of what we want to be doing." I don't see it that way. Kimberley: No, I don't either. I think it's healthy to engage in life. Reid: And if we think about, what we're really trying to do is to sit with a generic sense of uncertainty, then this allows us to do it because, in essence, the obsession is a kind of question that is urging you to answer. And when you turn away, engage in something else, you are leaving that question on the table. And that is exposure to pure uncertainty. I just feel like in our field, in exposure, we're doing so much to ask people to expose themselves to the specifics and drill down about that as a way to change neurology. And we know that's really the gold standard based on all the research that has been done. But I think it really adds a degree of distress focusing on that specific that maybe we can circumvent. Kimberley: Do you see a place for the exposure in some settings? I mean, you're talking about being aggressive with it. Does that ever involve, like you said, staring your fear in the face purposely? Reid: Well, yeah. And how do you do that? Well, what you do is you either structure or spontaneously step into circumstances that would tend to provoke the obsession. So, do something that I've been avoiding for fear that thought is going to come up or anything that I have been blocking or avoiding out of fear of having the obsession or anything that tends to provoke the obsession. I want to step into those scenes. So, step into the scene, but the next move isn't like, "Okay, come on obsessions. I need to have an obsession now." No. If you step into the scene that typically you have an obsession with and you don't have the obsession, well, that's cool. That's fine. That's progress. That's great. Now you got to find something else to step into it with. However, most people with thinking rituals, it goes on most of the day anyway. So, we're going to have a naturalistic exposure just living the day. Kimberley: The day is the exposure. Reid: And for people who are structuring it and you know you're about to step into a scene where you have the obsession, you can, in that way, be prepared to remind yourself, cue yourself ahead of time what your intention is. The more difficult practice is moving through your day and then getting caught by it. So, you get caught by it and then you start digging to fix the content and it takes a little more time to go, "Oh, I'm doing it again." We're doing exposure. This is exposure. You have to do exposure. I'm just saying that there's a different way to do it instead of sitting down and conjuring up the obsession in order to sit with the distress of the specific. Kimberley: I'm going to ask you a question that I haven't asked the others, just because it's coming up specifically for me. Some clients or some of my therapist clients have reported, "Okay, we're doing good. We're doing good. We're not doing the mental compulsion." And the obsession keeps popping up. "Come on, just a little. Come on, let's just work it out." And they go, "No, no, no, not engaging in you." And then it comes back up. "No, no, no, not engaging in you." And much of the time is spent saying, "Not today, not today," or whatever terminology. And then they become concerned that instead of doing mental compulsions, they're just spending the whole time saying, "Not today, not today." And they're getting concerned. That's becoming compulsive as well. So, what would you say? Are you feeling like that's a great technique? Where would you intervene if not? Reid: Well, I think it's fine if it is working like we're describing it, which is not today, turning away, engaging in something else. So, we've got to be careful around this "not today" thing if you forget to do-- Kimberley: The thing Reid: Moment #6, which is find something else to be engaged in. Then you're going to be-- it's almost, again, you're trying to neutralize, "Oh, this is nothing." So, we want to make sure that we really complete the whole process around that. And the other way that we-- again, mindfulness and acceptance, the way we can get to it is we have the expression of front burner and back burner. So, we want to take the obsessiveness and the urges and just move them to the back burner, which means they can sit there, they can try to distract you, they can try to pull your attention. So, here you are at work and you're really trying to do right by the disorder, but you're trying to work, and it's still coming over here trying to get to you. You're going to be a little distracted. You're not going to be performing your work quite as well as you would if your mind were clear. And that is the risk that you need to take. That is the price that you need to pay. And that's why you need to have that determination and that perspective to be able to say, "Geez, this is hard. This is what I need to be doing." You have to talk to yourself. You have to. We talk to ourselves all day long. This is thinking, thinking, thinking. So, we know people with thinking rituals are talking about the urges and so forth. And we've got to redirect how we talk about it in the moment. Kimberley: Okay. So good. What I really want to hear about is your ideas around rules. Reid: Sure. And again, nobody seems to talk about rules. I'm a very big component or a proponent of rules. And here's one reason. What are thinking rituals all about? It's all about thinking, thinking, thinking, thinking, thinking. What do we need to do in the treatment strategy? Well, first off, the disorder is compelling me to fill my mind with thoughts in order to feel safe. I need to come up with a strategy and tactics that reduce my thinking. Then if I don't reduce my thinking, I'm not going to get stronger. One of the ways to reduce my thinking is to say, "I don't need to think about this anymore. I've already figured out what I need to do." So, during no problem times, during therapeutic times, whether you're sitting with your therapist or figuring this out on your own, you come up with literally what we've been talking about, "What I need to do when an obsession takes place? And then here's what I'm going to do next." Kimberley: So, you're making decision-- Reid: I'm going to turn my attention. I'm sorry, go ahead. Make Decisions Ahead of Time Kimberley: Sorry. You're making decisions ahead of time. Is that what you mean? Reid: Absolutely. You're making decisions. This is rules of engagement. So, we're not talking about having to get really specific moment by moment. We're talking about thinking rituals. So, it's rules of engagement. Well, simply put, initially, the rule of engagement has to do with those six moments we talked about, which is, okay, when this pops up, this is how I'm going to respond to it. So, we want to have that. All that we've talked about decide that ahead of time. And then as I would say, lock it down, lock it down. And now the part of you who is victim to the disorder, when the obsessiveness starts again, when the urge to do the compulsion starts again, I want to have all of me stand behind the rules, because if we don't have predetermined rules, what is going to run the day? What's going to win the day? What's going to win the day in the moment is the disorder shows up. The victim side, the victim to the disorder is also going to show up and it's going to say, those rules that I was talking about before, "This seems like a bad idea. I don't think in this circumstance that's the right thing to do." So, if we don't lock it down and we don't have a hierarchy, which is, what I was saying, we're not killing off the side of us that gets obsessive and is being controlled by the disorder. But we are elevating the therapeutic voice, "I'll do that again with my hands." This is a zero-sum game. So, if I bring my attention to what I've declared what I need to do now, then by default, my attention toward that messages of my threatened self are going to diminish. And this is what I've been talking about with you around determination. You have to be so determined, because it's so tantalizing. Even if they say this isn't going to take me very long to complete this mental ritual, and then it'll be off my plate, and I won't have to be scared about the outcome of not doing this, why wouldn't I do that? So, that's what we're really competing against in those moments of engagement. Thinking Strategically Kimberley: Right. So good. I'm so grateful for what you're sharing. Okay. I want to really quickly touch on, and I think you have, but I want to make sure I'm really clear in terms of thinking strategically. It sounds like everything you just said is a part of that thinking strategic model. I love the idea that you come into the day, having made your decisions upfront with the rules. You've got a plan, you know the steps in the moment. Thinking strategically, tell me if that's what that is or if there's something we've got to add to it. Reid: Yeah. So, yes, all that you just said is that, that we're understanding the principles of treatment based on the principles of what the disorder has intended for us. And then we're trying to manifest those principles in, how do we act in the moment? How do we engage in that in the moment? The other thing we want to think about in terms of how I think about strategic treatment is we're looking for the pattern and messing with the pattern. So, I talked earlier about postponing. We insert postponing into the pattern. It's much easier to add something to a pattern than to try to pull something away. So, if we add postponing or add that beat where I go, "Oh, there's my obsession," now we're starting to mess with the pattern. I'll give you a couple of-- these are really tactics. Let me tell you about a couple of others and these seem surprisingly ridiculous. Okay, maybe not surprisingly ridiculous. Kimberley: Appropriately ridiculous. Reid: I'm sure you experience this. I experience a lot where people go, "Look, I'd love to do what you're saying, but these obsessions are just pounding away at me all day long. I can't interrupt them. I can't do it." What I would like people to be focused on is, what can we do to make keeping the ritual, keeping the obsession more difficult than letting it go? So, we talked about postponing. That doesn't quite do what I'm saying right now. One of the things I'll have people do is to sing it. I know, and I'm not going to demonstrate. Kimberley: Please. I will. Reid: And here's what you do. If I can't stop my obsessions, I can't park them, then when I notice – there's moment #4 – when I notice my obsessions-- and we can do this in a time-limited-- I'm a cognitive therapist, so we do behavioral experiment. So, we can just do an experiment. We can go, "Okay, for the next three days, three weeks, three hours, whatever we decide, anytime I notice the obsession coming up, instead of saying it urgently and anxiously in my mind, I must sing it." It just means lilting my voice. "Oh my gosh, how am I ever going to get through this? I don't count the tiles on the ceiling. I'm not sure I can really handle what's going to happen next. Oh my gosh, I feel so anxious about--" you see why I don't demonstrate. Kimberley: Encore, encore. Reid: SO, it's just lilting the voice like that. A couple of things are going on. One is obviously we're disrupting the pattern. But just as important, who in their right mind, having a thought that is threatening, would sing it? So, simply by singing my obsession instead of stating it, I'm degrading the content, I'm degrading the topic. And so, that's why I would do it. And again, that's what we were saying. You got to lock it down. You got to go signal versus noise. This is noise. It's acceptable to me to be doing this. This is very difficult. With such a short period of time, I don't drill that home as much as I might. This is really, really hard, but it is an intervention. So, singing it is one thing that I will sometimes have some people do. And the other one is to write it down. And this means literally carrying a notepad with you and a pen throughout your day. And anytime your obsession starts to pop up, you pull that notepad out and you start writing your obsession. And I'm not saying put it in an organized paragraph fashion or a bulleted list or anything like that. We're talking about stenographer in the courtroom. I want to, in that moment, when I start obsessing, to step back, pull out my notepad, because I said for the next three days, I'm going to do this, and then I'm going to write every single thing that's popping up in my mind. Kimberley: So, it'd be like, "What if you want to kill her? You might want to kill her. There's a knife. I noticed a knife. Do I want to kill her with a knife? Am I a bad person?" Reid: Oh, it's harder than that. It's harder than that, Kimberley, because you're not only saying, "Do I want to kill her? There's the knife. Oh, what did I just say?" Now I got to write, "Oh, what did I just say? Oh, the knife. Oh, the knife. Do I want to kill her with the knife?" So, every utterance, we're not saying every utterance. And so, there's going to be a message of, "Did I just say that right? Now I can't remember what I said. Damn it, damn it." All of that. Now, again, a couple of things are happening. I'm changing modes of communication. The disorder wants me to do this by thinking. You and I know, you can have an obsessive thought a thousand times in a day. You can't write it a thousand times. So, now we're switching from the mode of communication that serves the disorder to a mode of communication that disrupts it. And if I really commit myself to writing this, after a while, now I'm at a choice point. Now when obsession pops up later and I go, "Oh, I'm obsessing again. Well, I can either start writing it," or "Maybe I can just let it go right now because I don't want to write it. It's just so much work. Okay, let me go distract myself." So, all of a sudden, we've done exposure and response prevention without the struggle, because I don't want to do what I have agreed to do locked down, which is write this. So, it empowers. Writing it, just like singing it, empowers me to release it, especially people with thinking rituals. The whole idea of using postponing around the rituals, singing the obsession if I need to, writing down the obsession as tactics to help break things up, and then just keep coming back to what's our intention here. This is a mental health disorder. I keep getting sucked into the topic. I don't think I can-- here's I guess the last thing I would say on my end is, this is it, which is, I don't know if this is going to work. I don't know how painful whatever is coming next is going to be by not doing my ritual. I am going to have faith. I mean, this is what happens. You have to have faith and a belief in something and someone outside of your mind, because your mind is contaminated and controlled by the disorder. You can't keep going up into your thinking and try to figure out how to get out of this wet paper bag. You're just not-- you can't. So, you got to have faith and trust. And that's a giant leap too. Because initially, when we do treatment with people, however we do it, they've got to be doing something they don't know is going to be helpful. When people start doing the singing thing or the writing down thing, for instance, after a while, they go, "Wow, that really worked. Okay, I'm going to do that some more." And that's what we need. Initially, you just have to have faith and experiment. That's why we like to do short experiments. I don't say, "Hey, do this over the next 12 weeks and you'll get better." I go, "Look, I know you think this over here, I'm thinking it's this over here. How about we structure something for the next X number of minutes, hours, days, and just see what you notice if you can feel like you can afford to do that." Kimberley: So good. I've just got one question and then I'm going to let you go. I'm going to first ask my question and then I want you to explain, tell us about your course. When you sing the song, I usually have my staff sing it to a song they know, like Happy Birthday or Auld Lang Syne, whatever it may be. You are saying just up and down, "No, no, no," that kind of thing. Is there a reason for that? Reid: Well, I don't want people to have to make a rhyme. I don't want them to have to-- Kimberley: It's just for the sake of it. Reid: I'm totally fine with what you're saying. Okay, I'm going to-- you can figure it out. It's like going, "Okay, anytime I hear my obsession come up, I'm going to make my obsession the voice of Minnie Mouse. So, I'm going to degrade it by having to be a little mouse on my shoulder, anything to degrade it." If you've got to set little songs or you ask your client what they would put it to, then yeah. And then in the session, we're talking about the therapist, demonstrate it and have them practice it with you in order to get it. Kimberley: Right. I've even had clients who are good at accents, like do it in different accents. They bring out-- Reid: You've got a good one. You're really practicing that Australian accent. Kimberley: Very. I practiced for many years to get this one. All right. You talk about the six-moment game. I've had the joy of having taken that course. Can you tell us if that's what you want to tell us about, about where people can hear about you and all the good stuff you've got? Reid: Sure. Well, I would start with just saying anxieties.com. It's anxieties, plural, .com. And that's my website, a free website. It's got every anxiety disorder and OCD. You've got written instruction around how to do some of the work that we're talking about. And then I've got tons of free video clips that people can watch and learn a bunch of stuff. I laid out, in the last two years, a four-hour course, and I filmed it. And so, it is online now. I take people all the way through what I call OCD & the 6-Moment Game: Strategies and Tactics , because I want to empower people in that way. So, I talk about all the stuff that you and I are rushing over right now. It's got a full written transcript as an eBook, a PDF eBook. I've got a workbook that lets people figure out how to do these practices on their own. All of that. In fact, you can get-- I can't say how to get it at this moment. Maybe you can post something, I don't know. But I will give anybody the workbook, that's 37 pages, and it takes you through a bunch of stuff. No cost to you, send it to anybody else you want. So, I feel like that, first off, we don't have enough mental health professionals to treat the people with mental health disorders in this world today. And so, we need to find delivery systems. That will help reach more people. And I believe in Stepped Care. And Stepped Care is a protocol, both in physical medicine and in mental health, which says that first step of Stepped Care and treatment is self-help. And I call it self-help treatment, because the first step is relatively inexpensive, empowering the patient or the client, and giving them directions about how to get stronger. And a certain percentage of people, that will be enough for them. And so, all of us who have written self-help books and so forth, that's our intention. And now, I'm trying to go one step beyond self-help books to be able to have video that gives people more in-depth. What I want is for that first step, the principles that are in that first step, go up to the next step. So, if a self-help course or a book or whatever is not sufficient to finish the work, then you go up one level to maybe a self-help group or a therapeutic group and work further there. And if you can't complete your work, then go up the next step, which is individual treatment, the next step, which is intensive outpatient treatment, the next step, mixture medications, and so forth. And so, if we can carry a set of principles up, then everybody's on the same page and you're not starting all over again. So, I focus on step one. I'm a simple guy. Kimberley: I'm focused on step one too, which is what you're doing with me right now, which makes me so happy. I'm so grateful for you for so many reasons. Reid: Well, I'm happy to be doing this, spending time with you. It's great. And trying to figure out how to deliver the information concisely. It's still a work in progress. Thank you for giving me an opportunity. Kimberley: No, thank you. I've loved hearing about all of these major points of your work. I'm so grateful for you. So, thank you so much for coming on again. I didn't have a coughing fit during this episode like I did the last one. Reid: Nothing to make fun of you about. Kimberley: Thank you so much, Reid. You're just the best. Reid: Well, great constructing this whole thing. This is what I'm talking about too, is to have a series of us that eventually everybody will see and work their way down and get all these different positions and opinions from people who already do this work. And so, that's great. You have a choice, so that's great. Kimberley: Love it. Thank you. Reid: Okay. Talk again sometime.

May 20, 2022

SUMMARY: In this weeks podcast, we talk with Dr Jon Grayson about managing mental compulsions. Jon talks about how to use Acceptance to manage strong intrusive thoughts and other obsessions. Jon addressed how to use acceptance with OCD, GAD and other Anxiety disorders. Covered in This Episode: What is a Mental Compulsion? What is the difference between Mental Rumination and Mental Compulsions? How to use Acceptance for Mental Compulsions How to practice acceptance when the intrusive thoughts are so strong. Links To Things I Talk About: Jon's Book Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty Jon's Website https://www.laocdtreatment.com/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit Episode - 285. Welcome back, everybody. We are on episode three of the six-part series. And if you have listened to the previous episodes, I am sure you are just full of information, but hopefully ready to hear some more. Today, we have Dr. Jonathan Grayson. He's here to talk about his specific way of managing mental compulsions. As you may know, if you've listened before, I strongly urge you to start and go in order. So, first, we started with Mental Compulsions 101. That was with yours truly, myself. Then Jon Hershfield came in. He talked about mindfulness and really went in, gave some incredible tools. Shala Nicely, again, gave some lived experience and really the tools that worked for her. And I have just been mind-blown with both of their expertise. And it doesn't stop there. We have amazing Dr. Jonathan Grayson today talking about all of the ways that he manages mental compulsions and how he brings specific concepts to help a client be motivated and lean into that response prevention and to reduce those mental compulsions. I am again blown away with how amazing and respectful and kind and knowledgeable these experts are. I just am overwhelmed with joy to share this with you. Again, please remember this should not replace professional mental health care. We are here at CBT School, who is the host of this series. We're here to provide you skills and tools, and resources specifically if you don't have access to those resources. That is a huge part of our mission. So, even though we have ERP School – and that is an online course, you can take it from your home – we wanted to offer this freely because so many people are seeming to be misunderstanding mental compulsions, and it's an area I really have been excited to share with you in this free series. So, I'm not going to yammer on anymore. I'm going to let you hear the amazing wisdom of Jonathan Grayson. Have a wonderful day. Kimberley: Welcome. I am so honored to have you here, Jon Grayson. Jonathan: It is always a pleasure. Kimberley: Okay. So, I actually am really, really interested to hear your point of view. As we go through a different episode, I actually am learning things. I thought I knew it all, but I'm learning and learning. So, I'm so excited to get your view on managing mental compulsions or how you address them. My first question is, do you call them mental compulsions, mental rituals, rumination? How do you frame it? Jonathan: I'm never really too big on jargony, but mental compulsions are mental rituals. And I think that's trying to-- and I think the thing about mental rituals is some people don't know they have them. I mean, some people know, but some people will describe it as, "I just obsess, I don't have rituals." but then when you listen, they do. And the ritual part is trying to reassure themselves or convince themselves that whatever it is they're worrying about isn't. So, they have both the fear part like, "Oh my God, what if this is true? But wait, here's why it's not true. Now I know that's not really true. But what if it is true?" So, that is what I would call mental compulsion or rituals. Kimberley: Right. How do you-- let's say you're sitting across from a patient or a client they are doing either predominantly mental compulsions or that's a huge part of the symptoms that they have. How would you address in your own way, teaching somebody how to manage mental compulsions? Jonathan: I think there's two answers to the question because I never have, and one has to do with what is the content, because I believe every set of mental rituals – I believe it for all forms of OCD, whether there's a very strong behavioral component or it's all mental – it has its own set of arguments that we're going to use. Of course, when I talk about arguments, I know this will be a shock to you, but to me, it always has to do with coping with uncertainty, because I think the purpose of mental compulsions is to deny reality. That is, there is something I don't want to be true and I keep trying to convince myself it's not true. Now often it's a low probability. But low probability is not no probability. Sometimes I have clients a little confused, saying like, "I tell myself it's low probability," and they actually feel better. Is that okay? And the answer is, it depends. If I'm trying to convince myself, I don't have to worry about it because it's a low probability, no, that's a ritual. If I'm just saying it's a low probability, I mean, way actually with OCD , it's very easy because people don't mind saying it's low prob they. They like saying it's low probability, but they don't want the last sentence to be "But it might happen." So, it's like, as long as you're answering "It might happen," then you're dealing with reality because everything is a low probability, even if it's really small. So, one part has to do with the content. And I think for every set of obsessions, there is, what is the content they're doing? I think in a more general way, the goal of treatment is basically accepting that low probability things might happen. I was recently saying to people that I hope the probability of nuclear war is no worse than that. It was as bad as likely as a worldwide pandemic. Some people would freak out like, "You think there's going to be a war?" First of all, I know anything, but they were missing the point. It's like, no, I really mean it's as likely as a pandemic, which means it's not likely. However, the thing about the pandemic, low probability things can happen. So yeah, we're probably okay. And so, the thing about acceptance that everyone hates is acceptance is second best. We spend so much time talking about how great acceptance is and I really think it's a disservice in some respects to not point out what acceptance means because it almost always is. Here's something you don't want that you might have to live with. If I lose a loved one, we start in denial. And for me, denial is defined as I'm comparing life to a fantasy. I have a woman in a bad relationship and she thinks he really loves the guy, but it's like, he'd be so good if only he would change X, Y, and Z. And of course, if he changed X, Y, and Z, he would be someone else. So, they're in love with a fantasy. And when somebody dies, the fantasy is life would be better if they were here. It's a fantasy because that's never happening again. So, we have to get them to the point. And of course, the thing, the reason I mentioned death is it points out a really important thing about acceptance. You don't get to just decide, "I'm going to accept." I lose a loved one. I don't care how or where you are. You're starting in denial because you're missing them and you want them there. And after about a year, if you've gone through mourning, you accept it. It's not like you don't care they're gone. You can still cry. You can still miss them. But when you're doing something you're enjoying and in the present not comparing to what it would be with that person. So, acceptance, I'm pretty sure, always sucks. However, it's better than fantasy because the fantasies never happen. So, it doesn't matter if it's likely or unlikely. It's just a matter that this is your fear and the thing that's hard for people to deal with fear is to cope with it. You're going to say, "How would I try to live with the worst happening?" And people's initial response to something is, "Yeah, but I don't want that." There are multiple reasons that we need to do acceptance. If I'm correct about denial, that's comparing reality to fantasy. Well, not acceptance means what I want will never happen. So, for me to want that there's no possibility something will occur is probably not true. I don't care if it means that maybe this reality doesn't exist and I'm going to wake up, and some of the things that discover I've created all of reality, there's nothing. I don't know that that's likely, but I can't prove it's not likely. So, I think people go in circles. And you can hear it. The thing about the pandemic, you could hear the regular population denial. Because when I say it's comparing reality to fantasy, a lot of times that sounds cool. And people don't quite get what it means, but here are statements of denial early in the pandemic, "Well, this can't go on more than a few weeks." Honestly, at the beginning, I was like, "Of course, it's going on for a few weeks. They have to have a vaccination. They're telling us that's two years down the road. This is going on for a long time." Kimberley: I was in team two weeks. Jonathan: Yeah. "It can't last. I can't take it." Saying "I can't take it," although you're expressing the feeling like "I really hate this," but including in the words "I can't take it" is a fantasy as if you have a choice. And in a way, luckily, most people who say they can't take it didn't kill themselves. It's proved that they can't take it. They took it. They kept going on. It's like, they didn't want to imagine continuing to live that way. So, acceptance is like, "Yeah, this is going to happen. Yes, it can keep going." How will you try to cope with the worst? And go on, I'll shut up. You look like you want to say something. Kimberley: No, no. I'm following you. I'm really enjoying this. I actually wrote down the word "cope" right at the beginning because I think that that's such a keyword here. To stay out of the fantasy, would you say that's true? Jonathan: Well, yes. The worst might-- I mean, I always feel like if I'm doing therapy and if somebody has intolerance of uncertainty, they don't like uncertainty, I have to treat that problem. And what I mean by that is we have a lot of therapists who impose their own feelings on the client. If I have a therapist that I have somebody who's socially anxious and saying, "I'm afraid if I go in a room, some people won't like me." Almost every therapist is going to say, "Oh, well, that's the fact, they might not like you." But that same patient is like, "I'm afraid if I touch the doorknob, I'm going to get sick." "Oh no, that won't happen." Well, that's not the issue. Now therapist is-- if I have a problem of threat estimation, that's fine, but that's not it. I don't want to know that it's a low probability, I want no probability. So, we have to deal with the fact that this is what the person's afraid of. This is what they fear. Somebody will say, "Well, but they don't have cancer issue. Why should they worry about it?" But let's face it. If they did have cancer, the focus would be coping with the fact they're dying. And if they're afraid of having cancer, I'd say the treatment is the same. Now, the only great thing is they probably won't have cancer, so it's not a fear they will have to probably deal with. They want to have the second part of it like, "And I'm dying." But to be more prepared-- and I think what you've done wisely, like hearing that, yes, what you've done wisely is you're talking about the fact that this is not just a nosy problem. This is a problem for everyone, coping with uncertainty. I hate to do a plug. It's okay. It's a while away. Actually, Liz McIngvale and I, we're working on a book, talking about-- well, the book is partially-- and we'll be doing some talks on it. We're saying that ERP is not the gold standard of treatment for OCD . And we're going to say that it's not the gold standard because it's lacking the gold. It really needs to be ERP plus gold. But that's awkward because I like to be calling these initials. So, we want to use initials. Do you happen to know the chemical symbol for gold? Kimberley: F-- no. FE is copper. Jonathan: No, that's iron. Kimberley: Iron. Jonathan: Yeah. AU. Kimberley: AU. Jonathan: The gold standard of treatment-- Kimberley: Like Australia. Jonathan: Well, no. ERP plus AU. AU as in Accepting Uncertainty. Kimberley: Oh, my trap. Jonathan: Yeah. It took me a while to work that around. Kimberley: Now you sure it's not Australia. Jonathan: But our point is what we want to write. We want to write a book that's not only about helping therapists deal with every presentation of OCD and how you deal with the uncertainty problem, but we're also arguing that it's a book for everyone that people can learn from OCD, a disorder that intolerance uncertainty is like the core. Because I always feel that our clients who get better, they're not normal. They are better than normal because they're coping with uncertainty, because the average person really doesn't do that. Well, I mean, in the pandemic, you got to see how bad non-sufferers are. So, I think the core of coping with mental obsessions is this. Well, what if the worst happens? And so many people, "I don't want to think it," and that leaves us stuck because we're not stupid. If you say to somebody-- if you get a phone call from police and they say your spouse has died, your first response is you're just in this shock and you're just like frozen. And for a lot of things that are bad, that's the way people stop thinking. It's like, "I don't want to think about it." The thing is, if the police make that call, something happens next. And life goes on. And back for clients, I often ask that in a sneaky way. What if this did happen? What would be next? What if he did have-- the doctor says, "Yeah, it can," so I freak out. What does that look like? "I'd be screaming." You're in the doctor's office, screaming. How long are you going to do that? And then you're going to go home and you need dinner. What do you do the next day? And even though we're going through something that sounds terribly scary, people oddly feel better after that. Now, this is first session. It's not like they've done treatment, but they feel better because a statement that is true, you can't do what you won't imagine. And I don't mean this as you would say, in the flowers and unicorns kind of way that you can do anything you can imagine. I do not mean that. But if you won't even imagine it, you can't do it. So, what would you do in X situation where it's like, no. Well, it's like the world is ending. When we imagine it, it's not like it's good. But it's like, oh, because the feeling that accompanies acceptance is a down, depressing feeling like, "Oh, that could happen." However, it's not frantic. Denial is frantic. "That can't happen. No, no." Again, everything at least has some low probability. Some things are higher. You could have cancer, yes. Your family could die. Those things are like, they're there. So, it's not like I get the choice. So, the statement of denial is frantic. The statement of acceptance is depressing, but it's not frantic. And so, I don't care how bad the disaster is. How would you try to cope? Because in most realities, that's what you're going to do. And I could pause at this moment because I don't know if this would be the point where I would then be shifting to, well, what are the mental compulsives we're talking about here? Because I think again, each one has its own set of arguments. You've heard my general thing. In some ways I think I'm reasonably good at applying it to myself. I think there's some areas I haven't been tested in. So, that's nice. I hope I could be-- I know what I want is possible because I've seen people do it. Would I be one of those good people? I can only hope. But at least because I know people have done it, I know it's possible. I like to believe-- go on, you. Yes. Kimberley: What does that look like? Can you paint me a picture of a client who does well using this strategy at managing mental compulsions ? Jonathan: A client that I-- there's a podcast on that, the OC stories, he was afraid of going crazy. And he had had this from age 19 to his late forties. And he had ERP, but ERP was always focused likely and we're going to focus on going crazy and all this stuff. Know whatever explicit just said to him, the goal of treatment is for you to risk going crazy. I told him that the first session and he began to cry because he's been spending more than 30 years trying to avoid this. And I'm saying, "Oh yeah, this might happen." And many people really are able to accept. And I never talk about accepting uncertainty. I talk about learning to accept uncertainty. Because really, if I can talk to you-- if it's just a decision, we're done the first session. But most people are convinced of recession. It took about three months to help convince him. And he kept going back and forth. And so, convincing him, we went through a number of things to work on it. So, I'm describing it quickly, so it sounds simple. But remember, three months. The first reason, and this is true of almost all rituals, mental compulsions, regardless, you don't have a choice. All your rituals do not prevent you from going crazy. He's avoiding places because you've got an anxiety attack there, so I'm not going to go there. It's like, sorry, it's a biological process that you're going crazy. That's doing nothing. So, one is, your rituals don't work. Two, for pretty much anything, you don't have a choice. Uncertainty is the fact of life. We talked about what it would look like and he went crazy. And we were going-- and we talked about, well, what's going to happen? Where are you going to go? He went through all these things. And because he's logical, at some point it's like, it could happen. And at that point, he's then able to spend the other work, which is not fun, which is then imagining going crazy and looking at all the things that scare the heck out of him so he could begin to function again. We wanted to treat going crazy, the way most people do this is not their problem. Treat, getting main paralyzed and disfigured in a car crash. We all know it's possible. Our brilliant plan is generally, I hope it doesn't happen. I'm not dealing with it until I'm bleeding out, crushed under the metal. To say, "I'm not going to be in a car accident today," it's like, really? I can't say that. So, our goal is to get whatever uncertainties in life there are to be like that. And it doesn't matter whether I'm afraid of going crazy. I'm afraid that I'm going to be a pedophile. I'm going to slice and dice my wife tonight. I'm going to flunk the test. These people don't like me. It doesn't matter what it is. It's still always the same. I mean, we can talk about odds, but not as simply reassurance because, again, it's reassurance if I want to know it's low odds, but if I want it to not be possible, it's not reassuring. It's like, it's probably not this, but it might be how we deal with it is that way. The other thing that we look at is, how does it work for you to fight against this uncertainty? What are you losing? And of course, the more pathological the problem is, the worse it is. So, if I have OCD, it could be destroying my life. I'm not only hurting myself, I'm hurting my family. Let's go how you're really torturing everybody. And sometimes I think, in that case, we're looking for reasons to get better. I always like people to look at all the harm they're doing to themselves and their family. And I think in a brilliant way, just to plug you, I think your book, your new book really partially addresses that because the self-compassion part isn't just like, okay, be nice to yourself, stop suffering. It's like, if you're going to love yourself, what kind of life do you want to make for yourself? What are your values going to be? Because I think we transform this process of coping into something more than simply confronting fear. It becomes something for myself. And secondarily, not as preferable, but sometimes easier to get to – it becomes not only confronting a fear, it becomes an act of love. Because you know what, I'm going to stop being a pain in the ass to my family. I'm now going to put all of us first. And so, we're really going to have-- what are my values, and how does this interfere with my values? And again, it doesn't have to be as major as I'm dysfunctional, torturing my family with something OCD for any worry. Everybody's going to be happier if I can cope with my worries better. I mean, my family's going to be happier because they love me. It's really nice to see me not freaking out because they don't have-- because you want to help and there's no way to help. So, for me to be better and calmer and coping is nice for them. It's certainly nice for me, and isn't that what I would prefer in life? And so, when, when my life depends on me having a worry that's not allowed to happen, I don't get to enjoy things. Another coping thing I do that's smaller is I will ask people to notice what they're enjoying, no matter how, whatever level, even 5%. I think many times people will say, "Everything sucks, I don't enjoy anything because of this problem." Now that's not entirely true because in the course of interviewing them, there are a few times I'll get them to laugh for three seconds. And I admit if laughing three seconds were the goal, wow, that'd be great. But three seconds of laughter isn't much compared to a life of misery. But the thing is, they don't even notice that ever. The entire experience has been horrible and it's like-- and to get them to notice not what it should be, but what it was. I once did this with a guy. I sent him to the movies and I said, "Watch the movie, just tell me whatever you enjoyed. I don't care how little." And he came back and he said, "It didn't work. Everything was horrible." I'm like, "Okay, now tell me about the movie." So, he was describing the movie to me, it was a war movie, and it is clear, this guy liked the climax. So, I'm like-- Kimberley: Isn't that funny? The way our brain works? Jonathan: Yeah. And I said, "That was pretty cool, that climax. Are you sorry you saw that?" "No." I said, "Okay, you didn't do my assignment. Notice whatever you enjoyed. I don't care that it's not as good as it should have been. You clearly like that." And it makes a difference because it means a two-hour experience that he comes away believing he had nothing. It would be a slight change to go like, "I enjoyed a little bit of that." I try to tell people, think of it as like a little while of enjoyment that you don't notice exists, and we want to expand those. And most people would recognize that in a way, what we're talking about is a little bit of mindfulness. Like, okay, it sucks. I'm not arguing it doesn't suck, but a lot of mindfulness. It isn't like, I'm going to put you in a happy land. It's like, we were trying to do AND, not OR. The beginning of the pandemic, Kathy and I, we're out on our pandemic walk. And she said to me, "This would be such a great day if all this wasn't going on." I said, "You're wrong, Kathy." We should let you and your listeners know. You don't know this, but your husband does. Being married to a psychologist is not necessarily fun. Kimberley: So true. Jonathan: It is a beautiful day. We're walking together, it's beautiful. We're together, it is beautiful. It is a beautiful day AND it sucks that there's a pandemic. Kimberley: So true. Jonathan: Not OR, it's AND. In a sense, mindfulness is teaching us to live in that world of AND. This is awful AND I can still enjoy stuff, as opposed to it's either or. And again, some people go like, "Well, that's awful." And that's perfectly true, because we're going back to what is acceptance. Acceptance sucks. It's the second-best life. However, what's really great about the second-best life, the first best doesn't exist. So, it's like, yeah, it's second-best, but it's this or nothing. So, I think those are a lot of the principles of doing it and I think to do it, it's like, why would I take this risk? It's not a risk, but essentially, it's like, why would I accept living like this, whatever this is? And I don't have a choice. What am I losing by not living like this? Am I hurting my family? What would life be like if I could be okay with this? Depending who you are, that's an incredibly amazing change or it's a minor change. I mean, if I'm a very competent worrier and very successful, we're talking about way more peace. But if I'm competent, I'm interfering with my life and taking up a lot of time, we're now making major changes in the quality of life. And as you know, I can obsess or worry about anything from like, "I need to be the best." And I always ask people, what is so good about best? Because God forbid, you should be mediocre. God forbid, you should be a happy mediocre person than the best person. And so, for some-- Kimberley: Well, that's still a piece of denial, isn't it? They have this idea that the best is no pain. Jonathan: Yeah. Kimberley: There's no pain at the top. Jonathan: Yeah. Right. And generally, there's some other assumption that-- I don't know. Somehow, I'm deficient of, I'm not best. So, it's like the only way I can know. It's another set of issues. What is it that I fear that I have to cope with? Not being best. Okay, I get you want to be best. Why? Well, best is best. I mean, it's nice, I guess. When I think about being well-known, I generally think of being well-known as icing. That is, what makes my life great? For me, I love what I'm doing, and what I'm doing is, besides talking a lot because I love talking, but I like working with people, and I just really enjoy it. I have no plans on retiring because I like this too much. That's almost all year round. Being famous and well-known, that's about six days a year when I go to conventions. And I say, it's like icing to indicate I am weak enough. I'll admit I'm weak enough to really enjoy it. But I also recognize it is nothing. It doesn't have any substance. And the thing about fame, you're always going to lose it. You're never famous enough. And there's a poem by Shelly that I think really characterizes it. It describes a traveler in an ancient land. It's come across a huge fallen monument and it's describing the magnificence of what this had been. And he comes to the base of the statue where these words are written: "My name is Ozymandias, King of Kings; Look on my Works, ye Mighty, and despair!" That's fame. It's empty I can gorge, but it doesn't mean anything because what I enjoy is what I actually do. It'd be sad if my life was like, it's good six days a year when I can feel it. Kimberley: Right. And I think what's important, particularly for the sufferer, is you still have uncertainty in your life. Jonathan: I don't know any way to be certain, so I know nothing. Kimberley: Right. You know what I was reflecting on, and this is just me reflecting, is last year, maybe it was the beginning of this year, I gave myself the exercise to catch the mini toddler tantrums that showed up in my mind. Jonathan: I love that term. Great. Did you make that up? Kimberley: I think I did because it-- Jonathan: Take credit. It's great. Love it. Kimberley: It feels like a toddler tantrum in my mind. Jonathan: It's perfect. It's that "But I don't want that." I love it. Oh, I love it. Go on. Kimberley: Yeah. I did a whole podcast about it last year because I was just noticing toddler tantrum after toddler tantrum, and I regulate myself really well. But it was showing up. And then as you're talking, I'm thinking about how that was me resisting acceptance. That toddler tantrum is probably where I have the option to pull out of rumination and be present when I can catch it and be like, "Okay, you're totally in denial. You're in a fantasy land." And so, that really speaks to me as a way to catch when you're up in that place of rumination. Jonathan: That's perfect. Kimberley: Yeah. For me, that was really powerful. I love that you brought that up because I think that is the bridge. I'm totally out of acceptance when I'm in a toddler tantrum. Jonathan: Right. Because when you get better, as you're describing, you can deal that pull of like, "This is what it is. No, no, no." You can feel that pull back and forth because you don't get completely lost and it's like, ah. Kimberley: Yeah. It was such a visual. I could see it tantruming out. "No, no, no." And so, I love that you brought that in particularly in this way, like I said, of catching the compulsion. So, thank you. That actually consolidated-- Jonathan: I'm just now obsessing about how I'm going to work this in. We'll give you credit. Kimberley: You do. The Kimberly Quinlan "toddler tantrum," I'm very well-known for it now. No, I am so thankful for you for bringing all this up. Is there-- because I want to be respectful of your time, is there anything else that you want to address when it comes to conceptualizing or managing mental compulsions? Jonathan: I think that I'm afraid I have to be patient. Again, thinking about death, I don't get to accept just because I want to. You have some people who try to accept like, "I'm accepting and I'm accepting it." It's like, yeah, sorry. I can be working towards learning it. I think sometimes people have an insight. An insight is not like you suddenly know some new piece of information. Insight is something that you basically knew, suddenly it's true. I had somebody have that the other day when that's hurting and they felt like it was trivial trying to explain to me what happened, but I already had this concept. I said, "I know. It's like, you've always known you feel like going wrong." "No, you don't get it. It's really true." So, it was very cool. And so, I think it's a gradual process where I get better at it. And because life is completely uncertain in every which way, there's always opportunities to practice it, better personal. And you may scare other people. And one client who was very scared of a lot of things, especially of one of their pets dying. As they got uncertain and told, and then they could talk about it pretty calmly with people, "Oh yeah, I think she's going to die at some point." And people would be horrified. She could sound so calm, but she was like, not that she likes it and she really doesn't want it to happen, but she could also think about it and think about life after that. And I think some people mistakenly will say something like, "Oh my God, you're making life complete miserable. All you're thinking about is all these nightmares that can happen all the time. That's terrible." That's crazy because-- I thought I'd use a clinical term. Because what happens when I accept uncertainty? Somebody else has said this. Unfortunately, I haven't made it up. I become, in a positive way, hopeless future. And what I mean by hopeless is the way most people who aren't scared of the car crash, or it's not like, I'm okay with a car crash. It's like, what can I do? And when I become hopeless about control, that is when I get to live in the present because I'm no longer in the past or the future. Let's face it. The truth is that's all we have. The past of great memories or terrible memories, the future's hopes, all we have is the present, this moment, my entire life and your entire life with each other. Everything else we like might not be there at this moment. So, I get to have the only thing there is, which is the present. And again, I can't just decide because you see people do this, "I'm going to live in the present. I'm going to enjoy the present now. Enjoy the present." It's like, I have to learn to give things up. To steal from this woman who wrote this book of compassion: "To be kind to myself, to let myself learn, to not expect it all at once." Again, if we were talking OCD, I don't know why we were talking about that. If we were talking about OCD, every particular variation has its own uncertainties to cope with. Scrupulosity, how do I learn to believe in a God and simultaneously admit I might be wrong? How do I live in a world where probably I'm not going to slice and dice Kathy tonight? But if I do, how would I try to-- what would I do the next step? When my son was 16 and going out on dates. And of course, he would never be home on time. And Kathy always wanted to call him. And I wouldn't let her call him not to be nice to him, but I knew as she knew, his cell phone would be on. So, calling somebody you're worried about in their cell phone on is not going to be comforting. So, she'd go like, "Well, when can I call him?" So, I'd make this mental calculation. Okay, he should be home now. I think he'll be home in these many minutes. And let me add another half hour and say, you can call him dead. And she could for some reason, which is unusual, she would then go to sleep. And I would go there and I think, "Huh, he's probably okay. He's probably not doing anything terrible. Probably nothing terrible is happening to him. But tonight could be the night that our lives change and everything is screwed up forever." And then I would go to sleep. That's just the truth. Kimberley: Yeah. It's powerful. I'll be calling you, and my kids are teenagers, saying "Coach me, coach me." Jonathan: Yeah. And I will give you the following advice. It gets so much easier when they're 23. Kimberley: Yes, I know. Jonathan: Until your acceptance is, "Oh yeah," you're screwed till then. Kimberley: It's true. I'm so grateful for you and your time and all your wisdom. I feel like I'm sitting and just absorbing it all for myself, which I'm loving. Jonathan: Thank you. Kimberley: Tell us, I know you've been on the podcast before, but tell us where people can hear more about you and your work. You obviously have a new book, which I did not know about. Jonathan: Well, we are working on it and we're at the stage of working it, not procrastinating. We're at the stage of doing a bunch of presentations on the idea, because I've just seen so many treatments fail because it didn't address uncertainty. Although I always focus on certainty, it really is-- the bottom part of dealing with that is coping with life. It transcends OCD. So, I don't know. What would you like to know about me? Kimberley: Where can people find you? Jonathan: Where can people find me? Easily on the internet. Website is a laocdtreatment.com. But I think my name plus OCD tends to come up a lot. Kimberley: Your book? Jonathan: I have a book. It's Freedom From OCD . I think there are a lot of good OCD books. Of course, I like mine because I agree with it most. But it's a little scary when people read it before they see me because it is almost my entire repertoire minus maybe about 40 minutes. I feel like I'm going to be repeating myself, but somehow that doesn't seem to be a problem. Apparently, hearing it out loud is different than reading it. Kimberley: Well, and that's the whole point, right? I have the same situation as people need to hear it more than once too, in some cases. Not as a form of reassurance, but I think we all need to hear it. Even me today having a little light bulb moment I think is really cool, even though I've heard that before. So, I will have your website and your work in the show notes. Jonathan: Very kind. Kimberley: Thank you so much for being here and sharing. Jonathan: I don't know if you figured it out yet. I know I've told you this, but I'll just repeat it. Probably if you asked me to come on, the answer will always be yes. So, thank you. Kimberley: I'm so happy. No, I remember you saying that last time. Like I said to you, before we started recording, I have wanted to do this series for quite a while. And I had you right there going. I already put you on the list because I already knew. You told me you would say yes. Jonathan: And so, apparently, I'm not dishonest or not that dishonest. Kimberley: Not at all. When I texted to ask you, I actually already had you on the list and scheduled you in. Jonathan: It was a confidence that you could well have. Kimberley: Yeah. I'm so grateful. And yes, we will definitely have you on. It's always a pleasure. Jonathan: All right. Okay. Take care. Thank you very much.

May 13, 2022

SUMMARY: In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions. In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions . Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School , that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need. If you're wanting additional information about ERP School, please go to CBTSchool.com . With that being said, let's go straight over to this episode with Shala Nicely. Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, "What's wrong with you? What are you doing?" you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy , straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD . I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. So, for instance, an example that I use in Is Fred in the Refrigerator? , my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into 'may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use 'may or may nots' and how I teach my clients to use 'may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'. But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it. What I'll do with clients, I'll say, "If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention." That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, "Oh, that's my OCD." I'm not going to say, "OCD, I'm not talking to you." I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on. Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, "I want you to repeat after me." I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, "Well, what is your OCD saying right now?" And they'll say, "Well, that's blood and it could have AIDS in it, and I'm going to get sick." I'll say, "Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on." And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, "That may or may not be blood, I may or may not get AIDS, I may or may not get sick," I'll say, "Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that." And so, "I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS," over again until people start to say, "Oh, okay. I guess I don't have any control over this," because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle. Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. "Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute," and then over and over. "My family may or may not be left destitute. My family may or may not be left destitute, whatever," until we're hitting all the things that could be circulating in your head. Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the 'may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody. And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, "Really?" But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I'm like, "Well, I don't bother because I'm going to be dead, because I have breast cancer." That's where my mind took it because I've had OCD long enough that if I get a really scary and I start and I play around in the content, I'm going to start losing insight and I'm going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you're believing what the OCD says like, "Oh, well, I might as well just give up, I have breast cancer," and then becoming depressed, and then acting like it's true. And then that's reinforcing the whole cycle. So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the 'may or may nots' that helped because I was trying to help my brain understand, "Well, I may or may not have breast cancer. And if I do, I mean, I'll go to the doctor, I'll do what I need to do, but there's nothing I can do about it right now in my head other than what I'm doing." Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use 'may or may nots' with clients unless they are unable through numbing that they might be doing. If they're unable to actually feel what they're saying, because they're used to turning it over in their head and pulling the anxiety down officially, and so I can't get a rise out of the OCD because there's a lot of really little subtle mental compulsions going on, then I'll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into 'may or may nots'. But there's nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you're prone to losing insight into your OCD when you've got a really big one, I think that's a risk factor for using that particular type of scripting. Magical Thinking and Mental Compulsions Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I'm actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you? Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don't hit this green light, then somebody's going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with 'may or may nots' too. I'll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it's certainly the creative stuff And to one-up the OCD, you use the scripting to be like, "Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I'm such a bad person." This 'may or may not' is in all this crazy stuff too, because that's how to win, is to one up the OCD. It thinks that's scary, let's go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not. Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I've always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you're just doing it and it's so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone's really struggling to engage in 'may or may nots' and so forth? Shala: Yeah. Well, thank you for the kind words, first off. I think that it's really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they've been to multiple therapists before they get to somebody who does ERP. And so, they feel like they're the victim at the hands of a very cruel abuser that they can't get away from. And so, they feel beaten down and they don't know how to get out of their heads. They feel like they're trapped in this mental prison. They can't get out. And if somebody is struggling like that, and they're doing the 'may or may nots' and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. So, what I'll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they're never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: "OCD, I'm not listening to you anymore. I'm not doing what you want. I am strong. I can do this." And I might add some 'may or may nots' in there. "And I want to be anxious. Come on, bring it on. You think that's scary? Give me something else." I know you're having Reid Wilson on as part of this too. I learned all that "bring it on" type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I've seen people just completely break down in tears of sort of, "Oh my gosh, I could do this," like tears of empowerment from standing up and yelling at their OCD. If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It's all about really taking what's in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you're saying it in your head, it's going to get mixed up with all the jumble of mental ruminating that's going on. And saying it out loud makes it hard for you to ruminate. It's not impossible, but it's hard because you're saying it. Your brain really is only processing one thing at a time. And so, if you're talking and really paying attention to what you're saying, it's much harder to be up in your head spinning this around. And so, adding these empowerment scripts in with the 'may or may nots' helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, "You've beaten me enough. No more. This is my life. I'm not letting you ruin it anymore. I am taking this back. I don't care how long it takes. I don't care what I have to do. I'm going to do this." And that builds people up enough where they can feel like they can start approaching these exposures. Kimberley: I love that. I think that is such-- I've had that same experience of how powerful empowerment can be in switching that behavior. It's so important. Now, one thing I really want to ask you is, do you switch this method when you're dealing with other anxiety disorders – health anxiety , social anxiety , panic disorder ? What is your approach? Is there a difference or would you say the tools are the same? Shala: There's a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it's all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I'm doing this while I'm having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we're trying to create those symptoms and then talk out loud and say, "Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you've ever had." So, it's all about amping up the symptoms. With social anxiety, it's a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don't work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That's the cognitive work with OCD. I do not work on the cognitive work on the content. I'm not going to say to somebody, "Well, the chance you're going to get AIDS from that little spot of blood is very small." That's not going to be helpful With social anxiety, we're actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It's more of a cognitive method. We're going out and saying, "Gosh, my new belief, instead of everybody's judging me, is, well, everybody is probably thinking about themselves and I'm going to go do some things that my social anxiety wouldn't want me to do and test out that new belief." I might have them use that new belief, but also if their anxiety gets really high and they're having a hard time saying, "Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me." But really, we're trying to do something a little bit different with social anxiety. Kimberley: And what about with generalized anxiety ? With the mental, a lot of rumination there, do you have a little shift in how you respond? Shala: Yeah. So, it's funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what's the difference between OCD and GAD is they're really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They're also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They're just worried about more "real-life" things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people's OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it "worry time" in GAD. It's got a different name, but it's basically the same thing. Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, "Here is my strategy, here is my plan to target mental rituals"? What would you say? Shala: So, as I mentioned, I think the 'may or may nots' are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I'm working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my "man in the park" metaphor. So, we've all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don't run home and go, "Oh my gosh, we got to pack all our things up because it's the end of the world. We have to get with all of our relatives and be together because we're all going to die." We don't do that. We hear what this guy's saying, and then we go on with our days, again, even if you might agree with some of the content. Now, why do we do that? We do that because it's not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn't affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That's how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, "Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you're right. Tell me more, tell me more." And we're interacting with him, trying to get some reassurance that maybe he's wrong, that maybe he does really mean the end of the world is coming soon. Maybe it's going to be like in a hundred years. Eventually, we get to the point where we're handing out pamphlets for him. "Here, everybody, take one of these." What we're doing with 'may or may nots' is we're learning how to walk by the man in the park and go, "The world may or may not be ending. The world may or may not be ending. I'm not taking a pamphlet. The world may or may not be ending." So, we're trying to not interact with him. We're trying to take what he's saying and hold it in our heads without doing something compulsive that's going to make our anxiety higher. What we're trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we're really-- it's just not relevant. It's just not part of our life. So, we just move on. And we're not trying to shove him away. It's just like any other noise or sound or activity that you would just-- it doesn't even register in your consciousness. That's what we're trying to do. Now I think another way to think about this is if you think-- say you're in an art gallery. Art galleries are quiet and there are lots of people standing around, and there's somebody in there that you don't like or who doesn't like you or whatever. You're not going to walk up to that person and tap on their shoulder and say, "Excuse me, I'm going to ignore you." You're just going to be like, "I know that person is there. I'm just going to do what I'm doing." And I think that's-- I use that to help people understand this transition, because we're basically going from 'may or may nots' where we're saying, "OCD, I'm not letting you do this to me anymore," so we are being really aggressive with it, to this being able to be in the same space with it, but we're not talking to it at all because we don't need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them. Kimberley: That's so interesting. I've never thought of it that way. Shala: And so, that's where I'm trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don't give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, "We need to act as though what OCD is saying doesn't matter." And that was revolutionary to me to hear that. And that's what we're trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you're not giving OCD anything to work with. And typically, it'll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that's okay. It's a process. And I think if you have trouble trying to do shoulders back, man in the park, use 'may or may nots'. You can use the combination. But I think we're trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day. OCD, BDD, and Mental Rituals Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn't read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact? Shala: That's a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it's a little bit scared, it's probably going to speak to you. It's still going to be not a very nice voice. It might be urgent and pleading. But if it's super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it's super scared and it's going to get super big and it's going to get super loud in your head because it's trying desperately to help you understand you've got to save it because it thinks it's in danger. That's all its content. Then I think-- and if you have trouble ignoring it because it's screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that's hard to ignore. That's hard to act like that's not relevant because it hurts. There's so much noise. That's when you might have to use a may or may not type approach because it's just so loud, you can't ignore it, because it's so scared. And that's okay. And again, sometimes I'll have to use that. Not too terribly often just because I've spent a long time working on how to use the shoulder's back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it's being also plays into this. Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that's going to work in all situations, but I think you're right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? Shala: Absolutely. If people are up in their heads and they don't want to use 'may or may nots', I'll try to use some other things. If I really, really think that that's what we need right now, is we need scripting, I'll try to sell them on why. But at the end of the day, it's always my client's choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it's more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There's no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they've been doing it for a long time, just because otherwise, it's like, I'm giving them a bicycle, they've never ridden a bicycle before and I won't give them any training wheels. And that's really, really hard. Some people can do it. I mean, some people can just be like, "Oh, I'm to stop doing that in my head? Okay, well, I'll stop doing that in my head." But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads. Kimberley: Amazing. All right. Any final statements from you as we get close to the end? Shala: I think that it's important to, as you're working on this, really think about what you're doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, "Hey, I'm saying this to myself in my head, is that helpful or harmful?" Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don't do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. And know too that if you've had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that's okay. It doesn't mean you're not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don't want to be perfectionistic about that like, "I must eliminate every single mental ritual that I have or I'm not going to be in a good recovery." That's approaching your ERP like OCD would do. And we don't want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you've got going on. Shala: You can go to ShalaNicely.com and I have lots of free blog posts I've written on this. So, there are two blog posts, two pretty extensive blog posts on 'may or may nots'. So, if you go on my website and just search may or may not, it'll bring up two blog posts about that. If you search on shoulders back or man in the park, you'll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting , which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I've got two books. You can find on Amazon, Everyday Mindfulness for OCD , Jon Hershfield and I co-wrote. And we talk about 'may or may nots' and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life , is also on Amazon or bookstores, Audible, and that kind of thing. Kimberley: I wonder too, if we could-- I'm going to put links to all these in the show note. I remember you having a word with your OCD, a video? Shala: Oh yes, that's true. Kimberley: Can we link that too? Shala: Yes. And that one I have under my COVID resources, because I'm so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I'm like, "Dude, we're not doing this anymore." And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. Kimberley: It was so powerful. Shala: Well, thank you. And it's fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you're going to be compassionate with it. "Gosh, OCD, I'm so sorry," You're scared we're doing this anyway. Sometimes you're going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it's okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it's behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it's just not going to ever not be there, but it's fine. We can live together and live in this uncertainty and be happy anyway. Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It's so wonderful. Shala: Thank you so much for having me.

May 13, 2022

SUMMARY: In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions. In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions . Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School , that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need. If you're wanting additional information about ERP School, please go to CBTSchool.com . With that being said, let's go straight over to this episode with Shala Nicely. Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, "What's wrong with you? What are you doing?" you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy , straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD . I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. So, for instance, an example that I use in Is Fred in the Refrigerator? , my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into 'may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use 'may or may nots' and how I teach my clients to use 'may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'. But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it. What I'll do with clients, I'll say, "If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention." That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, "Oh, that's my OCD." I'm not going to say, "OCD, I'm not talking to you." I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on. Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, "I want you to repeat after me." I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, "Well, what is your OCD saying right now?" And they'll say, "Well, that's blood and it could have AIDS in it, and I'm going to get sick." I'll say, "Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on." And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, "That may or may not be blood, I may or may not get AIDS, I may or may not get sick," I'll say, "Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that." And so, "I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS," over again until people start to say, "Oh, okay. I guess I don't have any control over this," because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle. Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. "Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute," and then over and over. "My family may or may not be left destitute. My family may or may not be left destitute, whatever," until we're hitting all the things that could be circulating in your head. Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the 'may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody. And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, "Really?" But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I'm like, "Well, I don't bother because I'm going to be dead, because I have breast cancer." That's where my mind took it because I've had OCD long enough that if I get a really scary and I start and I play around in the content, I'm going to start losing insight and I'm going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you're believing what the OCD says like, "Oh, well, I might as well just give up, I have breast cancer," and then becoming depressed, and then acting like it's true. And then that's reinforcing the whole cycle. So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the 'may or may nots' that helped because I was trying to help my brain understand, "Well, I may or may not have breast cancer. And if I do, I mean, I'll go to the doctor, I'll do what I need to do, but there's nothing I can do about it right now in my head other than what I'm doing." Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use 'may or may nots' with clients unless they are unable through numbing that they might be doing. If they're unable to actually feel what they're saying, because they're used to turning it over in their head and pulling the anxiety down officially, and so I can't get a rise out of the OCD because there's a lot of really little subtle mental compulsions going on, then I'll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into 'may or may nots'. But there's nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you're prone to losing insight into your OCD when you've got a really big one, I think that's a risk factor for using that particular type of scripting. Magical Thinking and Mental Compulsions Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I'm actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you? Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don't hit this green light, then somebody's going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with 'may or may nots' too. I'll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it's certainly the creative stuff And to one-up the OCD, you use the scripting to be like, "Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I'm such a bad person." This 'may or may not' is in all this crazy stuff too, because that's how to win, is to one up the OCD. It thinks that's scary, let's go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not. Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I've always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you're just doing it and it's so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone's really struggling to engage in 'may or may nots' and so forth? Shala: Yeah. Well, thank you for the kind words, first off. I think that it's really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they've been to multiple therapists before they get to somebody who does ERP. And so, they feel like they're the victim at the hands of a very cruel abuser that they can't get away from. And so, they feel beaten down and they don't know how to get out of their heads. They feel like they're trapped in this mental prison. They can't get out. And if somebody is struggling like that, and they're doing the 'may or may nots' and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. So, what I'll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they're never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: "OCD, I'm not listening to you anymore. I'm not doing what you want. I am strong. I can do this." And I might add some 'may or may nots' in there. "And I want to be anxious. Come on, bring it on. You think that's scary? Give me something else." I know you're having Reid Wilson on as part of this too. I learned all that "bring it on" type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I've seen people just completely break down in tears of sort of, "Oh my gosh, I could do this," like tears of empowerment from standing up and yelling at their OCD. If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It's all about really taking what's in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you're saying it in your head, it's going to get mixed up with all the jumble of mental ruminating that's going on. And saying it out loud makes it hard for you to ruminate. It's not impossible, but it's hard because you're saying it. Your brain really is only processing one thing at a time. And so, if you're talking and really paying attention to what you're saying, it's much harder to be up in your head spinning this around. And so, adding these empowerment scripts in with the 'may or may nots' helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, "You've beaten me enough. No more. This is my life. I'm not letting you ruin it anymore. I am taking this back. I don't care how long it takes. I don't care what I have to do. I'm going to do this." And that builds people up enough where they can feel like they can start approaching these exposures. Kimberley: I love that. I think that is such-- I've had that same experience of how powerful empowerment can be in switching that behavior. It's so important. Now, one thing I really want to ask you is, do you switch this method when you're dealing with other anxiety disorders – health anxiety , social anxiety , panic disorder ? What is your approach? Is there a difference or would you say the tools are the same? Shala: There's a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it's all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I'm doing this while I'm having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we're trying to create those symptoms and then talk out loud and say, "Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you've ever had." So, it's all about amping up the symptoms. With social anxiety, it's a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don't work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That's the cognitive work with OCD. I do not work on the cognitive work on the content. I'm not going to say to somebody, "Well, the chance you're going to get AIDS from that little spot of blood is very small." That's not going to be helpful With social anxiety, we're actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It's more of a cognitive method. We're going out and saying, "Gosh, my new belief, instead of everybody's judging me, is, well, everybody is probably thinking about themselves and I'm going to go do some things that my social anxiety wouldn't want me to do and test out that new belief." I might have them use that new belief, but also if their anxiety gets really high and they're having a hard time saying, "Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me." But really, we're trying to do something a little bit different with social anxiety. Kimberley: And what about with generalized anxiety ? With the mental, a lot of rumination there, do you have a little shift in how you respond? Shala: Yeah. So, it's funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what's the difference between OCD and GAD is they're really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They're also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They're just worried about more "real-life" things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people's OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it "worry time" in GAD. It's got a different name, but it's basically the same thing. Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, "Here is my strategy, here is my plan to target mental rituals"? What would you say? Shala: So, as I mentioned, I think the 'may or may nots' are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I'm working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my "man in the park" metaphor. So, we've all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don't run home and go, "Oh my gosh, we got to pack all our things up because it's the end of the world. We have to get with all of our relatives and be together because we're all going to die." We don't do that. We hear what this guy's saying, and then we go on with our days, again, even if you might agree with some of the content. Now, why do we do that? We do that because it's not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn't affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That's how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, "Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you're right. Tell me more, tell me more." And we're interacting with him, trying to get some reassurance that maybe he's wrong, that maybe he does really mean the end of the world is coming soon. Maybe it's going to be like in a hundred years. Eventually, we get to the point where we're handing out pamphlets for him. "Here, everybody, take one of these." What we're doing with 'may or may nots' is we're learning how to walk by the man in the park and go, "The world may or may not be ending. The world may or may not be ending. I'm not taking a pamphlet. The world may or may not be ending." So, we're trying to not interact with him. We're trying to take what he's saying and hold it in our heads without doing something compulsive that's going to make our anxiety higher. What we're trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we're really-- it's just not relevant. It's just not part of our life. So, we just move on. And we're not trying to shove him away. It's just like any other noise or sound or activity that you would just-- it doesn't even register in your consciousness. That's what we're trying to do. Now I think another way to think about this is if you think-- say you're in an art gallery. Art galleries are quiet and there are lots of people standing around, and there's somebody in there that you don't like or who doesn't like you or whatever. You're not going to walk up to that person and tap on their shoulder and say, "Excuse me, I'm going to ignore you." You're just going to be like, "I know that person is there. I'm just going to do what I'm doing." And I think that's-- I use that to help people understand this transition, because we're basically going from 'may or may nots' where we're saying, "OCD, I'm not letting you do this to me anymore," so we are being really aggressive with it, to this being able to be in the same space with it, but we're not talking to it at all because we don't need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them. Kimberley: That's so interesting. I've never thought of it that way. Shala: And so, that's where I'm trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don't give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, "We need to act as though what OCD is saying doesn't matter." And that was revolutionary to me to hear that. And that's what we're trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you're not giving OCD anything to work with. And typically, it'll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that's okay. It's a process. And I think if you have trouble trying to do shoulders back, man in the park, use 'may or may nots'. You can use the combination. But I think we're trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day. OCD, BDD, and Mental Rituals Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn't read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact? Shala: That's a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it's a little bit scared, it's probably going to speak to you. It's still going to be not a very nice voice. It might be urgent and pleading. But if it's super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it's super scared and it's going to get super big and it's going to get super loud in your head because it's trying desperately to help you understand you've got to save it because it thinks it's in danger. That's all its content. Then I think-- and if you have trouble ignoring it because it's screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that's hard to ignore. That's hard to act like that's not relevant because it hurts. There's so much noise. That's when you might have to use a may or may not type approach because it's just so loud, you can't ignore it, because it's so scared. And that's okay. And again, sometimes I'll have to use that. Not too terribly often just because I've spent a long time working on how to use the shoulder's back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it's being also plays into this. Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that's going to work in all situations, but I think you're right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? Shala: Absolutely. If people are up in their heads and they don't want to use 'may or may nots', I'll try to use some other things. If I really, really think that that's what we need right now, is we need scripting, I'll try to sell them on why. But at the end of the day, it's always my client's choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it's more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There's no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they've been doing it for a long time, just because otherwise, it's like, I'm giving them a bicycle, they've never ridden a bicycle before and I won't give them any training wheels. And that's really, really hard. Some people can do it. I mean, some people can just be like, "Oh, I'm to stop doing that in my head? Okay, well, I'll stop doing that in my head." But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads. Kimberley: Amazing. All right. Any final statements from you as we get close to the end? Shala: I think that it's important to, as you're working on this, really think about what you're doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, "Hey, I'm saying this to myself in my head, is that helpful or harmful?" Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don't do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. And know too that if you've had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that's okay. It doesn't mean you're not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don't want to be perfectionistic about that like, "I must eliminate every single mental ritual that I have or I'm not going to be in a good recovery." That's approaching your ERP like OCD would do. And we don't want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you've got going on. Shala: You can go to ShalaNicely.com and I have lots of free blog posts I've written on this. So, there are two blog posts, two pretty extensive blog posts on 'may or may nots'. So, if you go on my website and just search may or may not, it'll bring up two blog posts about that. If you search on shoulders back or man in the park, you'll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting , which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I've got two books. You can find on Amazon, Everyday Mindfulness for OCD , Jon Hershfield and I co-wrote. And we talk about 'may or may nots' and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life , is also on Amazon or bookstores, Audible, and that kind of thing. Kimberley: I wonder too, if we could-- I'm going to put links to all these in the show note. I remember you having a word with your OCD, a video? Shala: Oh yes, that's true. Kimberley: Can we link that too? Shala: Yes. And that one I have under my COVID resources, because I'm so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I'm like, "Dude, we're not doing this anymore." And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. Kimberley: It was so powerful. Shala: Well, thank you. And it's fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you're going to be compassionate with it. "Gosh, OCD, I'm so sorry," You're scared we're doing this anyway. Sometimes you're going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it's okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it's behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it's just not going to ever not be there, but it's fine. We can live together and live in this uncertainty and be happy anyway. Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It's so wonderful. Shala: Thank you so much for having me.

May 13, 2022

SUMMARY: In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions. In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator ? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions . Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School , that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need. If you're wanting additional information about ERP School, please go to CBTSchool.com . With that being said, let's go straight over to this episode with Shala Nicely. Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, "What's wrong with you? What are you doing?" you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy , straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD . I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. So, for instance, an example that I use in Is Fred in the Refrigerator? , my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into 'may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use 'may or may nots' and how I teach my clients to use 'may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'. But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it. What I'll do with clients, I'll say, "If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention." That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, "Oh, that's my OCD." I'm not going to say, "OCD, I'm not talking to you." I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on. Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, "I want you to repeat after me." I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, "Well, what is your OCD saying right now?" And they'll say, "Well, that's blood and it could have AIDS in it, and I'm going to get sick." I'll say, "Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on." And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, "That may or may not be blood, I may or may not get AIDS, I may or may not get sick," I'll say, "Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that." And so, "I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS," over again until people start to say, "Oh, okay. I guess I don't have any control over this," because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle. Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. "Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute," and then over and over. "My family may or may not be left destitute. My family may or may not be left destitute, whatever," until we're hitting all the things that could be circulating in your head. Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the 'may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody. And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, "Really?" But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I'm like, "Well, I don't bother because I'm going to be dead, because I have breast cancer." That's where my mind took it because I've had OCD long enough that if I get a really scary and I start and I play around in the content, I'm going to start losing insight and I'm going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you're believing what the OCD says like, "Oh, well, I might as well just give up, I have breast cancer," and then becoming depressed, and then acting like it's true. And then that's reinforcing the whole cycle. So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the 'may or may nots' that helped because I was trying to help my brain understand, "Well, I may or may not have breast cancer. And if I do, I mean, I'll go to the doctor, I'll do what I need to do, but there's nothing I can do about it right now in my head other than what I'm doing." Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use 'may or may nots' with clients unless they are unable through numbing that they might be doing. If they're unable to actually feel what they're saying, because they're used to turning it over in their head and pulling the anxiety down officially, and so I can't get a rise out of the OCD because there's a lot of really little subtle mental compulsions going on, then I'll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into 'may or may nots'. But there's nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you're prone to losing insight into your OCD when you've got a really big one, I think that's a risk factor for using that particular type of scripting. Magical Thinking and Mental Compulsions Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I'm actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you? Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don't hit this green light, then somebody's going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with 'may or may nots' too. I'll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it's certainly the creative stuff And to one-up the OCD, you use the scripting to be like, "Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I'm such a bad person." This 'may or may not' is in all this crazy stuff too, because that's how to win, is to one up the OCD. It thinks that's scary, let's go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not. Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I've always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you're just doing it and it's so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone's really struggling to engage in 'may or may nots' and so forth? Shala: Yeah. Well, thank you for the kind words, first off. I think that it's really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they've been to multiple therapists before they get to somebody who does ERP. And so, they feel like they're the victim at the hands of a very cruel abuser that they can't get away from. And so, they feel beaten down and they don't know how to get out of their heads. They feel like they're trapped in this mental prison. They can't get out. And if somebody is struggling like that, and they're doing the 'may or may nots' and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. So, what I'll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they're never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: "OCD, I'm not listening to you anymore. I'm not doing what you want. I am strong. I can do this." And I might add some 'may or may nots' in there. "And I want to be anxious. Come on, bring it on. You think that's scary? Give me something else." I know you're having Reid Wilson on as part of this too. I learned all that "bring it on" type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I've seen people just completely break down in tears of sort of, "Oh my gosh, I could do this," like tears of empowerment from standing up and yelling at their OCD. If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It's all about really taking what's in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you're saying it in your head, it's going to get mixed up with all the jumble of mental ruminating that's going on. And saying it out loud makes it hard for you to ruminate. It's not impossible, but it's hard because you're saying it. Your brain really is only processing one thing at a time. And so, if you're talking and really paying attention to what you're saying, it's much harder to be up in your head spinning this around. And so, adding these empowerment scripts in with the 'may or may nots' helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, "You've beaten me enough. No more. This is my life. I'm not letting you ruin it anymore. I am taking this back. I don't care how long it takes. I don't care what I have to do. I'm going to do this." And that builds people up enough where they can feel like they can start approaching these exposures. Kimberley: I love that. I think that is such-- I've had that same experience of how powerful empowerment can be in switching that behavior. It's so important. Now, one thing I really want to ask you is, do you switch this method when you're dealing with other anxiety disorders – health anxiety , social anxiety , panic disorder ? What is your approach? Is there a difference or would you say the tools are the same? Shala: There's a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it's all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I'm doing this while I'm having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we're trying to create those symptoms and then talk out loud and say, "Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you've ever had." So, it's all about amping up the symptoms. With social anxiety, it's a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don't work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That's the cognitive work with OCD. I do not work on the cognitive work on the content. I'm not going to say to somebody, "Well, the chance you're going to get AIDS from that little spot of blood is very small." That's not going to be helpful With social anxiety, we're actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It's more of a cognitive method. We're going out and saying, "Gosh, my new belief, instead of everybody's judging me, is, well, everybody is probably thinking about themselves and I'm going to go do some things that my social anxiety wouldn't want me to do and test out that new belief." I might have them use that new belief, but also if their anxiety gets really high and they're having a hard time saying, "Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me." But really, we're trying to do something a little bit different with social anxiety. Kimberley: And what about with generalized anxiety ? With the mental, a lot of rumination there, do you have a little shift in how you respond? Shala: Yeah. So, it's funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what's the difference between OCD and GAD is they're really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They're also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They're just worried about more "real-life" things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people's OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it "worry time" in GAD. It's got a different name, but it's basically the same thing. Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, "Here is my strategy, here is my plan to target mental rituals"? What would you say? Shala: So, as I mentioned, I think the 'may or may nots' are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I'm working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my "man in the park" metaphor. So, we've all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don't run home and go, "Oh my gosh, we got to pack all our things up because it's the end of the world. We have to get with all of our relatives and be together because we're all going to die." We don't do that. We hear what this guy's saying, and then we go on with our days, again, even if you might agree with some of the content. Now, why do we do that? We do that because it's not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn't affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That's how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, "Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you're right. Tell me more, tell me more." And we're interacting with him, trying to get some reassurance that maybe he's wrong, that maybe he does really mean the end of the world is coming soon. Maybe it's going to be like in a hundred years. Eventually, we get to the point where we're handing out pamphlets for him. "Here, everybody, take one of these." What we're doing with 'may or may nots' is we're learning how to walk by the man in the park and go, "The world may or may not be ending. The world may or may not be ending. I'm not taking a pamphlet. The world may or may not be ending." So, we're trying to not interact with him. We're trying to take what he's saying and hold it in our heads without doing something compulsive that's going to make our anxiety higher. What we're trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we're really-- it's just not relevant. It's just not part of our life. So, we just move on. And we're not trying to shove him away. It's just like any other noise or sound or activity that you would just-- it doesn't even register in your consciousness. That's what we're trying to do. Now I think another way to think about this is if you think-- say you're in an art gallery. Art galleries are quiet and there are lots of people standing around, and there's somebody in there that you don't like or who doesn't like you or whatever. You're not going to walk up to that person and tap on their shoulder and say, "Excuse me, I'm going to ignore you." You're just going to be like, "I know that person is there. I'm just going to do what I'm doing." And I think that's-- I use that to help people understand this transition, because we're basically going from 'may or may nots' where we're saying, "OCD, I'm not letting you do this to me anymore," so we are being really aggressive with it, to this being able to be in the same space with it, but we're not talking to it at all because we don't need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them. Kimberley: That's so interesting. I've never thought of it that way. Shala: And so, that's where I'm trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don't give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, "We need to act as though what OCD is saying doesn't matter." And that was revolutionary to me to hear that. And that's what we're trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you're not giving OCD anything to work with. And typically, it'll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that's okay. It's a process. And I think if you have trouble trying to do shoulders back, man in the park, use 'may or may nots'. You can use the combination. But I think we're trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day. OCD, BDD, and Mental Rituals Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn't read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact? Shala: That's a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it's a little bit scared, it's probably going to speak to you. It's still going to be not a very nice voice. It might be urgent and pleading. But if it's super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it's super scared and it's going to get super big and it's going to get super loud in your head because it's trying desperately to help you understand you've got to save it because it thinks it's in danger. That's all its content. Then I think-- and if you have trouble ignoring it because it's screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that's hard to ignore. That's hard to act like that's not relevant because it hurts. There's so much noise. That's when you might have to use a may or may not type approach because it's just so loud, you can't ignore it, because it's so scared. And that's okay. And again, sometimes I'll have to use that. Not too terribly often just because I've spent a long time working on how to use the shoulder's back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it's being also plays into this. Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that's going to work in all situations, but I think you're right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? Shala: Absolutely. If people are up in their heads and they don't want to use 'may or may nots', I'll try to use some other things. If I really, really think that that's what we need right now, is we need scripting, I'll try to sell them on why. But at the end of the day, it's always my client's choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it's more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There's no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they've been doing it for a long time, just because otherwise, it's like, I'm giving them a bicycle, they've never ridden a bicycle before and I won't give them any training wheels. And that's really, really hard. Some people can do it. I mean, some people can just be like, "Oh, I'm to stop doing that in my head? Okay, well, I'll stop doing that in my head." But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads. Kimberley: Amazing. All right. Any final statements from you as we get close to the end? Shala: I think that it's important to, as you're working on this, really think about what you're doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, "Hey, I'm saying this to myself in my head, is that helpful or harmful?" Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don't do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. And know too that if you've had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that's okay. It doesn't mean you're not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don't want to be perfectionistic about that like, "I must eliminate every single mental ritual that I have or I'm not going to be in a good recovery." That's approaching your ERP like OCD would do. And we don't want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you've got going on. Shala: You can go to ShalaNicely.com and I have lots of free blog posts I've written on this. So, there are two blog posts, two pretty extensive blog posts on 'may or may nots'. So, if you go on my website and just search may or may not, it'll bring up two blog posts about that. If you search on shoulders back or man in the park, you'll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting , which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I've got two books. You can find on Amazon, Everyday Mindfulness for OCD , Jon Hershfield and I co-wrote. And we talk about 'may or may nots' and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life , is also on Amazon or bookstores, Audible, and that kind of thing. Kimberley: I wonder too, if we could-- I'm going to put links to all these in the show note. I remember you having a word with your OCD, a video? Shala: Oh yes, that's true. Kimberley: Can we link that too? Shala: Yes. And that one I have under my COVID resources, because I'm so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I'm like, "Dude, we're not doing this anymore." And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. Kimberley: It was so powerful. Shala: Well, thank you. And it's fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you're going to be compassionate with it. "Gosh, OCD, I'm so sorry," You're scared we're doing this anyway. Sometimes you're going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it's okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it's behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it's just not going to ever not be there, but it's fine. We can live together and live in this uncertainty and be happy anyway. Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It's so wonderful. Shala: Thank you so much for having me.

May 13, 2022

SUMMARY: In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions. In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator ? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions . Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use. So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School , that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need. If you're wanting additional information about ERP School, please go to CBTSchool.com . With that being said, let's go straight over to this episode with Shala Nicely. Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, "What's wrong with you? What are you doing?" you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them. Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy , straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD . I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it. So, for instance, an example that I use in Is Fred in the Refrigerator? , my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera. And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into 'may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use 'may or may nots' and how I teach my clients to use 'may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'. But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it. What I'll do with clients, I'll say, "If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention." That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, "Oh, that's my OCD." I'm not going to say, "OCD, I'm not talking to you." I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on. Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, "I want you to repeat after me." I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful. OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, "Well, what is your OCD saying right now?" And they'll say, "Well, that's blood and it could have AIDS in it, and I'm going to get sick." I'll say, "Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on." And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script. I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, "That may or may not be blood, I may or may not get AIDS, I may or may not get sick," I'll say, "Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that." And so, "I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS," over again until people start to say, "Oh, okay. I guess I don't have any control over this," because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle. Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. "Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute," and then over and over. "My family may or may not be left destitute. My family may or may not be left destitute, whatever," until we're hitting all the things that could be circulating in your head. Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the 'may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody. And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, "Really?" But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I'm like, "Well, I don't bother because I'm going to be dead, because I have breast cancer." That's where my mind took it because I've had OCD long enough that if I get a really scary and I start and I play around in the content, I'm going to start losing insight and I'm going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you're believing what the OCD says like, "Oh, well, I might as well just give up, I have breast cancer," and then becoming depressed, and then acting like it's true. And then that's reinforcing the whole cycle. So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the 'may or may nots' that helped because I was trying to help my brain understand, "Well, I may or may not have breast cancer. And if I do, I mean, I'll go to the doctor, I'll do what I need to do, but there's nothing I can do about it right now in my head other than what I'm doing." Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use 'may or may nots' with clients unless they are unable through numbing that they might be doing. If they're unable to actually feel what they're saying, because they're used to turning it over in their head and pulling the anxiety down officially, and so I can't get a rise out of the OCD because there's a lot of really little subtle mental compulsions going on, then I'll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into 'may or may nots'. But there's nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you're prone to losing insight into your OCD when you've got a really big one, I think that's a risk factor for using that particular type of scripting. Magical Thinking and Mental Compulsions Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I'm actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you? Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don't hit this green light, then somebody's going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with 'may or may nots' too. I'll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it's certainly the creative stuff And to one-up the OCD, you use the scripting to be like, "Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I'm such a bad person." This 'may or may not' is in all this crazy stuff too, because that's how to win, is to one up the OCD. It thinks that's scary, let's go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not. Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I've always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you're just doing it and it's so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone's really struggling to engage in 'may or may nots' and so forth? Shala: Yeah. Well, thank you for the kind words, first off. I think that it's really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they've been to multiple therapists before they get to somebody who does ERP. And so, they feel like they're the victim at the hands of a very cruel abuser that they can't get away from. And so, they feel beaten down and they don't know how to get out of their heads. They feel like they're trapped in this mental prison. They can't get out. And if somebody is struggling like that, and they're doing the 'may or may nots' and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner. So, what I'll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they're never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: "OCD, I'm not listening to you anymore. I'm not doing what you want. I am strong. I can do this." And I might add some 'may or may nots' in there. "And I want to be anxious. Come on, bring it on. You think that's scary? Give me something else." I know you're having Reid Wilson on as part of this too. I learned all that "bring it on" type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I've seen people just completely break down in tears of sort of, "Oh my gosh, I could do this," like tears of empowerment from standing up and yelling at their OCD. If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It's all about really taking what's in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you're saying it in your head, it's going to get mixed up with all the jumble of mental ruminating that's going on. And saying it out loud makes it hard for you to ruminate. It's not impossible, but it's hard because you're saying it. Your brain really is only processing one thing at a time. And so, if you're talking and really paying attention to what you're saying, it's much harder to be up in your head spinning this around. And so, adding these empowerment scripts in with the 'may or may nots' helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, "You've beaten me enough. No more. This is my life. I'm not letting you ruin it anymore. I am taking this back. I don't care how long it takes. I don't care what I have to do. I'm going to do this." And that builds people up enough where they can feel like they can start approaching these exposures. Kimberley: I love that. I think that is such-- I've had that same experience of how powerful empowerment can be in switching that behavior. It's so important. Now, one thing I really want to ask you is, do you switch this method when you're dealing with other anxiety disorders – health anxiety , social anxiety , panic disorder ? What is your approach? Is there a difference or would you say the tools are the same? Shala: There's a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it's all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I'm doing this while I'm having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we're trying to create those symptoms and then talk out loud and say, "Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you've ever had." So, it's all about amping up the symptoms. With social anxiety, it's a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don't work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That's the cognitive work with OCD. I do not work on the cognitive work on the content. I'm not going to say to somebody, "Well, the chance you're going to get AIDS from that little spot of blood is very small." That's not going to be helpful With social anxiety, we're actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It's more of a cognitive method. We're going out and saying, "Gosh, my new belief, instead of everybody's judging me, is, well, everybody is probably thinking about themselves and I'm going to go do some things that my social anxiety wouldn't want me to do and test out that new belief." I might have them use that new belief, but also if their anxiety gets really high and they're having a hard time saying, "Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me." But really, we're trying to do something a little bit different with social anxiety. Kimberley: And what about with generalized anxiety ? With the mental, a lot of rumination there, do you have a little shift in how you respond? Shala: Yeah. So, it's funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what's the difference between OCD and GAD is they're really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They're also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They're just worried about more "real-life" things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people's OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it "worry time" in GAD. It's got a different name, but it's basically the same thing. Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, "Here is my strategy, here is my plan to target mental rituals"? What would you say? Shala: So, as I mentioned, I think the 'may or may nots' are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I'm working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my "man in the park" metaphor. So, we've all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don't run home and go, "Oh my gosh, we got to pack all our things up because it's the end of the world. We have to get with all of our relatives and be together because we're all going to die." We don't do that. We hear what this guy's saying, and then we go on with our days, again, even if you might agree with some of the content. Now, why do we do that? We do that because it's not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn't affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That's how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, "Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you're right. Tell me more, tell me more." And we're interacting with him, trying to get some reassurance that maybe he's wrong, that maybe he does really mean the end of the world is coming soon. Maybe it's going to be like in a hundred years. Eventually, we get to the point where we're handing out pamphlets for him. "Here, everybody, take one of these." What we're doing with 'may or may nots' is we're learning how to walk by the man in the park and go, "The world may or may not be ending. The world may or may not be ending. I'm not taking a pamphlet. The world may or may not be ending." So, we're trying to not interact with him. We're trying to take what he's saying and hold it in our heads without doing something compulsive that's going to make our anxiety higher. What we're trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we're really-- it's just not relevant. It's just not part of our life. So, we just move on. And we're not trying to shove him away. It's just like any other noise or sound or activity that you would just-- it doesn't even register in your consciousness. That's what we're trying to do. Now I think another way to think about this is if you think-- say you're in an art gallery. Art galleries are quiet and there are lots of people standing around, and there's somebody in there that you don't like or who doesn't like you or whatever. You're not going to walk up to that person and tap on their shoulder and say, "Excuse me, I'm going to ignore you." You're just going to be like, "I know that person is there. I'm just going to do what I'm doing." And I think that's-- I use that to help people understand this transition, because we're basically going from 'may or may nots' where we're saying, "OCD, I'm not letting you do this to me anymore," so we are being really aggressive with it, to this being able to be in the same space with it, but we're not talking to it at all because we don't need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them. Kimberley: That's so interesting. I've never thought of it that way. Shala: And so, that's where I'm trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don't give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, "We need to act as though what OCD is saying doesn't matter." And that was revolutionary to me to hear that. And that's what we're trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you're not giving OCD anything to work with. And typically, it'll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that's okay. It's a process. And I think if you have trouble trying to do shoulders back, man in the park, use 'may or may nots'. You can use the combination. But I think we're trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day. OCD, BDD, and Mental Rituals Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn't read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact? Shala: That's a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it's a little bit scared, it's probably going to speak to you. It's still going to be not a very nice voice. It might be urgent and pleading. But if it's super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it's super scared and it's going to get super big and it's going to get super loud in your head because it's trying desperately to help you understand you've got to save it because it thinks it's in danger. That's all its content. Then I think-- and if you have trouble ignoring it because it's screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that's hard to ignore. That's hard to act like that's not relevant because it hurts. There's so much noise. That's when you might have to use a may or may not type approach because it's just so loud, you can't ignore it, because it's so scared. And that's okay. And again, sometimes I'll have to use that. Not too terribly often just because I've spent a long time working on how to use the shoulder's back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it's being also plays into this. Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that's going to work in all situations, but I think you're right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say? Shala: Absolutely. If people are up in their heads and they don't want to use 'may or may nots', I'll try to use some other things. If I really, really think that that's what we need right now, is we need scripting, I'll try to sell them on why. But at the end of the day, it's always my client's choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it's more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There's no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they've been doing it for a long time, just because otherwise, it's like, I'm giving them a bicycle, they've never ridden a bicycle before and I won't give them any training wheels. And that's really, really hard. Some people can do it. I mean, some people can just be like, "Oh, I'm to stop doing that in my head? Okay, well, I'll stop doing that in my head." But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads. Kimberley: Amazing. All right. Any final statements from you as we get close to the end? Shala: I think that it's important to, as you're working on this, really think about what you're doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, "Hey, I'm saying this to myself in my head, is that helpful or harmful?" Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don't do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be. And know too that if you've had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that's okay. It doesn't mean you're not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don't want to be perfectionistic about that like, "I must eliminate every single mental ritual that I have or I'm not going to be in a good recovery." That's approaching your ERP like OCD would do. And we don't want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible. Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you've got going on. Shala: You can go to ShalaNicely.com and I have lots of free blog posts I've written on this. So, there are two blog posts, two pretty extensive blog posts on 'may or may nots'. So, if you go on my website and just search may or may not, it'll bring up two blog posts about that. If you search on shoulders back or man in the park, you'll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting , which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I've got two books. You can find on Amazon, Everyday Mindfulness for OCD , Jon Hershfield and I co-wrote. And we talk about 'may or may nots' and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life , is also on Amazon or bookstores, Audible, and that kind of thing. Kimberley: I wonder too, if we could-- I'm going to put links to all these in the show note. I remember you having a word with your OCD, a video? Shala: Oh yes, that's true. Kimberley: Can we link that too? Shala: Yes. And that one I have under my COVID resources, because I'm so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I'm like, "Dude, we're not doing this anymore." And I read it out loud and I recorded it out loud so that people could hear how I was talking to it. Kimberley: It was so powerful. Shala: Well, thank you. And it's fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you're going to be compassionate with it. "Gosh, OCD, I'm so sorry," You're scared we're doing this anyway. Sometimes you're going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it's okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it's behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it's just not going to ever not be there, but it's fine. We can live together and live in this uncertainty and be happy anyway. Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It's so wonderful. Shala: Thank you so much for having me.

May 6, 2022

SUMMARY: Covered in This Episode: What is a Mental Compulsion? What is the difference between Mental Rumination and Mental Compulsions? How to use Mindfulness for Mental Compulsions How to "Label and Abandon" intrusive thoughts and mental compulsions How to use Awareness logs to help reduce mental rituals and mental rumination Links To Things I Talk About: Links to Jon's Books https://www.amazon.com/ Work with Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/ Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. To learn about our Online Course for OCD, visit https://www.cbtschool.com/erp-school-lp . Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free, and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION I want you to go back and listen to that. That is where I walk you through Mental Compulsions 101. What is a mental compulsion, the types of mental compulsions, things to be looking out for. The reason I stress that you start there is there may be things you're doing that are mental compulsions and you didn't realize. So, you want to know those things before you go in and listen to the skills that you're about to receive. Oh my goodness. This is just so, so exciting. I'm mind-blown with how exciting this is all for me. First of all, let's introduce the guest for today. Today, we have the amazing Jon Hershfield. Jon has been on the episode before, even talking about mental compulsions. However, I wanted him to status off. He was so brave. He jumped in, and I wanted him to give his ideas around what is a mental compulsion, how he uses mental compulsion treatment with his clients, what skills he uses. Little thing to know here, he taught me something I myself didn't know and have now since implemented with our patients over at my clinic of people who struggle with mental compulsions. I've also uploaded that and added a little bit of that concept into ERP School, which is our course for OCD, called ERP School. You can get it at CBTSchool.com. Jon is amazing. So, you're going to really feel solid moving into this. He gives some solid advice. Of course, he's always so lovely and wise. And so, I am just so excited to share this with you. Let's just get to the show because I know you're here to learn. This is episode two of the series. Next week we will be talking with Shala Nicely and she will be dropping major truth bombs and major skills as well, as will all of the people on the series. So, I am so, so excited. One thing to know as you move into it is there will be some things that really work for you and some that won't. So, I'm going to say this in every episode intro. So, all of these skills are top-notch science-based skills. Each person is going to give their own specific nuanced way of managing it. So, I want you to go in knowing that you can take what you need. Some things will really be like, yes, that's exactly what I needed to hear. Some may not. So, I want you to go in with an open mind knowing that the whole purpose of this six-part series is to give you many different approaches so that you can try on what works for you. That's my main agenda here, is that you can feel like you've gotten all the ideas and then you can start to put together a plan for yourself. Let's go over to the show. I'm so happy you're here. ----- Kimberley: Welcome, Jon. I'm so happy to have you back. Jon: Hi, Kimberley. Thanks for having me back. Difference Between Mental Compulsions and Mental Rumination Kimberley: Okay. So, you're first in line and I purposely had you first in line. I know we've had episodes similar to this in the past, but I just wanted to really get your view on how you're dealing with mental compulsions. First, I want to check in, do you call them "mental compulsions" or do you call it "mental rumination"? Do you want to clarify your own idea? Jon: Yeah. I say mental compulsions or mental rituals. I use the terms pretty interchangeably. It comes up at the first, usually in the assessment, if not then in the first post-assessment session, when I'm explaining how OCD works and I get to the part we say, and then there's this thing called compulsions. And what I do is I describe compulsions as anything that you do physically or mentally to reduce distress, and this is the important part, specifically by trying to increase certainty about the content of the obsession. Why that's important is I think we need to get rid of this myth that sometimes shows up in the OCD community that when you do exposures or when you're triggered, you're just supposed to freak out and deal with it, and hopefully, it'll go away on its own. Actually, there are many things you can do to reduce distress that aren't compulsive, because what makes it compulsive is that it's acting on the content of the obsession. I mean, there might be some rare exceptions where your specific obsession has to do with an unwillingness to be anxious or something like that. But for the most part, meditation, breathing exercises, grounding exercises, DBT, certain forms of distraction, exercise – these can all reduce your physical experience of distress without saying anything in particular about whether or not the thought that triggered you is true or going to come. So, once I've described that, then hopefully, it opens people up to realize, well, it could really be anything and most of those things are going to be mental. So then, we go through, "Well, what are the different mental ways?" We know the physical ways through washing hands and checking locks and things like that. But what are all the things you're doing in your mind to convince yourself out of the distress, as opposed to actually working your way through the distress using a variety of distress tolerance skills, including acceptance? Kimberley: Right. Do you do the same for people with generalized anxiety or social anxiety or other anxiety disorders? Would you conceptualize it the same way? Mental Compulsions for General Anxiety Disorder vs OCD Jon: Yeah. I think for the most part, I mean, I do meet people. Some people who I think are better understood as having generalized anxiety disorder than OCD, and identifying with that concept actually helps them approach this problem that they have of dealing with uncertainty and dealing with worry and dealing with anxiety on close to home, regular everyday issues like finance and work and health and relationships and things like that. And there's a subsection of that people who, if you treat it like OCD, it's really helpful. And there's a subsection if you treat it like OCD, they think, "Oh no, I have some other psychiatric problem I have to worry about right now." I'm a fan of treating the individual that the diagnostic terms are there to help us. Fundamentally, the treatment will be the same. What are you doing that's sending the signal to your brain, that these ideas are threats as opposed to ideas, and how can we change that signal? Exposure & Response Prevention for Mental Compulsions Kimberley: Right. I thank you for clarifying on that. So, after you've given that degree of psychoeducation, what do you personally do next? Do you want to share? Do you go more into an exposure option? Do you do more response prevention? Tell me a little bit about it, walk me through how you would do this with a client. Jon: The first thing I would usually do is ask them to educate me on what it's really like to be them. And so, that involves some thought tracking. So, we'll use a trigger and response log. So, I keep it very simple. What's setting you off and what are you doing? And I'll tell them in the beginning, don't try too hard to get better because I want to know what your life is really like, and I'll start to see the patterns. It seems every time you're triggered by this, you seem to do that. And that's where they'll start to reveal to me things like, "Well, I just thought about it for an hour and then it went away." And that's how I know that they're engaging in mental review and rumination, other things like that. Or I was triggered by the thought that I could be sick and I repeated the word "healthy" 10 times. Okay. So, they're doing thought neutralization. Sometimes we'll expand on that. One of the clinicians in my practice took our thought records and repurposed them as a mental behavior log. So, it's what set you off. What did you do? What was the mental behavior that was happening at that time? And in some cases, what would've been more helpful? Again, I rely more on my patients to tell me what's going on than on me to tell them "Here's what's going on," so you get the best information. Logging Mental Rituals Kimberley: Right. I love that. I love the idea of having a log. You're really checking in for what's going on before dropping everything down. Does that increase their distress? How do they experience that? Jon: I think a lot of people find it very helpful because first of all, it's an act of mindfulness to write this stuff down because it's requiring you to put it in front of you and see it, which is different than having it hit you from inside your head. And so, that's helpful. They're seeing it as a thought process. And I think it also helps people come to terms with a certain reality about rumination that it's not a hundred percent compulsion in the sense that there's an element of rumination that's habitual. Your mind, like a puppy, is conditioned to respond automatically to certain things that it's been reinforced to do. And so, sometimes people just ruminate because they're alone or sitting in a particular chair. It's the same reason why people sometimes struggle with hair-pulling disorder, trichotillomania or skin picking . It's these environmental cues. And then the brain says, "Oh, we should do this now because this is what we do in this situation." People give themselves a really hard time for ruminating because they've been told to stop, but they can't stop because they find themselves doing it. So, what I try to help people understand is like, "Look, you can only control what you can control. And the more that you are aware of, the more you can control. So, this is where you can bring mindfulness into it." So, maybe for this person, there's such a ruminator. They're constantly analyzing, figuring things out. It's part of their identity. They're very philosophical. They're not thinking of it as a compulsion, and many times they're not thinking of it at all. It's just happening. And then we increased their awareness, like, "Oh, okay. I got triggered. I left the building for a while. And then suddenly, I realized I was way down the rabbit hole, convinced myself that's something terrible. So, in that moment I realized I'm supposed to stop, but so much damage has been done because I just spent a really long time analyzing and compulsing and trying to figure it out." So, strategies that increase our awareness of what the mind is doing are extraordinarily helpful because imagine catching it five seconds into the process and being able to say, "Oh, I'm ruminating. Okay, I don't need to do that right now. I'm going to return my attention to what I was doing before I got distracted." Kimberley: Right. I love the idea of this, the log for awareness, because a lot of people say, "Oh, maybe for half an hour a day." Once they've logged it, they're like, "Wow, it's four hours a day." I think it's helpful to actually recognize this, like how impactful it is on their life. So, I love that you're doing that piece. You can only control what you can control. What do you do with the stuff you can't control? Jon: Oh, you apply heavy doses of self-criticism until you hate yourself enough to never do it again. That's the other mental ritual that usually happens and people realize, "Oh, I've been ruminating," and they're angry at themselves. "I should know better." So, they're angry at themselves for something they didn't know they were doing, which is unfair. So, I use the term, I say, "label and abandon." That's what you do with all mental rituals. The moment you see it, you give it a name and you drop it. You just drop it on the floor where you were, you don't finish it up real quick. You don't analyze too much about it and then drop it. You're just like, "Oh, I'm holding this thing I must not hold," and you drop it. Label and abandon. What people tend to do is criticize then label, then criticize some more and then abandon. And the real problem with that is that the self-criticism is in and of itself another mental ritual. It's a strategy for reducing distress that's focused on increasing certainty about the content of the obsession. The obsession, in this case, is "I'm never going to get better." Now I know I'm going to get better because I've told myself that I'm being fooled and that I'll never do that again. It's not true. But then you wash your hands. They aren't really clean either. So, none of our compulsions really work. Self-Compassion for Mental Compulsions Kimberley: Doesn't have to make sense. Jon: Yeah. So, I think bringing self-compassion in the moment to be able to recognize it and recognize the urge to self-criticize and really just say like, "Oh, I'm not going to do that. I caught myself ruminating. Well done." Same thing we do when we meditate. Some people think that meditation has something to do with relaxation or something to do with controlling your mind. It's actually just a noticing exercise. Your mind wanders, you notice it. "Oh, look at that, I'm thinking." Back to the breath. That's a good thing that you noticed that you wandered. Not, "Oh, I wandered, I can't focus. I'm bad at meditating." So, it's really just changing the frame for how people are relating to what's going on inside. One, eliminating self-criticism just makes life a lot easier. Two, eliminating the self-criticism and including that willingness to just label the thought pattern or the thought process and drop it right where it is. You can start to catch that earlier and earlier and earlier. So, you're reducing compulsions. And you'll see that the activity, the neutralizing, the figuring it out, the using your mental strength against yourself instead of in support of yourself, you could see how that's sending the signal to the brain. "Wait, this is very important. I need to keep pushing it to the forefront." There's something to figure out here. This isn't a cold case in a box, on a shelf somewhere. This is an ongoing investigation and we have to figure it out. How do we know? Because they're still trying to figure it out. Kimberley: Right. How much do you think insight has to play here or how much of a role does it play? Jon: Insight plays a role in all forms of OCD. I mean, it plays a role in everything – insight into our relationships, insight into our career aspirations. I think one of the things I've noticed, and this is just anecdotal, is that the higher the distress and the poorer the distress regulation skills, often the lower the insight. Not necessarily the other way around. Some people have low insight and aren't particularly distressed by what's going on, but if the anxiety and the distress and the discomfort and disgust are so high that the brain goes into a brownout, I noticed that people switch from trying to get me to reassure them that their fears are untrue to trying to convince me that their fears are true. And to me, that represents an insight drop and I want to help them boost up their insight. And again, I think becoming more aware of your mental activity that is voluntary – I'm choosing to put my mind on this, I'm choosing to figure it out, it didn't just happen. But in this moment, I'm actually trying to complete the problem, the puzzle – becoming more aware that that's what you're doing, that's how you develop insight. And that actually helps with distress regulation. Kimberley: Right. Tell me, I love you're using this word. So, for someone who struggles with distress regulation, what kind of skills would you give a client or use for yourself? Jon: So, there are many different skills a person could use. And I hesitate to say, "Look, use this skill," because sometimes if you're always relying on one skill and it's not working for you, you might be resistant to using a different skill. In DBT, they have something called tip skills. So, changing in-- drastic changes in temperature, intense exercise, progressive muscle relaxation, pace breathing. These are all ways of shifting your perspective. In a more global sense, I think the most important thing is dropping out of the intellectualization of what's happening and into the body. So, let's say the problem, the way you know that you're anxious is that your muscles are tense and there's heat in your body and your heart rate is elevated. But there are lots of circumstances in your life where your muscles would be tense and your heart rate will be up and you'll feel hot, and you might be exercising, for example. So, that experience alone isn't threatening. It's that experience press plus the narrative that something bad is going to happen and it's because I'm triggered and it's because I can't handle the uncertainty and all this stuff. So, it's doing two things at once. It's dropping out of the thought process, which is fundamentally the same thing as labeling and abandoning the mental ritual, and then dropping into the body and saying, "What's happening now is my hands are sweaty," and just paying attention to it. Okay, alright, sweaty hands. I can be with sweaty hands. Slowing things down and looking at things the way they are, which is not intellectual, as opposed to looking at things the way they could be, or should be, or might have been, which again is a mental ruminative process. Kimberley: Right. Do you find-- I have found recently actually with several clients that they have an obsession. They start to ruminate and then somewhere through there, it's hard to determine what's in control and what's not. So, we want to preface it with that. But things get really out of control once they start to catastrophize even more. So, would you call the catastrophization a mental rumination, or would you call it an intrusive thought? How would you conceptualize that with a client? They have the obsession, they start ruminating, and then they start going to the worst-case scenario and just staying there. Jon: Yeah. There's different ways to look at it. So, catastrophizing is predicting a negative future and assuming you can't cope with it, and it's a way of thinking about a situation. So, it's investing in a false project. The real project is there's something unknown about the future and it makes you uncomfortable and you don't like it. How do you deal with that? That's worth taking a look at. The false project is, my plane is going to crash and I need to figure out how to keep the plane from crashing. But that's how the OCD mind tends to work. So, one way of thinking about catastrophizing is it's a tone it's a way-- if you can step back far enough and be mindful of the fact that you're thinking, you can also be mindful of the fact that there is a way that you're thinking. And if the way that you're thinking is catastrophizing, you could say, "Yeah, that's catastrophizing. I don't need to do that right now." But I think to your point, it is also an act. It's something somebody is doing. It's like, I'm going to see this through to the end and the hopes that it doesn't end in catastrophe, but I'm also going to steer it into catastrophe because I just can't help myself. It's like a hot stove in your head that you just want to touch and you're like, "Ouch." And in that case, I would say, yeah, that's a mental ritual. It's something that you're doing. I like the concept of non-engagement responses. So, things that you can do to respond to the thought process that aren't engaging it directly, that are helping you launch off. Because like I said, before you label and abandon. But between the label and abandon, a lot of people feel like they need a little help. They need something to drive a wedge between them and the thought process. Simply dropping it just doesn't feel enough, or it's met with such distress because whenever you don't do a compulsion, it feels irresponsible, and they can't handle that distress. So, they need just a little boost. What do we know about OCD? We know that the one thing you can't do effectively is defend yourself because then you're getting into an argument and you can't win an argument against somebody who doesn't care what the outcome of the argument is. The OCD just wants to argue. So, any argument, no matter how good it is, the OCD is like, "Great, now we're arguing again." How to Manage Mental Compulsions Kimberley: Yeah. "I got you." Jon: Yeah. So, what are our options? What are our non-engagement response options? One, which I think is completely undersold, is ignoring it. Just ignoring it. Again, none of these you want to only focus on because they could all become compulsive. And then you're walking around going, "I'm ignoring it, I'm ignoring it." And then you're just actually avoiding it. But it's completely okay to just choose not to take yourself seriously. You look at your email and it's things that you want. And then in there is a junk mail that just accidentally got filtered into the inbox instead of the spam box, and mostly what you do is ignore it. You don't even read the subject of it. You recognize that in the moment, it's spam and you move on as if it wasn't even there. Then there's being mindful of it. Mindful noting. Just acknowledging it. You take that extra beat to be like, "Oh yeah, there's that thought." In act, they would call this diffusion. I'm having a thought that something terrible is going to happen. And then you're dropping it. So, you're just stepping back and be like, "Oh, I see what's going on here. Okay, cool. But I'm not going to respond to it." And then as we get into more ERP territory, we also have the option of agreeing with the uncertainty that maybe, maybe not. "What do I know? Okay. Maybe the plane is going to crash. I can't be bothered with this." But you have to do it with attitude because if you get too involved in the linguistics of it, then it's like, well, what's the potential that it'll happen? And you can't play that game, the probability game. But it is objectively true that any statement that begins with the word "maybe" has something to it. Maybe in the middle of this call, this computer is going to explode or something like that. It would be very silly for me to worry about that, but you can't deny that the statement is true because it's possible. It's maybe. So, just acknowledging that, be like, "Okay, fine. Maybe." And then dropping it the way you would if you had some thought that you didn't find triggering and yet was still objectively true. And then the last one, which can be a lot of fun, can also be overdone, can also become compulsive, but if done well can make life a little bit more fun, is agreeing with the thought in an exaggerated humorous, sarcastic way. Just blowing it up. So, you're out doing the OCD. The OCD is very creative, but you're more creative than the OCD. Kimberley: Can you give me examples? Jon: Well, the OCD says your plane is going to crash. He said, your plane is going to crash into a school. Just be done with it, right? And that kind of shock where the bully is expecting you to defend yourself and instead, you just punched yourself in the face. He's like, "Yeah, you're weird. I'm not going to bother you anymore." That's the relationship one wants with their OCD. Kimberley: That's true. I remember in a previous episode we had with, I think it was when you had brought out your team book about saying "Good one bro," or "brah." Jon: "Cool story, brah." Yeah. Kimberley: Cool story brah. And I've had many of my patients say that that was also really helpful, is there's a degree of attitude that goes with that, right? Jon: Yeah. And because again, it's just a glitch in the system that, of course, you're conditioned to respond to it like it's serious. But once you realize it is, once you get the hint that it's OCD, you have to shift out of that, "Oh, this is very important, very serious," and into this like, "This is junk mail." And if you actually look at your junk mail, none of it is serious. It sounds serious. It sounds like I just inherited a billion dollars from some prince in Nigeria. That sounds very important. I Kimberley: I get that email every day pretty much. Jon: Yeah. But I look at it and immediately I know that it's not serious, even though the words in it sound very important. Kimberley: Yeah. So, for somebody, I'm sitting in the mind of someone who has OCD and is listening right now, and I'm guessing, to those who are listening, you're nodding and "Yes, this is so helpful. This is so helpful." And then we may finish the episode and then the realization that "This is really hard" comes. How much coaching, how much encouragement? How do you walk someone through treatment who is finding this incredibly difficult? Jon: I want to live in your mind. In my mind, let that same audience member is like, "This guy sucks." Kimberley: My mind isn't so funny after we start the recording. So, you're cool. Jon: Who is this clown? Again, it's back to self-compassion. I'm sure people are tired of hearing about it, but it's simply more objective. It is hard. And if you're acting like it shouldn't be hard or you're doing something wrong as a function, it's hard because you're doing something wrong, you're really confused. How could that be? You could not have known better than to end up here. Everything that brought you here was some other thought or some other feeling, and you're just responding to your environment. The question is right now where you have some control, what are you going to do with your attention? Right now, you're noticing, "Oh man, it's really hard to resist mental rituals. It's hard to catch them. It's hard to let go of them. It's hard to deal with the anxiety of thinking because I didn't finish the mental ritual. Maybe I missed something and somebody's going to get hurt or something like that because I didn't figure it out." It is really hard. I don't think we should pretend that it's easy. We should acknowledge that it's hard. And then we should ask, "Okay, well, I made a decision that I'm going to do this. I'm going to treat my OCD and it looks like the treatment for OCD is I'm going to confront this uncertainty and not do compulsions. So, I have to figure out what to do with the fact that it's hard." And then it's back to the body. How do you know that it's hard? "Well, I could feel the tension here and I could feel my heart rate and my breath." So, let's work with that. How can I relate to that experience that's coming up in a way that's actually helpful? The thing that I've been thinking about a lot lately is this idea that the brain is quick to learn that something is dangerous. Something happens and it hurts, and your brain is like, "Yeah, let's not do that again." And you might conclude later that that thing really wasn't as dangerous as you thought. And so, you want to re-engage with it. And you might find that's really hard to do, which is why exposure therapy is really hard because it's not like a one-and-done thing. You have to practice it because the brain is very slow to learn that something is safe, especially after it's been taught that it's dangerous. But that's not a bad thing. You want a brain that does that. You don't want a brain that's like, "Yeah, well, I got bit by one dog, but who cares? Let's go back in the kennel." You want a brain that's like, "Hold on. Are you sure about this?" That whole process of overcoming your fears, I think people, again, they're way too hard on themselves. It should take some time and it should be slow and sluggish. You look like you're getting better, and then you slip back a little bit, because it's really just your brain saying, "Listen, I'm here to keep you safe, and I learned that you weren't, and you are not following rules. So, I'm pulling you back." That's where that is coming from. So, that's the hard feeling. That's the hard feeling right there. It's your brain really trying to get you to say, "No, go back to doing compulsions. Compulsions are keeping you safe." You have to override that circuit and say, "I appreciate your help. But I think I know something that you don't. So, I'm going to keep doing this." And then you can relate to that hard feeling with like, "Good, my brain works. My brain is slow and sluggish to change, but not totally resistant. Over time, I'm going to bend it to my will and it will eventually let go, and either say this isn't scary anymore or say like, 'Well, it's still scary, but I'm not going to keep you from doing it.'" Kimberley: Right. I had a client at the beginning of COVID I think, and the biggest struggle-- and this was true for a lot of people, I think, is they would notice the thought, notice they're engaging in compulsions and drop it, to use your language, and then go, "Yay, I did that." And then they would notice another thought in the next 12 seconds or half a second, and then they would go, "Okay, notice it and drop it." And then they'd do it again. And by number 14, they're like, "No, this is--" or it would either be like, "This is too hard," or "This isn't working." So, I'm wondering if you could speak to-- we've talked about it being "too hard." Can you speak to your ideas around "this isn't working"? Jon: Yeah. That's a painful thought. I think that a lot of times, people, when they say it isn't working, I ask them to be more specific because their definition of working often involves things like, "I was expecting not to have more intrusive thoughts," or "I was expecting for those thoughts to not make me anxious." And when you let go of those expectations, which isn't lowering them at all, it's just shifting them, asking, well, what is it that you really want to do in your limited time on this earth? You're offline for billions of years. Now you're online for, I don't know, 70 to 100 if you're lucky, and then you're offline again. So, this is the time you have. So, what do you want to do with your attention? And if it's going to be completely focused on your mental health, well, that's a bummer. You need to be able to yes, notice the thought, yes, notice the ritual, yes, drop them both, and then return to something. In this crazy world we're living in now where we're just constantly surrounded by things to stimulate us and trigger us and make us think, we have lots of things to turn to that aren't necessarily healthy, but they're not all unhealthy either. So, it's not hard to turn your attention away from something and into a YouTube video or something like that. It is more challenging to shift your attention away from something scary and then bring it to the flavor of your tea. That's a mindfulness issue. That's all that is. Why is one thing easier than the other? It's because you don't think the flavor of your tea is important. Why? Because you're just not stimulated by the firing off of neurons in your tongue and the fact that we're alive on earth and that we've evolved over a million years to be able to make and taste tea. That's not as interesting as somebody dancing to a rap song. I get that, but it could be if you're paying a different kind of attention. So, it's just something to consider when you're like, "Well, I can't return to the present because it doesn't engage me in there." Something to consider, what would really engage you and what is it about the present that you find so uninteresting? Maybe you should take another look. Kimberley: Right. For me, I'm just still so shocked that gravity works. Whenever I'm really stuck, I will admit, my rumination isn't so anxiety-based. I think it's more when I'm angry, I get into a ruminative place. We can do that similar behavior. So, when I'm feeling that, I have to just be like, "Okay, drop away from, that's not helpful. Be aware and then drop it." And then for me, it's just like, "Wow, the gravity is pulling me down. It just keeps blowing my mind." Jon: Yeah. That's probably a better use of your thought process than continuing to ruminate. But you bring up another point. I think this speaks more closely to your question about when people say it's not working. I'm probably going to go to OCD jail for this, but I think to some extent, when you get knocked off track by an OCD trigger, because you made me think of it when you're talking about anger. Like, someone says something to you and makes you angry and you're ruminating about it. But it's the same thing in OCD. Something happens. Something triggers you to think like, "I'm going to lose my job. I'm a terrible parent," or something like that. You're just triggered. This isn't just like a little thought, you're like, "Oh, that's my OCD." You can feel it in your bones. It got you. It really got you. Now, you can put off ruminating as best you can, but you're going to be carrying that pain in your bones for a while. It could be an hour, could be a day, could be a couple of days. Now, if it's more than a couple of days, you have to take ownership of the fact that you are playing a big role in keeping this thing going and you need to change if you want different results. But if it's less than a couple of days and you have OCD, sometimes all you can do is just own it. "All right, I'm just going to be ruminating a lot right now." And I'm not saying like, hey, sit there and really try to ruminate. But it's back to that thing before, like your brain is conditioned to take this seriously, and no matter how much you tell yourself it's not serious, your brain is going to do what your brain is going to do. And so, can you get your work done? Try to show up for your family, try to laugh when something funny happens on TV, even while there's this elephant sitting on your chest. And every second that you're not distracted, your mind is like, "Why did they say that? Why did I do that? What's going to happen next?" And really just step back from it and say like, "You know what, it's just going to have to be like this for now." What I see people do a lot is really undersell how much that is living with OCD. "I'm not getting better." I had this happen actually just earlier today. Somebody was telling me, walking me through this story that was just full of OCD minds that they kept stepping on and they kept exploding and they were distressed and everything. And yet, throughout the whole process, the only problem was they were having OCD and they were upset. But they weren't avoiding the situation. They weren't asking for reassurance and they weren't harming themselves in any way. They were just having a rough time because they just had their buttons pushed. It was frustrating because they wouldn't acknowledge that that is a kind of progress that is living with this disorder, which necessarily involves having symptoms. I don't want people to get confused here and say like, "This is as good as it gets," or "You should give up hope for getting better." It's not about that. Part of getting better is really owning that this is how you show up in the world. You have your assets and your liabilities, and sometimes the best thing to do is just accept what's going on and work through it in a more self-compassionate way. Kimberley: Right. I really resonate with that too. I've had to practice that a lot lately too of accepting my humanness. Because I think there are times where you catch yourself and you're like, "No, I should be performing way up higher." And then you're like, "No, let's just accept these next few days are going to be rough." I like that. I think that that's actually more realistic in terms of what recovery really might look like. This is going to be a rough couple of days or a rough couple of hours or whatever it may be. Jon: Yeah. If you get punched hard enough in the stomach and knock the wind out of you, that takes a certain period of time before you catch your breath. And if you get punched in the OCD brain, it takes a certain amount of time before you catch your breath. So, hang on. It will get better. And again, this isn't me saying, just do as many compulsions as you want. It's just, you're going to do some, especially rumination and taking ownership of that, "Oh man, it's really loud in there. I've been ruminating a lot today. I'll just do the best I can." That's going to be a better approach than like, "I'm going to sit and track every single thought and I'm going to burn it to the ground. I'm going to do it every five seconds." Really, you're just going to end up ruminating more that way. Kimberley: Right. And probably beating yourself up more. Jon: Exactly. Kimberley: Right. Okay. I feel like that is an amazing place for us to end. Before we do, is there anything you feel like we've missed that you just want people to know before we finish up? Jon: I guess what's really important to know since we're talking about mental compulsions is that it's not separate from the rest of OCD and it's not harder to treat. People have this idea that, well, if you're a compulsive hand-washer, you can just stop washing your hands or you can just remove the sink or something like that. But if you're a compulsive ruminator about whether or not you're going to harm someone or you're a good person or any of that stuff, somehow that's harder to treat. I've not found this to be the case. Anecdotally, I haven't seen any evidence that this is really the case in terms of research. You might be harder on yourself in some ways, and that might make your symptoms seem more severe, but that's got nothing to do with how hard you are to treat or the likelihood of you getting better. Most physical rituals are really just efforts to get done what your mental rituals are not doing for you. So, many people who are doing physical rituals are also doing mental rituals and those who aren't doing physical rituals. Again, some people wash their hands. Some people wash their minds. Many people do both. A lot of this stuff, it has to do with like, "I expect my mind to be one way, and it's another." And that thing that's making it another is a contaminant, "I hate it and I want to go away and I'm going to try to get it to go away." And that's how this disorder works. Kimberley: Right. It's really, really wonderful advice. I think that it's actually really great that you covered that because I think a lot of people ask that question of, does that mean that I'm going to only have half the recovery of someone who does physical compulsions or just Googles or just seeks reassurance? So, I think it's really important. Do you feel like someone can overcome OCD if their predominant compulsion is mental? Jon: Absolutely. They may even have assets that they are unaware of that makes them even more treatable. I mean, only one way to find out. Kimberley: Yeah. I'm so grateful to you. Thank you for coming on. This is just filling my heart so much. Thank you. Jon: Thank you. I always love speaking with you. Kimberley: Do you want to share where people can find you and all your amazing books and what you're doing? Jon: My hub is OCDBaltimore.com. That's the website for the Center for OCD and Anxiety at Sheppard Pratt, and also the OCD program at The Retreat at Sheppard Pratt. And I'm on Instagram at OCDBaltimore, Twitter at OCDBaltimore. I don't know what my Facebook page is, but it's out there somewhere. I'm not hard to find. Falling behind a little bit on my meme game, I haven't found anything quite funny or inspiring enough. I think I've toured through all of my favorite movies and TV shows. And so, I'm waiting for some show that I'm into to inspire me. But someone asked me the other day, "Wait, you stopped with the memes." Kimberley: They're like, nothing's funny anymore. Jon: I try not to get into that headspace. Sometimes I do think that way, but yeah, the memes find me. I don't find them. Kimberley: I love it. And your books are all on Amazon or wherever you can buy books, I'm imagining. Jon: Yes. The OCD Workbook For Teens is my most recent one and the second edition of the Mindfulness Workbook for OCD is also a relatively recent one. Kimberley: Amazing. You're amazing. Thank you so much. Jon: Thank you.

Apr 29, 2022

SUMMARY: Welcome to the first week of this 6-part series on Mental Compulsions. This week is an introduction to mental compulsions. Ove the next 6 weeks, we will hear from many of the leaders in our feild on how to manage mental compulsions using many different strategies and CBT techniques. Next week, we will have Jon Hershfield to talk about how he using mindfulness to help with mental compulsions and mental rituals. In This Episode: What is a mental compulsion? Is there a different between a mental compulsion and mental rumination and mental rituals? What is a compulsion? Types of Mental Compulsions Links To Things I Talk About: How to reach Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 282 and the first part of a six-part series that I am overwhelmed and honored to share with you – all on mental compulsions. I have wanted to provide a free resource on mental compulsions for years, and I don't know why, but I finally got enough energy under my wings and I pulled it off and I could not be more excited. Let me tell you why. This is a six-part series. The next six episodes will be dedicated to managing mental compulsions, mental rituals, mental rumination. I will be presenting today the first part of the training, which is what we call Mental Compulsions 101. It will talk to you about all the different types of mental compulsions, give you a little bit of starter training. And then from there, it gets exciting. We have the most incredible experts in the field, all bringing their own approach to the same topic, which is how do we manage mental compulsions? We don't talk about mental compulsions enough. Often, it's not addressed enough in treatment. It's usually very, very difficult to reduce or stop mental compulsion. I thought I would bring all of the leaders, not all of them, the ones I could get and the ones that I had the time to squeeze into this six-part series, the ones that I have found the most beneficial for my training and my education for me and my stuff. I asked very similar questions, all with the main goal of getting their specific way of managing it, their little take, their little nuance, fairy tale magic because they do work magic. These people are volunteering their time to provide this amazing resource. Welcome to number one of a six-part series on mental compulsions. I hope you get every amazing tool from it. I hope it changes your life. I hope you get out your journal and you write down everything that you think will help you and you put it together and you try it and you experiment with it and you practice and you practice because these amazing humans are so good and they bring such wisdom. I'm going to stop there because I don't want to go on too much. Of course, I will be starting. And then from there, every week for the next five weeks after this one, you will get a new take, a new set of tools, a new way of approaching it. Hopefully, it's enough to really get you moving in managing your mental compulsion so you can go and live the life that you deserve, so that you can go and do the things you want without fear and anxiety and mental compulsions taking over your time. Let's do this. I have not once been more excited, so let's do this together. It is a beautiful day to do hard things and so let's do it together. Welcome, everybody. Welcome to Mental Compulsions 101. This is where I set the scene and teach you everything you need to know to get you started on understanding mental compulsions, understanding what they are, different kinds, what to do, and then we're going to move over and let the experts talk about how they personally manage mental compulsions. But before they shared their amazing knowledge and wisdom, I wanted to make sure you all had a good understanding of what a mental compulsion is and really get to know your own mental compulsions so you can catch little, maybe nuanced ways that maybe you're doing mental compulsions. I'm going to do this in a slideshow format. If you're listening to this audio, there will be a video format that you can access as well here very soon. I will let you know about that. But for right now, let's go straight into the content. Who is Kimberley Quinlan? First of all, who am I? My name is Kimberley Quinlan. A lot of you know who I am already. If you don't, I am a marriage and family therapist in the State of California. I am an Australian, but I live in America and I am honored to say that I am an OCD and Anxiety Specialist. I treat all of the anxiety disorders. I also treat body-focused repetitive behaviors, and we specialize in eating disorders as well. The reason I tell you all that is you probably will find that many different disorders use mental compulsions as a part of their disorder. My hope is that you all feel equally as included in this series. Now, as well as a therapist, I'm also a mental health educator. I am the owner, the very proud owner of CBTSchool.com. It is an online platform where we offer free and paid resources, educational resources for people who have anxiety disorder orders or want to just improve their mental health. I am also the host of Your Anxiety Toolkit Podcast. You may be watching this in a video format, or you may actually be listening to this because it will also be released. All of this will be offered for free on Your Anxiety Toolkit Podcast as well. I wanted to just give you all of that information before we get started so that you know that you can trust me as we move forward. Here we go. What is a Mental Compulsion? First of all, what is a mental compulsion? Well, a mental compulsion is something that we do mentally. The word "compulsion" is something we do, but in this case, we're talking about not a physical behavior, but a mental behavior. We do it in effort to reduce or remove anxiety, uncertainty, some other form of discomfort, or maybe even disgust. It's a behavior, it's a response to a discomfort and you do that response in a way to remove or resist the discomfort that you're feeling. Now, we know that in obsessive-compulsive disorder, there are a lot of physical compulsions. A lot of us know these physical compulsions because they've been shown in Hollywood movies. Jumping over cracks, washing our hands, moving objects – these are very common physical compulsions – checking stoves, checking doors. Most people are very understanding and acknowledge that as being a part of OCD . But what's important to know is that a lot of people with OCD don't do those physical compulsions at all. In fact, 100% of their compulsions are done in their head mentally. Now, this is also very true for people with generalized anxiety. It's also very true for some people with health anxiety or an eating disorder, many disorders engage in mental compulsions. Mental Compulsion Vs Mental Ritual? For the sake of this series, we use the word "mental compulsion," but you will hear me, as we have guests, you will hear me ask them, do you call them "mental compulsions"? Some people use the word "mental ritual." Some people use the word "mental rumination." There are different ways, but ultimately throughout this series, we're going to mostly consider them one and the same. But again, just briefly, a mental compulsion is something you do inside of your mind to reduce, remove, or resist anxiety, uncertainty, or some form of discomfort that you experience. Let's keep moving from here. What is a Compulsion Now, who does mental compulsions? I've probably answered that for you already. Lots of people do mental compulsions. Again, it ranges over a course of many different anxiety disorders and other disorders, including eating disorders. But again, generalized anxiety , social anxiety , phobias , health anxiety , post-traumatic stress disorder. Some of the people with that mental disorder also engage in mental compulsions. Predominantly, we talk a lot about the practice of mental compulsions for people with obsessive-compulsive disorder . The thing to remember is it's more common than you think, and you're probably doing more of them than you guessed. I'm hoping that this 101 training will help you to be able to identify the compulsions you're doing so that when we go through this series, you have a really good grasp of where you could practice those skills. Now, often when people find out they're doing mental compulsions, they can be very hard on themselves and berate and criticize themselves for doing them. I really want to make this a judgment-free and punish-free zone where you're really gentle with yourself as you go through this series. It's very important that you don't use this information as a reason to beat yourself up even more. So let's make a deal. We're going to be as kind and non-judgmental as we can, as we move through this process. Compassion is always number one. Do we have a deal? Good. Types of Mental Compulsions Here is the big question: Are there different types of mental compulsions? Now, I'm going to proceed with caution here because there is no clear differentiation between the different compulsions. I did a bunch of research. I also wrote a book called The Self-Compassion Workbook For OCD. There is no specific way in which all of the psychological fields agree on what is different types of mental compulsions. There are some guidelines, but there's no one list. I want to proceed with caution first by letting you know this list that we use with our patients. Now, as you listen, you may have different names for them. Your therapist may use different terminology. That's all fine. It doesn't mean what you have done is wrong or what we are doing is wrong. To be honest with you, this would be a 17-hour training if I were to be as thorough as listing out every single one. For the sake of clarity and simplicity, I've put them into 10 different types of mental compulsions. If you have ones that aren't listed, that doesn't mean it's not a mental compulsion. I encourage you to just check in. If you have additional or you have a different name, that's totally okay. Totally okay. We're just using this again for the sake of clarity and simplicity. Here we go. 1. Mental Repeating The first mental compulsion that we want to look at is mental repeating. This is where you repeat or you make a list of individual items or categories. It can also involve words, numbers, or phrases. Often people will do this for two reasons or more, like I said, is they may repeat them for reassurance. They may be repeating to see whether they have relief. They may be repeating them to see if they feel okay. They may be repeating them to see if any additional obsessions arise, or they may be repeating them to unjinx something. Now, that's not a clinical term, so let's just put that out there. What I mean by this is some people will repeat things because they feel like the first time something happened, it was jinx. Like it will mean something bad will happen. It's been associated with something bad, so they repeat it to unjinx it. We'll talk more about neutralizing compulsions here in a second, but that's in regards to mental repeating. You may do it for a completely different reason. Don't worry too much as we go through this on why you do it. Just get your notepad out and your pencil out and just take note. Do I do any mental repeating compulsions? Not physical. Remember, we're just talking about mental in this series. 2. Mental Counting This is where you either count words, count letters, count numbers, or count objects. Again, you will not do this out loud. Well, sometimes you may do it out loud in addition to mental, but we're mostly talking about things you would do silently in your head. Again, you may do this for a multitude of reasons, but again, we want to just keep tabs. Am I doing any mental counting or mental counting rituals? 3. Neutralization Compulsions or Neutralizing Compulsions What we're talking about here is you're replacing an obsession with a different image or word. Let's say you are opening your computer. As you opened the computer, you had an intrusive thought that you didn't like. And so in effort to neutralize that thought, you would have the opposite thought. Let's say you had a thought, a number. Let's say you've had the number that you feel is a bad number. You may neutralize it by then repeating a positive number, a number that you like, or a safe number. Or you may do a behavior, you may see something being done and you have a negative thought. So then, you recall a different thought or a prayer, it could be also a prayer, to undo that bad feeling or thought or sensation. Now, when it comes to compulsive prayer, that could be done as a neutralization. In fact, I almost wanted to make prayer its own category, because a lot of people do engage in compulsive prayer, particularly those who have moral and scrupulous obsessions. Again, not to say that all prayer is a compulsion at all, but if you are finding that you're doing prayer to undo a bad thought or a bad feeling or a bad sensation or a bad urge – when I say bad, I mean unwanted – we would consider that a neutralization or a neutralizing compulsion. 4. Hypervigilance Compulsions Now again, this is the term we use in my practice. Remember here before we proceed that hypervigilance is an obsession, meaning it can be automatic, unwanted, intrusive, but it can also be a compulsive behavior. It could be both or it could be one. But when I talk about the term "hypervigilance compulsions," this is also true for people with post-traumatic stress disorder, is it's a scanning of the environment. It's a scanning, like looking around. I always say with my clients, it's like this little set of eyes that go doot, doot, doot, doot really quick, and they're scanning for danger, scanning for potential fear or potential problems. They also do that when we're in a hypervigilance compulsion. We may do that with our thoughts. We're scanning thoughts or we're scanning sensations like, is this coming? What's happening? Where am I feeling things? You may be scanning and doing hypervigilance in regards to feeling like, am I having a good thought or a bad thought or a good feeling or a bad feeling? And then making meaning about that. You may actually also be hypervigilant about your reaction. If let's say you saw something that usually you would consider concerning and this time you didn't, you might become very hypervigilant. What does that mean? I need to make sure I always have this feeling because this feeling would mean I'm a good person or only good things will happen. The last one again is emotions, which emotions and feelings can sometimes go in together. Hypervigilant compulsion is something to keep an eye out. It could be simple as you just being hypervigilant, looking king around. Often this is true for people with driving obsessions or panic disorder. They're constantly looking for when the next anxiety attack is coming. 5. Mental Reassurance We can do physical reassurance, which is looking at Google, asking a friend like, are you sure nothing bad will happen? We can do physical, but we can also do mental reassurance, which is mentally checking to confirm an obsession is not or will not become a threat. This is true for basic like we already talked about and some checking and repeating behaviors. You may mentally stare at the doorknob to make sure it is locked. You may mentally check and check for reassurance once, twice, five times, ten times, or more. If the stove is off or that you are not having arousal is another one, or that you are not going to panic. You may be checking to get reassurance mentally that your fear is not going to happen. Again, some people's fear is fear itself. The fear of having a panic attack is very common as well. Again, we're looking for different ways that mentally we are on alert for potential danger or perceived danger. 6. Mental Review We've talked a lot about behaviors that we're doing in alert of anxiety. Mental review is reviewing and replaying past situations, figuring out the meaning of internal experiences, such as, what is the meaning of the thought I had? What is the meaning of the feeling I had? What is the meaning of that sensation? What does that mean? What is the meaning of an image that just showed up intrusively and repetitively in my mind? What is the meaning of an urge I have? This is very true for people with harm obsessions or sexual obsessions. When they feel an urge, they may review for hours, what did that mean? What does that mean about me? Why am I having those? And so the review piece can be very painful. All of these are very painful and take many, many hours, because not only are you reviewing the past, which can be hard because it's hard to get mental clarity of the past, but then you're also trying to figure out what does that mean about me or the world or the future. So, just things to think about. To be honest, mental review could cover all of the categories that we've covered, because it's all review in some way. But again, for the sake of clarity and simplicity, I've tried to break them up. You may want to break them up in different ways yourself. That is entirely okay. I just wanted to give you a little category here on its own. 7. Mental Catastrophization This is where you dissect and scrutinize past situations with potential catastrophic scenarios. Now, I made an error here because a lot of people do this about the future as well. But we'll talk about that here in a little bit. Mental catastrophization, if you have reviewed the past and you're going over all of the potential terrible situations. This is very true for people who review like, what did I say? Was that a silly thing to say? Was that a good thing to say? What would they think about me? Mental catastrophization is reviewing the past, but is also the future and reviewing every possible catastrophic scenario or opportunity that happened. Whether it happened or not, it doesn't really matter when it comes to mental compulsions. Usually, when someone does a mental compulsion, they're reviewing maybe's, the just in case it does happen, I better review it. 8. Mental Solving Very similar, again, which is anticipating future situations with or without potential what-if scenarios. Very similar to catastrophization compulsions. This is where you're looking into the future and going, "What if this happens? What if that happens? What if this happens? Well, what if that happens?" and going through multiple, sometimes dozens of scenarios of the worst-case scenarios on what may or may not happen. Again, it usually involves a lot of catastrophizing. But again, these are all safety behaviors. None of this means there's anything wrong with you or that you're bad or that you're not strong. Remember, our brain is just trying to survive. In the moment when we are doing these, our brain actually thinks it's coming up with solutions, but what we have to do, and all of the guests will talk about this, is recognize. Most of the time, the problem isn't actually happening. We're just having thoughts that it's happening. Again, this is reviewing thoughts of potential what-if scenarios. 9. Mental Self-Punishment I talk a lot about this in my book, The Self-Compassion Workbook For OCD. Mental self-punishment is a compulsion, a mental compulsion that is not talked about enough. One is criticizing, withholding pleasure, harshly disciplining yourself for your obsessions or even the compulsions that you've done. Often, we do this as a compulsion, meaning we think that if we punish ourselves, that will prevent us from having the obsession or the compulsion in the future. The fact here is beating yourself up actually doesn't reduce your chances of having thoughts and feelings and sensations and behaviors or urges. But that is why we do them. It's to catch when you are engaging in criticizing or withholding or punishing compulsions. 10. Mental Comparison Again, not a very common use of compulsions, but this is one I like to talk about a lot. Most of my patients with OCD and with anxiety will say that they know for certain that they compare more than their friends and family members who do not have anxiety disorders. I've put it here just so that you can catch when you are engaging in mental comparison, which is comparing your own life with other people's life, or comparing your own life with the idea that you thought you should have had for your life. So, an idea of how your life was supposed to be. This is a compulsive behavior because it's done again to reduce or remove a feeling or a sensation or a discomfort of anxiety or uncertainty you have around your current situation. It's really important to catch that as well because there's a lot of damage that can be done from comparing a lot with other people or from a fantasy that you had about the way your life should or shouldn't look. Again, we will talk about this in episodes, particularly with Jonathan Grayson. He talks a lot about this one. I just wanted to add that one in as well. They're the main top 10 mental compulsions. Again, I want to stress, these are not a conclusive list that is the be-all and end-all. A lot of clinicians may not agree and they may have different ways of conceptualizing them. That is entirely okay. I'm never going to pretend to be the knower of all things. That is just one way that we conceptualize it here at our center with our staff and our clients to help patients identify ways in which they're behaving mentally. Something to think about here, though, is you may find some of your compulsions are in more than one category. You might say, "Well, I do mental comparison, but it's also a self-punishment," or "I do mental checking, but it's also a form of reassurance." That's okay too. Don't worry too much about what section it should be under. Again, it's very fluid. We want you just to be able to document. It doesn't matter what category it is particularly. I really just wanted this 101 for you to do an inventory and see, "Oh, wow, maybe I'm doing more compulsions than I thought." Because sometimes they're very habitual and we are doing them before we even know we're doing them. I just want to keep reminding you guys it's okay if it looks a little messy and it's okay if your list is a little different. The main question here as we conclude is: How do I stop? Well, the beauty is I have the honor of introducing to you some of the absolute, most amazing therapists and specialists in the planet. I fully wholeheartedly agree with that. While I wish I could have done 20 people, I picked six people who I felt would bring a different perspective, who have such amazing wisdom to share with you on how to manage mental compulsions. Now, why did I invite more than one person? Because I have learned as a clinician and as a human being, there is not one way to treat something. When I first started CBT School, I was under the assumption that there is only one way to do it and it's the right way or the wrong way. From there, I have really grown and matured into recognizing that what works for one person may not work for the next person. As we go through this series, I may be asking very, very similar questions to each person. You will be so amazed and in awe of the responses and how they bring about a small degree of nuance and a little flare of passion and some creativity of each person and bring in a different theme. I'm so honored to have these amazing human beings who are so kind to offer their time, to offer this series, and help you find what works for you. As you go through, I will continue reminding you, please keep asking yourself, would this work for me? Am I willing to try this? The truth is, all of them are doable for everybody, but you might find for your particular set of compulsions specific tools work better. So trial them, see what works, be gentle, experiment. Don't give up. It may require multiple tries to really find some little win. Please, just listen, enjoy, take as many notes as you can, because literally, the wisdom that is dropped here is mind-blowing. I've been treating OCD for over a decade and I actually stopped a few things after I learned this and went straight to my staff and said, "We have to make a new plan. Let's implement this. This is an amazing skill for our clients. Let's make sure we do it." Even I, I'm a student of some of these amazing, amazing people. How do I stop? Stay tuned, listen, learn, take notes, and most importantly, put it into practice. Apply. That's where the real change happens. Now, before we finish, please do note this series should not replace professional healthcare. This or any product provided by CBT School should be used for education purposes only, so please take as much as you can. If you feel that you need more support, please reach out to a therapist in your area who can help you use these tools and maybe pick a part. Maybe there's a few things that you need additional help with, and that is okay. Thank you, guys. I am so excited to share this with you. Have a wonderful day.

Apr 22, 2022

SUMMARY: This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions. In This Episode: How anxiety and arousal impact each other (its a cycle) Arousal Non-Concordance and how it impacts people with anxiety and OCD How to take the shame out of arousal struggles Understanding why anxiety impacts orgasms and general intimacy Links To Things I Talk About: Article I wrote about OCD and Arousal Non-Concordance https://www.madeofmillions.com/articles/whats-going-ocd-arousal Come as You are By Emily Nagoski, PhD Come as You Are Workbook By Emily Nagoski, PhD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 281. Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We're actually in the middle of a heatwave. It is April when I'm recording this and it is crazy how hard it is, but I'm totally here for it. I'm liking it because I love summer. Talking about heat, let's talk about anxiety and arousal today. Shall we? Did you get that little pun? I'm just kidding really. Today, we're talking about anxiety and arousal. I don't know why, but lately, I'm in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we're too afraid to talk about. I'm just going to go there. For some reason, I'm having this strong urge with the podcast to just talk about the things that I feel we're not talking about enough. And several of my clients actually were asking like, "What resources do you have?" And I have a lot of books and things that I can give people. I was like, "All right, I'm going to talk about it more." So, let's do it together. Before we do that, let's quickly do the review of the week. This one is from, let's see, Jessrabon621. They said: "Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more." Thank you so much, Jess. This week's "I did a hard thing" is from Anonymous and they say: "I learned it's okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I'm learning to face OCD and realize that it's not my fault. I'm learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness." This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they've used self-compassion as their hard thing. Let's get into the episode. Let me preface the episode by we're talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she's off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She's doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts. Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I'm referring to today is Come as You Are. It's an amazing book. But I'm actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It's got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it's so filled with amazing information. I'm going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it's so helpful for those who have anxiety. It's like she's speaking directly to us. She's like, it's so helpful to have this context. Here's the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We're going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you're having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps. So let's first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it's true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you're feeling fine about it, we all have what's called inhibitors and exciters. Here is an example. An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you're probably already feeling a ton of judgment here like, "I shouldn't be aroused by this and I should be aroused by this. What if I'm aroused by this? And I shouldn't be," and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I'll talk about this more, sometimes it's for reasons that don't make a lot of sense and that's okay. Let's talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There's exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth. We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You're just so wiped out and you're so exhausted and your brain is foggy. It's just like nothing. That would be, in my case, an inhibitor. I'm not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one. It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It's all as important. Go and speak with your doctor. That's super important. Make sure medically everything checks out if you're noticing a dip or change in arousal that's concerning you. The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don't like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal. It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that's what's happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you're not in a relationship as well, and that's totally fine. This is for all relationships. There's no specific kind. Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don't actually have a lot of research on that, but I'm sure there are some hormonal impacts on men as well. There's also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you're being touched. Sometimes there's certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay. Really what I'm trying to get at here isn't breaking it down according to the workbook, but there's so many factors that may influence your arousal. Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there's tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you're noticing. Now, before we move on, we've talked about a lot of people who are struggling with arousal, and they've got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don't understand, that don't make sense to you, or maybe go against your values. I've got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I'm quoting her and citing her throughout this whole podcast. She says, "Bodies do not say yes or no. They say sex-related or not sex-related." Let me say it again. "Bodies do not say yes or no. They say sex-related or not sex-related." This is where I want you to consider, and I've experienced this myself, is just because something arouses you doesn't mean it brings you pleasure. Main point. We've got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it. An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it's sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It's not to try and resolve like, does that mean I like it? Does that mean I'm a terrible person? What does that mean? I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn't say yes or no, they say it's either sex-related or not sex-related. Here's the funny thing, and I've done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you're holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn't mean that you're now aroused by pencils or pens. It's that it was labeled as sex-related, so often your brain will naturally press the accelerator. That's often how I educate people, particularly who are having arousal that concerns it. It's the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it's not your body saying yes or no, it's your body saying sex-related or not sex-related. It's important to just help remind yourself of that so that you're not responding to the content so much and getting caught up in the compulsive behaviors. A lot of my patients in the past have reported, particularly during times when they're stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don't understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There's probably some content that impacted that, which is again, very, very, normal. this is why when I'm talking with patients – I've done episodes on this in the past, and we've in fact had sex therapists on the podcast in the past – is they've said, if you've lost arousal, it doesn't mean you give up. It doesn't mean you say, "Oh, well, that's that." What you do is you move your attention to the content that pumps the gas. When I mean content, it's like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you're doing, whether it's with a partner or by yourself, or in whatever means that works for you. You can bring that back. There's another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones. Again, if your goal is to be aroused, you might find it's very hard to be aroused because the context of that is pressure. I don't know about you, but I don't really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There's literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it's forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you're likely to spin out with anxiety. It's really no different. So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you're trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what's going on for you. Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present. A couple of things here. We've talked about erections, that's for people who struggle with that. It's also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we've been misled to believe that if you're not lubricated, you mustn't be aroused or that you mustn't want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn't mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant. Again, some people, I've talked to clients and they're so ashamed of that. But I think it's important to recognize that that's just because somebody taught us that, and sadly, it's a lot to do with patriarchy and that it was pushed on women in particular that that meant they're like a good woman if they're really lubricated. And that's not true. That's just fake, false. No science. It has no basis in reality. Now we've talked about lubrication. We've talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can't reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often. What I want you to do, and this is your homework, is don't focus on arousal. Focus on pleasure. Focus on the thing that-- again, it's really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn't mean thought suppress. That doesn't mean judge your thoughts because that in and of itself is an inhibitor often. I want to leave you with that. I'm going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like "The bodies don't say yes or no, they say sex-related or not sex-related." I'll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both. Most people I know that I've talked to about this-- and I'm not a sex therapist. Again, I'm getting all of this directly from the workbook, but most of the clients I've talked to about this and we've used some worksheets and so forth, they've said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn't feel so great. I'll move towards what feels good – is moving in that direction non-judgmentally and curiously that they've had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what's current and present in your senses. That's all I got for you for today. I think it's enough. Do we agree? I think it's enough. I could talk about this all day. To be honest, and I've said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I'll probably do it when I'm 70. And that will be awesome. I'll be down for that, for sure. I just love this content. Now, again, I want to be really clear. I'm not a sex therapist. I still have ones to learn. I still have. Even what we've covered today, there's probably nuanced things that I could probably explain better. Again, which is why I'm going to stress to you, go and check out the book. I'm just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I'm just going to tell you this quick story. I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, "Wouldn't it be wonderful if I didn't just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn't that a beautiful goal? Isn't that so? Because it's not just the anxiety, it's the little tiny areas in our lives that it impacts." That's when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let's talk about pee and poop, which is one episode we recently did. Let's talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure. I love you. Thank you for staying with me for this. This was brave work you're doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff. Finish up, again, do check out the book. Her name is Emily Nagoski. I'll leave a link in the show notes. One day we'll get her on. But in the meantime, I'll hopefully just give you the science that she's so beautifully given us. Have a wonderful day. I'll talk to you soon. See you next week. Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you. Have a good day.

Apr 22, 2022

SUMMARY: This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions. In This Episode: How anxiety and arousal impact each other (its a cycle) Arousal Non-Concordance and how it impacts people with anxiety and OCD How to take the shame out of arousal struggles Understanding why anxiety impacts orgasms and general intimacy Links To Things I Talk About: Article I wrote about OCD and Arousal Non-Concordance https://www.madeofmillions.com/articles/whats-going-ocd-arousal Come as You are By Emily Nagoski, PhD Come as You Are Workbook By Emily Nagoski, PhD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 281. Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We're actually in the middle of a heatwave. It is April when I'm recording this and it is crazy how hard it is, but I'm totally here for it. I'm liking it because I love summer. Talking about heat, let's talk about anxiety and arousal today. Shall we? Did you get that little pun? I'm just kidding really. Today, we're talking about anxiety and arousal. I don't know why, but lately, I'm in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we're too afraid to talk about. I'm just going to go there. For some reason, I'm having this strong urge with the podcast to just talk about the things that I feel we're not talking about enough. And several of my clients actually were asking like, "What resources do you have?" And I have a lot of books and things that I can give people. I was like, "All right, I'm going to talk about it more." So, let's do it together. Before we do that, let's quickly do the review of the week. This one is from, let's see, Jessrabon621. They said: "Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more." Thank you so much, Jess. This week's "I did a hard thing" is from Anonymous and they say: "I learned it's okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I'm learning to face OCD and realize that it's not my fault. I'm learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness." This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they've used self-compassion as their hard thing. Let's get into the episode. Let me preface the episode by we're talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she's off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She's doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts. Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I'm referring to today is Come as You Are. It's an amazing book. But I'm actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It's got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it's so filled with amazing information. I'm going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it's so helpful for those who have anxiety. It's like she's speaking directly to us. She's like, it's so helpful to have this context. Here's the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We're going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you're having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps. So let's first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it's true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you're feeling fine about it, we all have what's called inhibitors and exciters. Here is an example. An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you're probably already feeling a ton of judgment here like, "I shouldn't be aroused by this and I should be aroused by this. What if I'm aroused by this? And I shouldn't be," and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I'll talk about this more, sometimes it's for reasons that don't make a lot of sense and that's okay. Let's talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There's exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth. We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You're just so wiped out and you're so exhausted and your brain is foggy. It's just like nothing. That would be, in my case, an inhibitor. I'm not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one. It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It's all as important. Go and speak with your doctor. That's super important. Make sure medically everything checks out if you're noticing a dip or change in arousal that's concerning you. The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don't like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal. It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that's what's happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you're not in a relationship as well, and that's totally fine. This is for all relationships. There's no specific kind. Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don't actually have a lot of research on that, but I'm sure there are some hormonal impacts on men as well. There's also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you're being touched. Sometimes there's certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay. Really what I'm trying to get at here isn't breaking it down according to the workbook, but there's so many factors that may influence your arousal. Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there's tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you're noticing. Now, before we move on, we've talked about a lot of people who are struggling with arousal, and they've got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don't understand, that don't make sense to you, or maybe go against your values. I've got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I'm quoting her and citing her throughout this whole podcast. She says, "Bodies do not say yes or no. They say sex-related or not sex-related." Let me say it again. "Bodies do not say yes or no. They say sex-related or not sex-related." This is where I want you to consider, and I've experienced this myself, is just because something arouses you doesn't mean it brings you pleasure. Main point. We've got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it. An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it's sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It's not to try and resolve like, does that mean I like it? Does that mean I'm a terrible person? What does that mean? I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn't say yes or no, they say it's either sex-related or not sex-related. Here's the funny thing, and I've done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you're holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn't mean that you're now aroused by pencils or pens. It's that it was labeled as sex-related, so often your brain will naturally press the accelerator. That's often how I educate people, particularly who are having arousal that concerns it. It's the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it's not your body saying yes or no, it's your body saying sex-related or not sex-related. It's important to just help remind yourself of that so that you're not responding to the content so much and getting caught up in the compulsive behaviors. A lot of my patients in the past have reported, particularly during times when they're stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don't understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There's probably some content that impacted that, which is again, very, very, normal. this is why when I'm talking with patients – I've done episodes on this in the past, and we've in fact had sex therapists on the podcast in the past – is they've said, if you've lost arousal, it doesn't mean you give up. It doesn't mean you say, "Oh, well, that's that." What you do is you move your attention to the content that pumps the gas. When I mean content, it's like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you're doing, whether it's with a partner or by yourself, or in whatever means that works for you. You can bring that back. There's another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones. Again, if your goal is to be aroused, you might find it's very hard to be aroused because the context of that is pressure. I don't know about you, but I don't really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There's literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it's forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you're likely to spin out with anxiety. It's really no different. So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you're trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what's going on for you. Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present. A couple of things here. We've talked about erections, that's for people who struggle with that. It's also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we've been misled to believe that if you're not lubricated, you mustn't be aroused or that you mustn't want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn't mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant. Again, some people, I've talked to clients and they're so ashamed of that. But I think it's important to recognize that that's just because somebody taught us that, and sadly, it's a lot to do with patriarchy and that it was pushed on women in particular that that meant they're like a good woman if they're really lubricated. And that's not true. That's just fake, false. No science. It has no basis in reality. Now we've talked about lubrication. We've talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can't reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often. What I want you to do, and this is your homework, is don't focus on arousal. Focus on pleasure. Focus on the thing that-- again, it's really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn't mean thought suppress. That doesn't mean judge your thoughts because that in and of itself is an inhibitor often. I want to leave you with that. I'm going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like "The bodies don't say yes or no, they say sex-related or not sex-related." I'll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both. Most people I know that I've talked to about this-- and I'm not a sex therapist. Again, I'm getting all of this directly from the workbook, but most of the clients I've talked to about this and we've used some worksheets and so forth, they've said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn't feel so great. I'll move towards what feels good – is moving in that direction non-judgmentally and curiously that they've had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what's current and present in your senses. That's all I got for you for today. I think it's enough. Do we agree? I think it's enough. I could talk about this all day. To be honest, and I've said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I'll probably do it when I'm 70. And that will be awesome. I'll be down for that, for sure. I just love this content. Now, again, I want to be really clear. I'm not a sex therapist. I still have ones to learn. I still have. Even what we've covered today, there's probably nuanced things that I could probably explain better. Again, which is why I'm going to stress to you, go and check out the book. I'm just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I'm just going to tell you this quick story. I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, "Wouldn't it be wonderful if I didn't just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn't that a beautiful goal? Isn't that so? Because it's not just the anxiety, it's the little tiny areas in our lives that it impacts." That's when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let's talk about pee and poop, which is one episode we recently did. Let's talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure. I love you. Thank you for staying with me for this. This was brave work you're doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff. Finish up, again, do check out the book. Her name is Emily Nagoski. I'll leave a link in the show notes. One day we'll get her on. But in the meantime, I'll hopefully just give you the science that she's so beautifully given us. Have a wonderful day. I'll talk to you soon. See you next week. Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you. Have a good day.

Apr 22, 2022

SUMMARY: This episode addresses some common questions people have about anxiety and arousal. Oftentimes, we are too afraid to talk about anxiety and arousal, so I thought I would take this opportunity to address some of the questions you may have and take some of the stigma and shame out of discussing anxiety and how it impacts arousal, orgasm, intimacy, and sexual interactions. In This Episode: How anxiety and arousal impact each other (its a cycle) Arousal Non-Concordance and how it impacts people with anxiety and OCD How to take the shame out of arousal struggles Understanding why anxiety impacts orgasms and general intimacy Links To Things I Talk About: Article I wrote about OCD and Arousal Non-Concordance https://www.madeofmillions.com/articles/whats-going-ocd-arousal Come as You are By Emily Nagoski, PhD Come as You Are Workbook By Emily Nagoski, PhD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com . CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to CBTschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 281. Welcome back, everybody. How are you? It is a beautiful sunny day here in California. We're actually in the middle of a heatwave. It is April when I'm recording this and it is crazy how hard it is, but I'm totally here for it. I'm liking it because I love summer. Talking about heat, let's talk about anxiety and arousal today. Shall we? Did you get that little pun? I'm just kidding really. Today, we're talking about anxiety and arousal. I don't know why, but lately, I'm in the mood to talk about things that no one really wants to talk about or that we all want to talk about and we're too afraid to talk about. I'm just going to go there. For some reason, I'm having this strong urge with the podcast to just talk about the things that I feel we're not talking about enough. And several of my clients actually were asking like, "What resources do you have?" And I have a lot of books and things that I can give people. I was like, "All right, I'm going to talk about it more." So, let's do it together. Before we do that, let's quickly do the review of the week. This one is from, let's see, Jessrabon621. They said: "Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more." Thank you so much, Jess. This week's "I did a hard thing" is from Anonymous and they say: "I learned it's okay to fulfill my emotions and just allow my thoughts and it gave me a sense of peace. Learning self-compassion is my hard thing and I'm learning to face OCD and realize that it's not my fault. I'm learning to manage and live my life for me like I deserve, and I refuse to let this take away my happiness." This is just so good. I talk about heat. This is seriously on fire right here. I love it so much. The truth is self-compassion practice is probably my hard thing too. I think that me really learning how to stand up for myself, be there for myself, be tender with myself was just as hard as my eating disorder recovery and my anxiety recovery. I really appreciate Anonymous and how they've used self-compassion as their hard thing. Let's get into the episode. Let me preface the episode by we're talking about anxiety and arousal. If I could have one person on the podcast, it would be Emily Nagoski. I have been trying to get her on the podcast for a while. We will get her on eventually. However, she's off doing amazing things. Amazing things. Netflix specials, podcasts, documentaries. She's doing amazing things. So, hopefully, one day. But until then, I want to really highlight her as the genius behind a lot of these concepts. Emily Nagoski is a doctor, a psychology doctor. She is a sex educator. She has written two amazing books. Well, actually, three or four. But the one I'm referring to today is Come as You Are. It's an amazing book. But I'm actually in my hand holding the Come as You Are Workbook. I strongly encourage you after you listen to this podcast episode to go and order that book. It is amazing. It's got tons of activities. It might feel weird to have the book. You can get it on Kindle if you want to have it be hidden, but it's so filled with amazing information. I'm going to try and give you the pieces that I really want you to take away. If you want more, by all means, go and get the workbook. The workbook is called The Come as You Are Workbook: A Practical Guide to the Science of Sex. The reason I love it is because it's so helpful for those who have anxiety. It's like she's speaking directly to us. She's like, it's so helpful to have this context. Here's the thing I want you to consider starting off. A lot of people who have anxiety report struggles with arousal. We're going to talk about two different struggles that are the highlight of today. Either you have no arousal because of your anxiety, or you're having arousal at particular times that concern you and confuse you and alarm you. You could be one or both of those camps. So let's first talk about those who are struggling with arousal in terms of getting aroused. So the thing I want you to think about is commonly-- and this is true for any mental health issue too, it's true for depression, anxiety disorders, eating disorders, dissociative disorders, all of them really. But the thing I want you to remember, no matter who you are and what your experience is, even if you have a really healthy experience of your own sexual arousal and you're feeling fine about it, we all have what's called inhibitors and exciters. Here is an example. An inhibitor is something that inhibits your arousal. An exciter is something that excites your arousal. Now you're probably already feeling a ton of judgment here like, "I shouldn't be aroused by this and I should be aroused by this. What if I'm aroused by this? And I shouldn't be," and so forth. I want us to take all the judgment out of this and just look at the content of what inhibits our arousal or excites our arousal. Because sometimes, and I'll talk about this more, sometimes it's for reasons that don't make a lot of sense and that's okay. Let's talk about an inhibitor, something that pumps the brakes on arousal or pleasure. It could be either. There's exciters, which are the things that really like the gas pedal. They just really bring on arousal, bring on pleasure, and so forth. We have the content. The content may be first mental or physical, and this includes your health, your physical health. For me, I know when I am struggling with POTS, arousal is just barely a thing. You're just so wiped out and you're so exhausted and your brain is foggy. It's just like nothing. That would be, in my case, an inhibitor. I'm not going to talk about myself a lot here, but I was just using that as an example. You might say your anxiety or your obsession is an inhibitor. It pumps the brakes on arousal. It makes it go away. Worry is one. It could also be other physical health, like headaches or tummy aches, or as we said before, depression. It could be hormone imbalances, things like that. It's all as important. Go and speak with your doctor. That's super important. Make sure medically everything checks out if you're noticing a dip or change in arousal that's concerning you. The next one in terms of content that may either excite you or inhibit you is your relationship. If your relationship is going well, you may or may not have an increase in arousal depending on what turns you on. If your partner smells of a certain smell or stench that you don't like, that may pump the brakes. But if they smell a certain way that you do really like and really is arousing to you, that may excite your arousal. It could also be the vibe of the relationship. A lot of people said at the beginning of COVID, there was a lot of fear. That was really, really strong on the brakes. But then all of a sudden, no one had anything to do and there was all this spare time. All of a sudden, the vibe is like, that's what's happening. Now, this could be true for people who are in any partnership or it could be just you on your own too. There are things that will excite you and inhibit your arousal if you're not in a relationship as well, and that's totally fine. This is for all relationships. There's no specific kind. Setting is another thing that may pump the brakes or hit the gas for arousal, meaning certain places, certain rooms, certain events. Did your partner do something that turned you on? Going back to physical, it could also depend on your menstrual cycle. People have different levels of arousal depending on different stages of their menstrual cycle. I think the same is true for men, but I don't actually have a lot of research on that, but I'm sure there are some hormonal impacts on men as well. There's also ludic factors which are like fantasy. Whether you have a really strong imagination, that either pumps the brakes or puts the gas pedal in terms of arousal. It could be like where you're being touched. Sometimes there's certain areas of your body that will set off either the gas pedal or the brakes. It could be certain foreplay. Really what I'm trying to get at here isn't breaking it down according to the workbook, but there's so many factors that may influence your arousal. Another one is environmental and cultural and shame. If arousal and the whole concept of sex is shamed or is looked down on, or people have a certain opinion about your sexual orientation, that too can impact your gas pedal and your brakes pedal. So, I want you to explore this, not from a place of pulling it apart really aggressively and critically, but really curiously and check in for yourself, what arouses me? What presses my brakes? What presses my gas? And just start to get to know that. Again, in the workbook, there's tons of worksheets for this, but you could also just consider this on your own. Write it down on your own, be aware over the next several days or weeks, just jot down in a journal what you're noticing. Now, before we move on, we've talked about a lot of people who are struggling with arousal, and they've got a lot of inhibitors and brake pushing. There are the other camp who have a lot of gas pedal pushing. I speak here directly to the folks who have sexual obsessions because often if you have sexual obsessions, the fact that your sexual obsession is sexual in nature may be what sets the gas pedal off, and all of a sudden, you have arousal for reasons that you don't understand, that don't make sense to you, or maybe go against your values. I've got a quote that I took from the book and from the workbook of Emily Nagoski. Again, none of this is my personal stuff. I'm quoting her and citing her throughout this whole podcast. She says, "Bodies do not say yes or no. They say sex-related or not sex-related." Let me say it again. "Bodies do not say yes or no. They say sex-related or not sex-related." This is where I want you to consider, and I've experienced this myself, is just because something arouses you doesn't mean it brings you pleasure. Main point. We've got to pull that apart. Culture has led us to believe that if you feel some groinal response to something, you must love it and want more of it. An example of this is for people with sexual obsessions, maybe they have OCD or some other anxiety disorder, and they have an intrusive thought about a baby or an animal. Bestiality is another very common obsession with OCD or could be just about a person. It could be just about a person that you see in the grocery store. When you have a thought that is sex-related, sometimes because the context of it is that it's sex-related, your body may get aroused. Our job, particularly if you have OCD, is not to try and figure out what that means. It's not to try and resolve like, does that mean I like it? Does that mean I'm a terrible person? What does that mean? I want you to understand the science here to help you understand your arousal, to help you understand how you can now shift your perspective towards your body and your mind and the pleasure that you experience in the area of sexuality. Again, the body doesn't say yes or no, they say it's either sex-related or not sex-related. Here's the funny thing, and I've done this experiment with my patients before, is if you look at a lamp post or it could be anything, you could look at the pencil you're holding and then you bring to mind a sexual experience, you may notice arousal. Again, it doesn't mean that you're now aroused by pencils or pens. It's that it was labeled as sex-related, so often your brain will naturally press the accelerator. That's often how I educate people, particularly who are having arousal that concerns it. It's the same for a lot of people who have sexual trauma. They maybe are really concerned about the fact that they do have arousal around a memory or something. And then that concerns them, what does that mean about me? And the thing to remember too is it's not your body saying yes or no, it's your body saying sex-related or not sex-related. It's important to just help remind yourself of that so that you're not responding to the content so much and getting caught up in the compulsive behaviors. A lot of my patients in the past have reported, particularly during times when they're stressed, their anxiety is really high, life is difficult, any of this content we went through, is they may actually have a hard time being aroused at all. Some people have reported not getting an erection and then it completely going for reasons they don't understand. I think here we want to practice again non-Judgment. Instead, move to curiosity. There's probably some content that impacted that, which is again, very, very, normal. this is why when I'm talking with patients – I've done episodes on this in the past, and we've in fact had sex therapists on the podcast in the past – is they've said, if you've lost arousal, it doesn't mean you give up. It doesn't mean you say, "Oh, well, that's that." What you do is you move your attention to the content that pumps the gas. When I mean content, it's like touch, smell, the relationship, the vibe, being in touch with your body, bringing your attention to the dance that you're doing, whether it's with a partner or by yourself, or in whatever means that works for you. You can bring that back. There's another amazing book called Better Sex Through Mindfulness, and it talks a lot about bringing your attention to one or two sensations. Touch, smell being two really, really great ones. Again, if your goal is to be aroused, you might find it's very hard to be aroused because the context of that is pressure. I don't know about you, but I don't really find pressure arousing. Some may, and again, this is where I want this to be completely judgment-free. There's literally no right and wrong. But pressure is usually not that arousing. Pressure is not that pleasurable in many cases, particularly when it's forceful and it feels like you have to perform a certain way. Again, some people are at their best in performance mode, but I want to just remind you, the more pressure you put on yourself on this idea of ending it well is probably going to make some anxiety. Same with test anxiety. The more pressure you put on yourself to get an A, the more you're likely to spin out with anxiety. It's really no different. So, here is where I want you to catch and ask yourself, is the pressure I put on myself or is the agenda I put on myself actually pumping the brakes for me when it comes to arousal? Is me trying not to have a thought actually in the context of that, does that actually pump the brakes? Because I know you're trying not to have the thought so that you can be intimate in that moment and engaged in pleasure. But the act of trying not to have the thought can actually pump the brakes. I hope that makes sense. I want you to get really close to understanding what's going on for you. Everyone is different. Some things will pump the brakes, some things will pump the accelerator. A lot of the times, thought suppression pumps the brakes. A lot of the times, beating yourself up pumps the brakes. A lot of the time, the more goal, like I have to do it this way, that often pumps the brakes. So, keep an eye out for that. Engage in the exciters and get really mindful and present. A couple of things here. We've talked about erections, that's for people who struggle with that. It's also true for women or men with lubrication. Some people get really upset about the fact that there may or may not be a ton of lubrication. Again, we've been misled to believe that if you're not lubricated, you mustn't be aroused or that you mustn't want this thing, or that there must be something wrong with you, and that is entirely true. A lot of women, when we study them, they may be really engaged and their gas pedal is going for it, but there may be no lubrication. And it doesn't mean something is wrong. In those cases, often a sex therapist or a sex educator will encourage you to use lubrication, a lubricant. Again, some people, I've talked to clients and they're so ashamed of that. But I think it's important to recognize that that's just because somebody taught us that, and sadly, it's a lot to do with patriarchy and that it was pushed on women in particular that that meant they're like a good woman if they're really lubricated. And that's not true. That's just fake, false. No science. It has no basis in reality. Now we've talked about lubrication. We've talked about erection. Same for orgasm. Some people get really frustrated and disheartened that they can't reach orgasm. If for any reason you are struggling with this, please, I urge you, go and see a sex therapist. They are the most highly trained therapists. They are so sensitive and compassionate. They can talk with you about this and you can target the specific things you want to work on. But orgasm is another one. If you put pressure on yourself to get there, that pumps the brakes often. What I want you to do, and this is your homework, is don't focus on arousal. Focus on pleasure. Focus on the thing that-- again, it's really about being in connection with your partner or yourself. As soon as you put a list of to-dos with it is often when things go wrong. Just focus on being present as much as you can, and in the moment being aware of, ooh, move towards the exciters, the gas pedal things. Move away from the inhibitors. Be careful there. Again, for those of you who have anxiety, that doesn't mean thought suppress. That doesn't mean judge your thoughts because that in and of itself is an inhibitor often. I want to leave you with that. I'm going to in the future do a whole nother episode about talking more about this idea of arousal non-concordance, which is that quote I use like "The bodies don't say yes or no, they say sex-related or not sex-related." I'll do more of that in the future. But for right now, I want it to be around you exploring your relationship with arousal, understanding it, but then putting your attention on pleasure. Being aware of both, being mindful of both. Most people I know that I've talked to about this-- and I'm not a sex therapist. Again, I'm getting all of this directly from the workbook, but most of the clients I've talked to about this and we've used some worksheets and so forth, they've said, when I put all the expectations away and I just focus on this touch and this body part and this smell and this kiss or this fantasy, or being really in touch with your own body, when I just make it as simple as that and I bring it down to just engaging in what feels good – sort of use it as like a north star. You just keep following. That feels good. Okay, that feels good. That doesn't feel so great. I'll move towards what feels good – is moving in that direction non-judgmentally and curiously that they've had the time of their lives. I really just want to give you that gift. Focus on pleasure. Focus on non-judgmentally and curiously, being aware of what's current and present in your senses. That's all I got for you for today. I think it's enough. Do we agree? I think it's enough. I could talk about this all day. To be honest, and I've said this so many times, if I had enough time, I would go back and I would become a sex therapist. It is a huge training. Sex therapists have the most intensive, extensive training and requirements. I would love to do it. But one day, I'll probably do it when I'm 70. And that will be awesome. I'll be down for that, for sure. I just love this content. Now, again, I want to be really clear. I'm not a sex therapist. I still have ones to learn. I still have. Even what we've covered today, there's probably nuanced things that I could probably explain better. Again, which is why I'm going to stress to you, go and check out the book. I'm just here to try and get you-- I was thinking about this. Remember, I just recently did the episode on the three-day silent retreat and I was sitting in a meditation. I remember this so clearly. I'm just going to tell you this quick story. I was thinking. For some reason, my mind was a little scattered this day and something came over with me where I was like, "Wouldn't it be wonderful if I didn't just treat anxiety disorders, but I treated the person and the many problems that are associated with the anxiety disorder? Isn't that a beautiful goal? Isn't that so? Because it's not just the anxiety, it's the little tiny areas in our lives that it impacts." That's when I, out of me, as soon as I finished the meditation, I went on to my-- I have this organization board that I use online and it was arousal, let's talk about pee and poop, which is one episode we recently did. Let's talk about all the things because anxiety affects it all. We can make little changes in all these areas and little changes. Slowly, you get your life back. I hope this gives you a little bit of your sexual expression back, if I could put it into words. Maybe not expression, but just your relationship with your body and pleasure. I love you. Thank you for staying with me for this. This was brave work you're doing. You probably had cringy moments. Hopefully not. Again, none of this is weird, wrong, bad. This is all human stuff. Finish up, again, do check out the book. Her name is Emily Nagoski. I'll leave a link in the show notes. One day we'll get her on. But in the meantime, I'll hopefully just give you the science that she's so beautifully given us. Have a wonderful day. I'll talk to you soon. See you next week. Please do leave a review. It helps me so much. If you have a few moments, I would love a review, an honest review from you. Have a good day.

Apr 15, 2022

In this week's podcast episode, we are reflecting on the question, "Does anxiety make you need to pee or poop? Yes, you read that right! Today, we are talking ALL about how anxiety can cause frequent urination and the fear of peeing your pants. Have you found yourself getting anxious you might need to pee or poop in public which, in turn, makes you need to pee or poop in public? Bathroom emergencies are way more common than you think. I even share a story of how I, myself, had to handle the urgency to 🏃🏼‍♀️🏃🏿‍♂️ to the restroom. In This Episode: Why do we need to pee and poop when we are anxious? What causes the psychological need to urinate or defecate when anxious? How to stop anxiety Urination How to manage a fear of peeing your pants or pooping your pants How to use mindfulness and self-compassion when experiencing nervous pee syndrome Links To Things I Talk About: Overcoming Anxiety and Panic h ttps://www.cbtschool.com/overcominganxiety ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 280. Welcome back, everybody. I am so thrilled to have you here with me again today. Today's format is going to be a little different. I have fused the "I did the hard thing" with the question that we're going to address today. Usually, I sit down to the microphone and I look at my screen and I think about what I want to talk about, and I just start talking about it. To be honest, that is how this show goes. It has always been how this show has gone. But a follower on Instagram reached out to me this week and posed a really great question. So, with her permission, I will anonymously invite you to listen to the question, and then we're going to talk about some solutions. The reason I wanted to go word for word is I think you're probably going to get what she's saying, because I've been in this position. I know most of my clients have been in this position. It's not the funniest thing to talk about. I mean, I love talking about it, but it's not the funniest thing for you to talk about, or often people have a lot of shame and embarrassment around this topic. So, I wanted to just, let's just talk about it. Now, the reason I say I love to talk about it is, you know probably from previous episodes, I commonly ask my clients pretty personal questions. And often questions are like, are you prioritizing time to pee and poop? Are you holding your pee and poop? My job is to ask the questions that people are often too afraid to bring up. I often ask some personal questions about sexual arousal and things like that, again, because I have been trained to understand there's a lot of stigma and shame, and embarrassment around these topics. And so I try to de-stigmatize them and take the shame out of them by just addressing them because they're normal human struggles that we have. As you may imagine, today, we're talking about anxiety and pee and poop, and how anxiety can often make us feel like we urgently need to pee or/and poop. That's the topic of today. I'm going to read you this. It's a two-part question. I'm going to address them separately, but all from the same situation. It said: "Kim, I hope you are well. I was reading your post yesterday about the hardest part of facing your fear." To give you some backstory, I did a post on what the hardest things about facing fears are. I posed this question to Instagram and everyone wrote in. And using the results of what everyone wrote in, I created a post. And number seven was physical symptoms, especially bowel issues, and it really resonated with me. Why do we need to pee and poop when we are anxious? "You have said before that when you get feelings of discomfort, to just sit with it and do nothing." That's a common theme I talk about, is if you have discomfort, do nothing at all. You just sit with it. "But when it comes to bowel issues or needing to urinate due to anxiety, I get confused at what to do. Should I be sitting with it or going to the loo because that's what my body needs? There are sort of two parts to my anxiety. With this, I'll give you an example." She said, "This weekend, I'm going to a christening and I get anxious for these types of events, like christenings, weddings, theater, anywhere where there is lots of people and they sit together in a certain way. I feel anxious about needing to go to the bathroom. It's almost like I'm anxious of the symptom of anxiety." Yes. Now this is exactly what it is like for so many people, and it's a really great question. Here is my response. Naturally, it's a normal part of the human instinct to need to pee and poop when you're anxious. Hundreds of thousands of years ago, when we were faced with danger or some kind of threat, in order to get away from that threat, usually you needed to be able to run many, many, many miles in a very short period of time. Now, we have cars and planes to get away from danger, or we have technology to help us to get away from danger. But back we needed to run that long-distance and exert a lot of energy. And so naturally, our bodies get rid of weight and waste so that you can be prepared to run a long distance away from the threat. Often the easiest way to get rid of that waste and weight is to defecate (to go poop) and to urinate, which is to go pee, or in some cases, throw up. Some people when they're anxious, because their brain has detected danger, whether there's danger or not, you may do one of those three things. That's a very, very normal approach to the fight, flight, and freeze. So, in this case, let's say your brain has set off a false alarm and is saying there's going to be lots of people there, and what if you need to pee and poop? So now you're afraid of the symptom of anxiety like they've asked. What do you do? So here is my answer to that. When we have any symptoms of anxiety – increase in heart rate, sweating, lots of racing, thoughts, it could be tummy ache, it could be the need to urinate – yeah, we do want to practice the art of sitting with it, meaning tolerating it without reacting to it in an aversive way, meaning trying to resist it, make it go away, how can we remove this discomfort from our life? When we do that, we get into a cycle where you're constantly trying to get rid of discomfort and that keeps you stuck. In this situation, yeah. If you have a slight urge to urinate or to go to the bathroom, if you're able to, do try to tolerate that discomfort. However, if there's a strong urge to go to the bathroom, there is absolutely nothing wrong with going to the bathroom. What I would say to you is it depends. The answer is it depends, and it's a very personal one. I will tell you a story personally. I know it was probably TMI, but I remember when I was becoming an American citizen, I was overwhelmingly anxious about this situation. I was afraid of everything. I was afraid of the test. I was really emotional about becoming an American. I felt like I was denouncing my country. I was so anxious about the security process. I was so afraid that I was going to mess up and get into some legal trouble, even though I'd done everything by the book. It was really, really overwhelming. The minute I got in line, which were these thousands of people in line, I needed to go to the bathroom, like right now, it had to happen. So, in that instance, yes, I'm going to ask somebody where the bathroom is and I'm going to go to the bathroom. So, I did okay. TMI, but we're talking about it. Everybody pees and poops, so I'm not embarrassed. Now, as soon as I got back in line, I lost my spot. I was at the back of the line again. My husband was with me. "Uh-oh, I need to go to the bathroom again." I already know, I've probably dropped a lot of that weight. My brain thinks that there's a major danger when there's not. So, my job then is I could have easily gotten out of line again to try and get rid of that discomfort and that fear and that uncomfortableness in my stomach. But because I knew I'd already gone, my job was, I really need to get into this security building as a government building. I can't keep getting out of line. My work then was to practice seeing if I could just hold that feeling. Now I'm not here at all saying or suggesting that you should hold for long periods of time or even to be where you're tolerating an experience of pain. Again, it depends. The answer is, it depends. If you've already gone, can you hold on? If let's say you're holding on and you're like, "Oh no, it's definitely coming, I need to go," by all means, go. That's not a compulsion. It's just you listening to your body. It's you giving yourself permission to just go with the flow and again, it's a wonderful exposure of giving your body's permission to run the show. How to stop Anxiety Urination? I think the answer is, listen to your body, see what you can do. Again, we always want to be experimenting with tolerating discomfort for long periods or as long as you can. Bit for no reason should you hold for long periods of time and put yourself in additional pain. Now that being said, if you're going to the bathroom, just to remove your anxiety about going to the bathroom, or you're going to the bathroom to remove your anxiety of whether or not you will pee or poop your pants, that's a different story. If you're going to the bathroom to relieve anxiety, not physical, like actual urgency to go to the bathroom, well then yes, you're giving into fear. We don't want to let fear win, particularly when your brain is telling us there's danger when there's not. A perfect example, I'm becoming a citizen. I have to take a test. There's no real danger. The worst thing that could happen is I fail the test or I don't bring a paper or something. In this case for the ceremony, the worst thing that could happen is you would need to go to the bathroom, right? Or even if you maybe-- again, the worst thing that could happen is you would have to go. But if fear is saying, "Oh no, no, there is really bad possible, maybe possible maybes," because fear does that, it always gives you the possible maybes – then no, we would not go to the bathroom just to relieve anxiety. If a lot of people, specifically those with panic disorder, they are very, very afraid of the sensations of anxiety. So, your job is actually, if that's the case, to practice leaning in and having those sensations, tolerating those sensations. Or if you're going to do exposure and response prevention, even better, you would purposely try to create the scenario so that you could simulate the anxiety and practice tolerating it that way. So, my answer, I know, isn't direct. It is, it depends. But when it does come to fear, it's always going to be the same – do not let fear make your choices. Do no. The next part of the question, I think, is another part of this, which I think is really important. So, they said, the second part is, "If I do need it and I have to leave the room during the ceremony, I wonder what people will think of me. I feel like I'm being a disruption. Also, if I have to move past anyone, I sit down, I feel like a nuisance. And then too, so often at the end of the seat--" so they sit at the end of the seat, excuse me, just in case. "Some of my compulsions, safety behaviors around this are needing to know where the nearest toilet is, going multiple times beforehand. Or I may do a certain number of pelvic floor squeezes whilst in the toilet." They said, "Sorry if this is a long message, I just wanted to explain fully. I think the main thing I'm asking you is, should I be sitting with the feeling or not? If you do not see this up, the rest is just saying about the message." There we go. I think there's so much great opportunity here for exposure and really willingness to be uncomfortable. The first thing is, everyone pees and poops. There is no shame in needing to go to the bathroom. I have a lot of clients who, when they're anxious, they got to go. They got to go. It's not anxiety. They've got to go to the bathroom or there's going to be an accident. Not the fear. It's like, "No, it's actually coming." If that's the case, your job is to give yourself permission to be a human with anxiety and to be gentle and compassionate toward yourself that yes, sometimes people need to leave ceremonies. If someone behind you is judging you for needing to leave, that is a full reflection on them. It means nothing about you. Human beings are allowed to come and go as they please. If they need to pee and poop, that is their right. What I would encourage you to do is, this is like a social anxiety sort of talk, and we've got some podcasts on social anxiety, but your job is to give other people permission to judge us and do nothing about it. Do nothing. Do nothing about their judgment, because their judgment is a full reflection of them and their beliefs, not of us. The next part is they've gone over a ton of safety behaviors – checking the toilet, going multiple times. I would strongly-- if it were my client and you guys do what's right for you always, take what you need, leave the rest. But if it were my client or if it were myself, I would strongly suggest other than otherwise not doing these behaviors. We don't want to be doing behaviors. This goes for every topic. We don't want to be doing behaviors just in case, that just in case behaviors keep us stuck in a cycle of anxiety, that just in case behaviors validate your fear as if your fear is true and important and a fact. We don't want to do that. We can't do that because when we do that, we keep the fear cycling. So, I would actually encourage you to not check for bathrooms, not go to the bathroom before, unless of course you genuinely need to, not just because of fear. If for some reason you have the need, practice saying "I can have it." If the feeling is the pressure is down in that bowel and that pelvic area, that won't kill you either. I always think of when I'm on an airplane to Australia, you know what happens? You get on the plane, you put your bags away. You're getting ready. And then they say, preparing for takeoff, the seatbelt light comes on, and then immediately you need to go pee. And you can't get up. They won't you, so you hold it. People hold it all the time. Again, we don't want you to push you through pain, but you can hold it. Be really honest with yourself. Nothing terrible is going to happen. If it's really urgent, of course, I mean, even on a plane, if you're really going to pee or poop your pants, they're going to let you stand up. They're not going to make you sit in the chair. Try not to be doing these behaviors. Practice tolerating the discomfort of other people possibly judging you. One thing to keep in mind here too is when-- let's say you go back to my story, I had to leave the line. I could have done a lot of mind reading, which is a cognitive distortion, which is going, "Oh, they think this and he thinks that, and she thinks that about me." That's all mind reading. You don't actually know what they're thinking. They might be thinking, what a beautiful dress you're wearing, or they might be thinking, man, I can't wait for this ceremony to be over. You have no idea, they might be thinking about something so different. So, it's important that we also practice not mind reading what people think about us. There you have it. These urgencies to go are normal. Everyone pees and poops. That's just the facts. It doesn't matter whether you do it once a day or 20 times a day, depending on if you're anxious. Give yourself to not be perfect. A lot of times, we also talk about when people are doing exposures or they're having a panic attack, they're like, "Ah, it's not just the panic attack. I don't want people to see me having a panic attack," or "It's not just the anxiety. I don't want to have to cry in public." The work here is you're a human being. If you're a human being, you won't be perfect. If you're holding yourself to a standard where you, number one, aren't allowed to cry, you're not allowed to pee, you're not allowed to poop, you're not allowed to disrupt other people, Well, that's a lot of expectations you're putting on yourself. That's a lot of pressure that you just created in your head. No one else is expecting perfection from you. So, maybe adjust the expectations there as well. Now the last thing I will address, which isn't specifically to the pee and the poop, is some people get a lot of gas when they're anxious. They have a strong urgency to pass gas. This is very common for people who have irritable bowel syndrome, same with getting diarrhea or needing to pee or poo. This is very common. If you have IBS, please do speak with a doctor. Let them know that you're struggling with this. There's nothing to be ashamed of. They can, of course, diagnose you, make sure they maybe get you some help in those areas. Again, if you need to pass gas, no different. Humans pass gas. It's not something to be completely ashamed of. Is it embarrassing? Yes, it is. But you do what you have to do. You just have to get through. I've heard so many people tell me stories of their most anxious moment being made more difficult because they had no choice, but to pass gas during that. And if that's the case for you as well, again, I think any human who ridicules someone for needing to pass gas, which is such a human thing, I think we pass gas 17 times on average a day. Everyone, not select people, everyone, anyone who passed judgment on you for that is probably may want to step up their ability to be compassionate and empathic. Again, it's not about you, it's about them. So, be super, super gentle with yourself. I think I hit my limit of how many times I said pee and poop, and now we've added in pass gas and we've even used the "diarrhea" word, which I think is epic. I think I've checked all the boxes for today's episode. So, I hope that it was helpful for you. I genuinely hope that it just dropped some of the anxiety and judgment you have about yourself in regards to the urgency to need to go and pee and poop. If I were to summarize it, I would say it's very common to need to urinate, go to the bathroom or even pass gas. Lots of people have even diarrhea, very, very strong diarrhea. If that is the case for you, do what you need to do as best as you can. It's okay if you need to go to the restroom. No problem. If you're only going to reduce your anxiety about needing to go, I encourage you to try and challenge that some. Again, we do not want to give all of our power to fear. We actually want to ignore fear and give it none of our attention. If you can do that, you're doing amazing hard work. I love you all so much. Thank you for holding space for me as we talk about all things, bowel-related and urination-related. Even though it's uncomfortable, it is so important for us to be having these conversations. I hope again, it was helpful for you, and thank you for holding space for me as we talk about these things together. All right. I love you all. I hope you're having an amazing, amazing week. I hope you're being kind to yourself and really opening your heart to your own suffering instead of shutting it down because you're suffering matters. It deserves to be held tenderly. It is a beautiful day to do hard things. I cannot finish an episode without saying it. I encourage you, if you've gotten this far in the episode, to practice the hard things as much as you can every single day. Have a wonderful day, everyone.

Apr 8, 2022

In todays podcast episode, together we do a self-compassion check in. First, we address what is self-compassion and then, we check in on our needs. Mindful Self-Compassion involves first, being aware of what we need and what needs tending to. In this episode, we also walk through a self-compassion meditation together. In This Episode: What is Self-Compassion? What do I need? How can I give myself self-compassion right now? Self-compassion meditation. Links To Things I Talk About: https://read.amazon.com/kp/embed?asin=B08WGW9XCZ&preview=newtab&linkCode=kpe&ref_=cm_sw_r_kb_dp_XSDYJ2MCRJBYEFCPS5NF&tag=cbtschool-20 ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAS T to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 279. Welcome back, everybody. Today on Your Anxiety Toolkit podcast, we are talking about self-compassion. We're doing a self-compassion check-in. It's been a little while since we've checked in on how are you doing with your self-compassion practice. Now, today, we have added a little meditation for you just to supercharge your self-compassion practice. That is my agenda for today. We haven't done a ton of check-ins lately because life just seems to get away from us. For those of you who do not know, in 2020, I wrote a book called The Self-Compassion Workbook For OCD. It was the joy of life and the biggest challenge of my life business-wise. It was such a huge agenda to have on my plate just as 2020 and COVID breakthrough, but I'm so grateful it's out. When it was released, I had a lot of stuff out about self-compassion. And then I haven't checked in with you guys on how you're doing. So that's what today is about. Now, before we get into the episode, let's do the "I did a hard thing" for the week. We always check-in and someone submits the thing that they've done that is hard, because what we like to say is "It's a beautiful day to do hard things." And today's is from Anonymous. They said: "I've recently been diagnosed with OCD and struggled my whole life with anxiety. Unfortunately, until now I was never properly diagnosed until I was 45. I have started working with a new therapist and we are focusing on ERP. At first, I couldn't even tell her about my fears and intrusive thoughts. I have harm OCD among other various categories. Now, we are doing imaginals around some of the things I never thought I could even address, and I'm so proud of myself." I'm proud of you too. "It is changing my life. I cannot tell you how important it is to get a proper diagnosis and never give up. You will get better. You just have to get the right help and be willing to do the hard things." Anonymous, you are giving me the chills. Now, for those of you who don't have access – anonymous has access to a therapist – if you don't have access to a therapist, we do have an online course called ERP School. An ERP School is an online course that will teach you how to practice ERP at home, in your pajamas, all the skills that you need to get you started. Now, it does require you to be self-motivated. But if you are self-motivated and you are ready to learn, head on over to CBTSchool.com and you can get all the information there. All right, let's go over to the show. It's self-compassion check-in time. WHAT IS SELF-COMPASSION? What is Self-Compassion? It means how have you been treating yourself? Remember, self-compassion is ultimately treating yourself with the same that you would treat somebody else. So, if somebody else came to you and said, "I'm struggling with A, B, and C," what would you say to them? How would you treat them? How would you respond to them? How would your body language change? Would your voice lower? Would your voice soften? Would you give them a hug if that was appropriate? Would you soften your eyes and let them know that everything was going to be okay, and that you had their back unconditionally? That is how you would treat yourself. So my question is, how are you doing with this? I want you to check in regularly, way more regularly than we are here today. But I want you to check in with yourself preferably every day or multiple times a day and ask yourself, how am I doing? And then we're going to move into, and I know a lot of you remember this from previous episodes, but I want you to ask yourself the golden self-compassion question, which is, what do I need right now? What do I need? Let's do this together. I want you to find a comfortable place. If you're driving, please do not close your eyes. You may listen along. If you're not driving, you may close your eyes. You may rest your shoulders. You may bring a gentle smile to your face. And I want you just to slowly bring your attention to your breath. And when I say breath, I don't mean the physical rise and fall of your chest. I want you to bring your attention to the air that is going in and out of your body. You breathe in... The air goes into your lungs, replenishes, restores you. And then you breathe out air. And I want you to become familiar with this air as it enters your body and exits your body, replenishing you, supporting you, feeding you. And as you bring your attention to this air, I want you to gently slowly drop down into where you are and ask yourself, what is it that I need right now? If you notice being bombarded by many, many thoughts, that's okay. Just tend to one at a time. Each one of them, each one of those thoughts gets a moment. And you are going to use your wise mind to decide which ones you're going to tend to. As you ask yourself "What do I need right now," you may notice your mind sharing with you, "I need rest. I need a moment. I need to laugh. I need food. I need to pee. I need water. I need to be kind to myself." And take one at a time and take stock in acknowledging nonjudgmentally that that's what you need. Nonjudgmentally, which means we're not going to judge that we need it. We're not going to treat ourselves poorly because we need it. We're just going to acknowledge that's what we need. Now, if you notice that your mind is coming up with other things like criticisms, a list of things to do, it might be telling you, you should be doing something different and more productive, they're the thoughts that we maybe don't tend to because you're tending to those all day. Now is the time to check in for what you need. Say, "I'll be right with you later, thoughts. Right now, it's time to nourish me, to fill my cup so I can go and do those things later." We breathe in air... And we breathe out air. Now we bring our attention to those needs and ask ourselves, is there anything we can tend to right now? Maybe the softening of your shoulders. Maybe to let go of the to-do list. Maybe to celebrate the wins that you've had today or yesterday or whenever. What do I need? Sometimes it's to cry. Sometimes it's to feel our feelings. Sometimes it's to validate our own feelings and that's our job. That's our job. What a wonderful opportunity and a wonderful job we have, which is to be our first line of support and care, that we deserve that. Maybe you're surprised by what's showing up in what you need. Maybe you're surprised that you need something and it's something that you don't usually need. That's okay, too. Just be curious and open to that voice inside you. Now, if you're struggling to identify what you need, I want you to just gently remind yourself that the wish to be compassionate towards yourself is self-compassion enough. If it doesn't land and you don't have this powerful experience or gentle experience, and for you, it's actually quite gritty and edgy, that's okay. Just the intention of being here and asking is so wonderful. I often think of my husband. If I went to him and he was struggling, and I said, "Is there anything I can do to support you?" he may not be ready to ask for my help. But just me offering it, the intention of being there to support means so much. And we can be that for ourselves. So again, take a deep breath in... And breathe out. And just give it one last time. Is there anything you can offer me in how I could support me? Which is you. Or is there anything you need? You might even offer it to your body parts if there's particular areas struggling. Mind, what do you need? Tummy, what do you need? Foot, what do you need? Neck, what do you need? Now, as you've done this, I hope that you have been kind and non-judgmental, and non-critical. But if you are, I still want you to see this as a win. The check-ins can be so rich even when they're bumpy. We're going to slowly open our eyes... We're going to bring our awareness to what's around us and come grounded into the present again. And I hope that it's the check-in you needed. I hope that you got to explore your needs, which are important, and then nothing to be embarrassed or ashamed of. It's okay to have needs. In fact, it's normal and natural and healthy to have needs. We all have them. Have a wonderful day, everybody. I hope you are doing well. Before we finish up, we are going to do the review of the week. This one is from Jessrabon621, and it says: "Amazing podcast! I absolutely love everything about this podcast! I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast for anyone struggling with anxiety or any mental health professional that wants to learn more." Thank you so much, Jessrabon621. I love, love, love, love your reviews. Please do leave a review. I am trying to get to a thousand reviews and I will be giving away a free pair of Beats headphones to one lucky winner who leaves a review. Have a wonderful day, everybody. And I will see you all next week.

Apr 1, 2022

In this week's episode of Your Anxiety Toolkit Podcast, I share what I learned from my 3-day silent meditation retreat. This 3-day silent meditation retreat was rough, I won't lie. I had to ride many highs and lows, so I wanted to share them with you. Links To Things I Talk About: Tara Brach Silent Meditation Retreat home schedule https://www.tarabrach.com/create-home-retreat/ Mindfulness Book https://www.amazon.com/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 178. Welcome back, everybody. I am so thrilled to be here with you today. I recently got back from a three-day silent retreat. I was by myself for the entire three days. It was a three-day silent retreat. I have done silent retreats in the past at Buddhist monasteries and Buddhist retreat centers. This is the first time I've done it on my own, and I followed the Tara Brach self-retreat website. I will leave the notes in the show notes so that you can check that out. It was amazing. I can't lie. I had so many mind-blowing moments and I want to share with you each and every single one. I'm going to give you the cliff notes version. Otherwise, I would have you here for days on end. But I am so excited to share that with you. Before we do that, of course, you know we always do the "I did a hard thing." This is a segment where someone can write in, submit the hard thing they've done. This one is by Mgwolfie1992, and they've said: "I have OCD and ASD. Certain shirts do not feel right. Before starting ERP, when I put on a shirt that's uncomfortable, I immediately take it off, which was making me late for work. After starting ERP, I have slowly worked my way up to wearing and keeping that uncomfortable shirt on for 12 minutes." Mgwolfie1992, this is just you doing the work. I'm so, so impressed. This is exactly what it's like for everybody listening or watching today, is it is about just small baby increments and getting yourself higher and higher and a little more difficult, a little more difficult. I'm so impressed with the work that you're doing. This is just so incredibly powerful and rewarding, and I hope that you keep going. Let's talk about what I learned from my three-day silent retreat. Just to give you a setup, I rented through Airbnb a small little cabin in the depths of Topanga, which is very close to where I live in Los Angeles. I was following the Tara Brach home retreat that she created at the beginning of COVID. Now, when COVID hit, I so desperately wanted to do this, but I was in the middle of writing The Self-Compassion Workbook For OCD, and so I did not have time or the bandwidth to really go and really be with myself. I just had so much going on. As you probably remember, the world just felt so scary and no one knew what was happening. So I definitely wasn't ready to do something at that time. After several years or even months at this point where I feel like I've really, really prioritized my mental health and my medical health, I was finally in a place where I just felt like I needed some time to really go and let go of some things. I could be doing this at home. I could do this every day and I have since I returned, but I really felt that I needed these three days to do a deep dive into really some things that I had been working through having a medical illness, a chronic illness. I have postural orthostatic tachycardia syndrome, really coming down out of the pandemic and so forth. So, I really felt like I just needed this time to really not have the kids around and just drop down in and do that really hard work. I took with me a journal. I took with me a book called Mindfulness by Joseph Goldstein. I strongly recommend that you try it. It is very heavy on Buddhist philosophy, but it is such an important book about mindfulness. And so to start off, the thing that I learned the most was I needed so desperately to go back to basics. Everything felt so complex – everything I was teaching, everything I was doing in therapy, the practices of my own. It just felt like there were so many spinning parts. When I got there, I just dropped down to like, "Kimberley, let's go back to the basics." So I wanted to share with you what those basics were. Number one, I went right back to the core of mindfulness, which was mostly me. The main agenda was to observe what showed up instead of being in reaction to it. Here, when life is so busy and chaotic and so many things happening at once, it's really hard to be an observer. I think I have lost my ability to do that. And so once I got there, I promised myself and my friends that I would not be contacting them, that I would have just one part of the day where I would text people back. I would check my phone, make sure everybody was okay and my clients were okay and my staff were okay. I would respond back, but very limited. And that throughout the day, if I felt the need to pick up my phone, or I felt the need to call, or I felt the need that I needed to talk to someone, that I had to stay in that feeling. And that's why I really chose the silent retreat. I wanted to create an environment where I couldn't rely on anybody except myself, and that no matter what I felt I had to hang on and I had to ride it out and I wanted to really drop down a little deeper and really explore what was going on for me. Now, the thing that was most profound is the first day was excruciating. I mean, painful. I had every emotion under the sun. At one point at the evening, when I told my husband I would call after me waiting through these emotions all day, I did text and he asked how I was doing, and I said, "This is so hard. I don't even want to be here." I didn't ask for his advice, but he did say via text, "Just keep going." So, I did. Of course, I did. But what was so fascinating to me, and one thing I really learned about myself, and I'm wondering if you do the same thing, is I had gone into this silent retreat not exhausted. Usually, by the time I take a break, I am so wiped out that I'm completely like starfish on the bed, completely out of it. This was really interesting because, for the first time, I wasn't exhausted, and on the first day, I kept having the thought, "You don't deserve this." I kept thinking, this is ridiculous. People are at war. There is floods in my home country. So many people have it worse than me. "You don't deserve this, Kimberley. This is unnecessary. This is actually very silly of you to have asked to do this three-day silent retreat." I was so shocked at those thoughts. Now, here is where the observing skill was so helpful for me. Instead of having that thought and then going, "Yeah, you're right," and then beating myself up or maybe even going home or feeling guilty or punishing myself, I just observed it and went, "Huh, that's interesting. I'm having thoughts that this is selfish," or "I'm having thoughts that this was silly." Instead of fusing with those thoughts, I just observed them. And I also observed the feeling and going, "Uh-huh, I feel guilty," or "I feel selfish." But instead of saying, "I am guilty and I am selfish," I didn't over-identify with those emotions, which is another mindfulness skill that I wanted to go back to the basics, is how much we over-identify with the thoughts we have. If something is uncomfortable, we go, "Oh, that means it must have to go away, and this is wrong. I'm wrong and I shouldn't be feeling this way." Instead, I just sat in it and I had this-- I want you to just imagine me. If you're listening to the podcast, you won't be able to see me. But if you're watching me on video right now, I just had my head and kept nodding and smiling, like I was almost dancing with my head and just going, "Uh-hmm, yes, brain, I hear you. Yes, mind, I can hear what you're saying, but I'm not going to connect with that. I'm going to allow it. I'm not going to push it away, but I'm just going to observe it." Oh my gosh, I had so many breakthroughs, one after or the other, of just catching these rules and beliefs I have and how invasive they are and how reactive I am to them. Even though I've practiced this for years, I just knew I needed this time to let go of all of this. Now the second thing I learned besides really dropping down into the basics and observing everything and not identifying was, in the Mindfulness book that I was reading, and I had it as my agenda to read it, is I had to practice going back to accepting impermanence. Now impermanence is a Buddhist concept that they talk about a lot. Basically, what it means is that this is temporary. As I sat and I meditated so much on this three-day retreat, not so much the second day, but the first and the third day were really good meditation days. I sat on my meditation seat and all I would do is just try to stay in the moment and notice the impermanence. So, as a satisfying feeling showed up, I would just notice that this is temporary, that it will go, and I'm not going to cling to it. As an uncomfortable thought showed up, I said to myself, "This is temporary. I'm not going to cling to it. I'm not going to push it away." Everything that showed up, I just kept going, "This is temporary. This is temporary." Some people would probably argue that that's a problem. Like, why would you push away good thoughts? But I had to keep reminding myself that my attachment to good is what creates a lot of my suffering. A lot about impermanence is also looking at the fact that everything is temporary. In this beautiful rental that I had was these beautiful windows. I would sit right at the edge of the window and I would overlook this beautiful creek, all these trees, and leaves. A part of the meditation that I had practiced and I have practiced for many years is to meditate on impermanence, which is to sit and look. This time my eyes were open, and everything I see, I contemplated how temporary it is. If it was a leaf that is just newly budded, I would imagine it fully coming into bloom, falling off the tree, and then completely breaking down into the ground where it was mud muddy and sludgy and yucky. And then looking at, let's say the wood and going, "Yes, that too will break down over time." Looking at my hand and my face and my body and imagining me too once was very youthful and now looking slightly older and acknowledging that that too is impermanence and that I too will die. From that meditation, I cried. I sobbed actually, and I let go of a lot of beliefs and values I was hanging onto that really aren't my values in terms of me having to stay young, that me having to stay liked by people, that I had to hold onto this idea. Instead, I was actually moving towards saying, "It's okay. You can like me or hate me, because you liking me may actually be temporary. You may only need me for a period in your life. And then you may not need me." And then again, observing what showed up for me and letting go of that too. It was just this massive cycle and it kept going and going. I would keep hitting these same things that I needed to let go of and learn and practice like observing and recognizing that things are temporary and that it doesn't mean anything about me. I know this may actually be a lot, but I can't tell you how powerful it was. It was such a beautiful experience of letting go, of catching where I'm attached to things, and then letting go of that as well. I'm not saying that because I let them go they don't bother me anymore. I am now in a cycle and it got me going and now allowing that letting go to be more automatic. Whereas before, I used to joke with my husband and my best friend. When they'd make a suggestion to me, like maybe they would offer me some advice, I would respond a little defensively. And that's one of the reasons I really wanted this three-day retreat, is I could feel the tension in me on how inflexible I was and how I was being stubborn and holding tight on things. I knew that's not what my core nature is. I'm going to keep this short and I'll give you one more thing that I learned. And this thing has probably been the most beautiful lesson I've ever learned. It's been so synchronistic because so many things have really reinforced things since I've returned. This is the idea of independence versus interdependence. I think since I recovered from my eating disorder, I have made it my goal to be independent. I don't want to rely on people. I don't want to ask them for help. I want to be a strong woman. I want to be a powerful human. I want to be peaceful in myself. I want to be self-sustaining, if that makes sense. This has been such amazing growth for me. I have learned so much and really learned my own strength because I made a deal with myself that I would always be my first person. Through that, I have learned to trust myself, to rely on myself, that I'm stronger than I thought. It's a big reason why I say it's a beautiful day to do hard things, is because I've practiced that my whole life. But I was reading something from one of these, in the Tara Brach retreat, she has a lot of retreat talks and I was listening to some of these Dharma talks. One of them was that we're interdependent. Even though we're independent, we also need other people. And that actually through being interdependent is where we build community. It made me realize that I think I've swung too far in the independence. If there was a pendulum swinging, I'd swung too far in the independence and I needed to recognize how much I need other people. I need my friends, I need my husband more, I need my children more in different areas, that I need to ask for help more. It doesn't mean I have to pay people. It doesn't mean they owe me. It doesn't mean I now fully swung the other direction into always being dependent. It's that I've acknowledged that change happens more on the local level. Since I created this podcast and I have an Instagram profile, I think my mind had very much gone to a large scale. Like, I have to make a huge difference, that I could make a huge difference. Something came through me, a sense of knowing in terms of, yes, I can make a large difference, but I can't forget the local difference that I can make, the connection with my neighbors, the connection with my school. Particularly since COVID, we've become so technological. How can I actually connect with people more on a one-to-one basis instead of a one-to-thousand? For some reason, that really spoke to me and I've never been more empowered and excited to serve you all because I think I needed to come out of the big crowd, thousands of people and really just start to go back to thinking one-to-one and thinking about the person instead of the crowd. I think that that will help me a lot in terms of being more connected, feeling more connected, feeling not lonely in things. They have that whole thing about you can be surrounded by people, but still feel lonely. I think that's probably why I felt lonely in the past. They're the main things I learn. There are so many more, but really, I just want to emphasize, if you can create a one day or even a half-day silent retreat where you sit and really be with your emotions and commit to seeing what comes up, you will be shocked at the explosion of experiences that you have inside you. It doesn't have to be three days. You don't have to rent someplace. You could do it in your own home, even in one room if you need it, and really drop down. When those really painful emotions come up, really sit with them and be with them and practice letting them wax and wane as much as you can. That's what I learned. I hope that that has been inspiring to you in some way or another. For me, I'm more committed to my meditation practice than I've ever been. I'm more committed to my mindfulness than I've ever been, and I'm more connected to my business than I've ever been, which is really, really beautiful. All right, thank you so much. I am so grateful for you being here with me today. I just love this work I'm doing with you and I hope that it is beneficial to you. Before we finish up, let's do the review of the week. This is from kdeemo and they said: "This podcast is a gift. I just found this podcast and I'm binging on the episodes. I learn something through each episode, and I love her practical advice and tools. I feel like part of a community-what a gift!" Thank you, kdeemo. Please, please do go and leave a review. I know you are very busy. I very much respect your time, but the best gift you can give me is just a view and honest review. It helps me to reach more people and that makes me feel so fulfilled and happy. Have a wonderful day, everybody.

Mar 25, 2022

Common treatment of derealization and depersonalization Kimberley Quinlan SUMMARY: Derealization & depersonalization are common experiences of anxiety. In this episode, we take a look at the definition of derealization and depersonalization. We also explore the common symptoms of derealization and depersonalization and the treatment of derealization and depersonalization. I also explore mindfulness and CBT skills to help you manage your discomfort and anxiety. In This Episode: The definition of derealization The definition of depersonalization Explore the symptoms of derealization Explore the symptoms of depersonalization Comparing derealization vs depersonalization Common treatment of derealization and depersonalization Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 227. Welcome back, everybody. I am so grateful to have this time with you. As you know, I promised this year would be the year I doubled down and get really into the nitty-gritty of some of the topics that people don't talk enough about regarding anxiety. Today is so in line with that value Today, we are talking about what is derealization and depersonalization. These are two what I would consider symptoms of anxiety. I see it all the time in my practice. I see it reported and commented all the time on Instagram. If you follow me on Instagram, we put out tons of free information there as well. This is such an important topic. And for some reason, we aren't talking about these two topics enough. My goal today is actually to give you a 101 on derealization and a 101 on depersonalization. We can touch upon derealization disorder and depersonalization disorder as well, but at the end, I want to give you as many tools as I can to point you in the right direction. Before we do that, let's do the "I did a hard thing," because we love that, right? The "I did a hard thing" is a segment where people submit the hard things they're doing. The main reason I do this is because, number one, you're my family. We're all in this together. But number two, often people, many years ago when I started the podcast, people were like, when I started saying it's a beautiful day to do hard things, which I say all the time, a lot of people were saying, "But how hard does it have to be? And how do I handle the hard things? Can you give me an example?" And so, these have been just such a wonderful way to share how other people are doing hard things. This one was submitted anonymously, and they said: "I've struggled with suicidal ideation for a very long time. And after years of therapy, self-discovery, and lots of hard work, I'm finally accepting that I am better off in the world than out of it." Now I just have to take a deep breath and nearly cry because this is seriously the hard work. Sometimes when we're talking about "I did a hard thing," we're talking about facing one small thing or one large thing, but I really want to honor Anonymous here and all of you who are doing this really long-term work and deep, deep work around really acknowledging how important you are and how much the world needs you in it and on it. So anonymous, I love you. You are amazing. I have such respect for the work that you've done and are doing, and thank you. Again. I think we don't talk about suicidal ideation enough either. In fact, I should really do an episode on that as well. I respect you and I'm so grateful you submitted this week. Okay, here we go. I have some notes, which I rarely use notes for episodes, but I didn't want to miss anything. I've got so much I want to share. I will do my best to break this down into, like I said, a 101, small bite-size helpful tools. You will hear me, as I talk, taking little deep breaths and that's because I have to practice slowing down. Just a little off-topic, when I'm doing podcasts, I get so geeked out that my brain races, and I'm all over the place and I'm talking fast and I have to slow down, "Kimberley, pump the breaks, lady." Let's together take a breath... and let's just be together. First let's talk about derealization. The definition of derealization is that derealization is a mental state or a psychological experience, it could also be a physiological experience, where things feel unreal. Not like, "Oh, that's totally unreal, man. Amazing." I'm talking where they don't feel real. When you have derealization, you might feel detached from your surroundings. You don't feel connected to what's going on around you, and people and objects may also seem unreal. Often people, when they have derealization or derealization disorder, feel like they're going crazy. Actually, they feel like they're going crazy. Not just the term that people use on the street. They actually feel like they're losing touch with reality. When we talk about derealization disorder, we'll talk about that here in a little bit, but we could use them interchangeably. Lots of people have derealization without having the disorder, but to have derealization disorder, you have to experience derealization. So I'm including them both there. Now the prevalence of derealization, I wanted to just give you this information because I felt it was very validating. I myself struggle with derealization and depersonalization. It was really validating for me to hear that more than half, more than 50% of people may have this disconnection from reality at least once in their lifetime. 2% of people experience it enough for it to become some kind of disorder, just like derealization disorder or even a dissociative disorder like amnesia. If you're concerned, you can go speak with your doctor or your therapist, or a licensed therapist for an assessment if you're concerned about it. A lot of people who I have seen have already been to the doctor, gotten cleared. Schizophrenic is often a very big concern. People often feel that they've been misdiagnosed. Now derealization is similar, but distinctly different from depersonalization, which we would talk about here soon. Some symptoms of derealization include feelings of being unfamiliar with your surroundings. You feel like you've never been there before, or you may feel like you're living in a movie or a dream. You may feel emotionally disconnected from your loved ones or colleagues or friends. You just feel very numb. Like I said, you're just very out of order. Things feel very strange. Your surroundings and the environment also may appear distorted, blurry, colorless, two-dimensional, or artificial. I remember the first time I ever had derealization. I was sitting across from a client and I was an intern. I was very anxious. I've talked about this on the podcast before. I was sitting across from them and all of a sudden, their body looked like a caricature of themselves. The caricature is where their body is really small and their head is huge. I was looking at my client, trying to be a therapist, and I'm thinking what happened. All of a sudden, their neck was very, very small and short and their head looked gigantic. It looked like a drawing, not three-dimensional, but two-dimensional. And that was so concerning to me. I freaked out. I got through the session. Thankfully, again, I had tools to use. But it was really scary. It actually brought on some panic later in that evening because it didn't go away for a little bit of time. Now, depersonalization, the definition of depersonalization involves feeling a detachment, not from your environment like in derealization, but from your own body and your thoughts and your feelings. Think of it like it's like you're watching yourself from an outsider. I always say it's like you're flying on the wall, looking at yourself, or it's like looking at a movie of yourself. Now, symptoms of depersonalization include feelings that you're an outsider observer, like I just said. You're disconnected to your body again. Others report that it feels like they're a robot and that they don't have control of their movements. Again, you feel like you're watching yourself and you don't have control of what's going to happen next. Another symptom of depersonalization may include the sense that your body and legs and arm appear distorted. They may feel enlarged or shrunken. Some people report that their head is wrapped in cotton. That's a different symptom. Another example I always use with my patients is often when I have depersonalization, which isn't very often anymore, is I'd look at my hand and I couldn't tell if it was my hand or not. I didn't feel like it was my hand. Again, really scary, can feel really concerning in the moment. Now you may also experience some numbness, whether that's emotional or physical. Some people say all of these symptoms are similar for derealization as well. You may feel like your memories lack emotion. Again, you're disconnected from your own experience. So, that can be an additional symptom of depersonalization. Now for both, I'm going to talk about them together now. For both, the duration of these symptoms may last just a few minutes, they can last a few hours. Some people, particularly if you have derealization disorder or depersonalization disorder, it can be days, weeks, and months. In that severity, I would encourage you to go and speak with a mental health provider who is trained and can assess you properly. Now, to be diagnosed with derealization or to be diagnosed with depersonalization, there is no lab test. There's no scan you can have. It requires a trained professional to review your symptoms and give you the diagnosis. You could probably, by listening to this, define for yourself whether you have the criteria to meet this classification. But if you're wanting to be sure, I strongly encourage you to seek professional help to get that diagnosis. Now, the prevalence of the struggles almost always start in late childhood or early adulthood. The statistics, this is why I have my notes today, the average age starts around 16. 95% of cases are diagnosed before the age of 25. Not always, but that has been the common statistics that they're showing. I think that's really helpful to know. Now, that being said, what do you do from here? The treatment of depersonalization and derealization is often CBT (Cognitive Behavioral Therapy). Basically, what we do, and this is a lot of the work that you probably already have skills if you've listened to a lot of the podcast episodes – a lot of it is around practicing your mindfulness tool. The first thing I want to let you know is it doesn't mean you're going crazy. I totally get that. It feels like you are, but it doesn't. The good news is, when you can't stop appraising it as "I am going crazy," you'll actually start to notice it's just a really strange feeling, but it doesn't mean anything is wrong. I once had a teen client who told me, he said he was laughing and we were giggling together. He said, "The crazy thing is some of my friends pay a lot of money to feel this way by using drugs," and he says, "I have it for free. I have this strange feeling, this out-of-body experience. And I don't even have to be under the control of a drug or a substance." He said, "When I looked at it from that perspective, I stopped appraising it as if it's dangerous." And that was a game-changer for him to stop appraising it as if it is a dangerous problem. For me now, when I have derealization, it usually occurs when I'm driving. I used to panic that that meant I was going to crash. But then when I just said, "Okay, I'm just having a feeling and I'm going to let it be there." I'm not going to do anything about it. I'm not going to judge it negatively. I'm going to allow it to rise and fall on its own. And I'm going to put all of my attention on just staying present. Now your brain is going to say, "Yeah, but present is bad. Present is terrible. Bad things are going to happen. What if you're going crazy?" And your job is actually to practice just letting those be thoughts, because that's what they are. They're thoughts. Just because you have them doesn't mean they're facts. Lots of people have derealization. The clients I've had who've had severe derealization and derealization and depersonalization disorder, they now say, "Yeah, it happens. No big deal. They just go about my day." Now in the early stages of treatment, you're going to hate this idea, but it works, is we actually used to purposely induce this sensation so that they could practice tolerating the discomfort without responding in unhealthy ways or in compulsive ways. We would sit them down and spin them around in a chair. We would have them stare at the wall. We would have them look at really psychedelic YouTube videos where the colors and the patterns are all wavy like seventies, like psychedelic. And we would practice inducing the feeling. From there, they would practice willingly allowing the discomfort and going about their day, being gentle with themselves, engaging in the things they value. Of course, they might feel great, and that's okay. You can slow down a little and do what you need to do. But ultimately, when you have depersonalization and derealization, the goal is simply to do nothing at all. Crazy. When I tell my patients that, they're like, "Oh my goodness, you're either crazy or you're brilliant." By the end, usually, they say that this treatment, not me, but the treatment is brilliant, because it teaches them not to be afraid of it and not to try and live their life avoiding it. I've had patients report that they've avoided things at great length just to avoid the experience of depersonalization and derealization. And when they avoid it, it just keeps them stuck and keeps them scared and keeps it happening more. The other thing I will add is, do not check to see if you're derealized or depersonalized, because just the act of checking for it, like a mental check, can actually bring on the symptoms. Now, that's easier said than done. Am I right? Yes, it's very hard. I know it's easy to say, "Just stop doing that." But if you're engaging in a lot of checking behavior, sometimes it's helpful to catch when you are and bring yourself back to the present, do whatever disengagement skills you can use to get you back into the present moment. Again, we don't want to push the discomfort away, but we also don't want to give too much hyper attention to these sensations and symptoms. If you're struggling with these symptoms, go and see a mental health professional. You can quiz them, ask them if they have skills in this. Look on their website, see if they've got any information about it that will help you to get the help that you need. This is great. Like I said, this is what I call derealization and depersonalization 101. But there are many, many other tools that you can use to help manage this. One day I will do my best to create an online course about this that goes into detail so you have that, but for right now, I hope that this is helpful. Now, before we finish up, I'm going to do the review of the week. We have an amazing review here from Jessrabon621 and they said: "Amazing podcast. I absolutely love everything about this podcast. I could listen to Kimberley talk all day and her advice is absolutely amazing. I highly recommend this podcast to anyone struggling with anxiety or any other mental health professional that wants to learn more." Thank you, Jessrabon621. I am so grateful that I've helped and I'm so happy that you've left a review. Thank you. I love your reviews. They help me so much. 2022 is the year that I want to get a thousand reviews. If you can help, I would be so grateful. Go in wherever you're listening, click on the reviews, leave a review. You don't have to write something. You can just rate it. Leave an honest review. I am so, so grateful. We will be giving a pair of Beats headphones to one lucky winner by the time we hit 1,000 reviews. So I am so grateful. Have a wonderful day, and I'll see you next week.

Mar 18, 2022

Mar 18, 2022

SUMMARY: Overcoming Health Anxiety is possible! Today, we interview Ken Goodman and his client Maria on overcoming hpyochondria using Cognitive Behavioral Therapy. In this episode of Your Anxiety Toolkit Podcast, you will learn key concepts of health anxiety and how to overcome their health anxiety. In This Episode: What it is like to have health anxiety The key concepts of treating Hypochondria Tips for managing fears of death and cancer. A step-by-step approach to overcoming health anxiety. Links To Things I Talk About: https://www.kengoodmantherapy.com/ Quiet Mind Solutions ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 226. Welcome back, everybody. If you have health anxiety, hypochondria, health anxiety disorder, or you know of somebody who has health anxiety, you are going to love this episode. I mean, love, love, love this episode. Today, we have Ken Goodman, who's on the show. He's a clinician who's here with his patient and they're sharing a success story, a recovery story of health anxiety, and it is so good. I am so honored to have both of them on. It was so fun to actually interview other people and the way they're doing it, and look at the steps that were taken in order to overcome health anxiety. And this is the overcoming health anxiety story of all stories. It is so, so good. I'm not going to waste your time going and telling you how good it is. I'm just going to let you listen to it because I know you're here to get the good stuff. Before we do that, I wanted to do the "I did a hard thing" and this one is from Dave. It says: "I've been trying to get back into meditating regularly. I was sitting at a desk this morning, reviewing my work emails. And I told myself, before I get even further in my day, I need to meditate. I did a guided meditation, even though I felt a strong pull inside to go back to work. I kept getting caught up in my thoughts, but I just kept telling myself it doesn't need to be a perfect meditation. I said the goal today is just to be able to sit without being busy for three minutes. Nothing more. It was hard, but I did it." Dave, thank you so much for the submission of the "I did a hard thing" segment, because I think that meditation is so important. In fact, I keep promising myself I'm going to implement it more into this podcast. And Dave has really looked at some of the struggles people have with meditation. And look at him, go, it's so amazing. Totally did it. So amazing. Dave, thank you so, so, so much. I love it. If you want to submit, you may submit your "I did a hard thing" by going to KimberleyQuinlan-lmft.com. If you go to the podcast page, there is a submission page right on the website. And from there, let's just go straight to the show. I hope you enjoy it. Kimberley: Welcome. I am so excited for this episode. Welcome, Ken and welcome, Maria. Ken: Thank you for having me. Maria: Hi, Kimberley. Kimberley: So, as you guys, we've already chatted, but I really want to hear. This is really quite unique and we get to see the perspective of a client and the therapist. If I could do one of these every single week, I would. I think it's so cool. So, thank you so much for coming on and sharing. We're going to talk about health anxiety . And so, Maria, we're going to go back and forth here, but do you want to share a little bit about your experience with health anxiety? Maria: Yes. I think I've had health anxiety probably for like 15, 20 years and not known about it. Looking back now, everything comes clear when you see the multiple pictures that you've taken of certain lumps and whatever five years ago. I'm like, "Oh my gosh, I have so many pictures that I've taken and so many different things." But yeah, I've been struggling for a while I think, and had multiple doctor's appointments. Until I realized that I had health anxiety, it was an everyday struggle, I think. Ken: Well, you came to me and you were mostly worried at the time about ticks and Lyme disease and skin cancer, but you told me that for the previous 15 years or so, you were worried about other things. What are those things? Maria: Well, I was mostly completely obsessed with moles on my skin and them being cancerous. And I was scared of ticks. I would not be able to walk through any grass or go hiking. I was scared that I would have to check my whole body to make sure that there were no ticks on me. I was completely scared of Lyme disease, and it just completely consumed my life really. And they were the main things. But looking back before that, I think that I always had a doctor's appointment on the go. I would book one, and as soon as they said, "You can book online," That was it for me. I would have one booked, and then I'd go, "Oh, what if there's something else next week? You know what, I'm just going to book one for next week, just in case something comes up." I am a terrible person when it comes to that because I'm taking up multiple doctor's appointments. And I knew that. But it was trying to reassure myself, trying to control the situation, trying to control next week already before it even happened. So, yeah. MARIA'S SYMPTOMS OF HEALTH ANXIETY Kimberley: Right. What did it look like for you? What did a day look like for you pre-treatment and pre-recovery? Maria: Some days it could be fine. I remember days where nothing was bothering me. It was such a nice feeling. And then I was scared because I never knew what was going to trigger me and it could be anything at any time. And I think that was the not knowing. And then as soon as I would latch onto something, I would come to the phone, I'd start Googling over and over again, hours of Googling and then checking. And then it was just ongoing. And then my whole day, I was in my head my whole day, just what if, what if, asking questions, going back to Google, trying to find that reassurance that of course never happened. Ken: Yeah. You tell me that you would take pictures of your moles and then compare them with the cancerous moles online and do those things. Maria: Yeah. And I would book-- and interestingly enough, looking back now, I went through a phase of always having a doctor's appointment. And then I also went through a phase of completely avoiding the doctor as well, not wanting to go because I didn't want them to say something that I knew was going to trigger a whole host of anxiety. So, I've gone through multiple doctors. And then once you start the doctor's appointments, then you're on a roller coaster. Because you walk away from that appointment, never feeling, or for me, never feeling reassured. Or feeling reassured for maybe a few minutes, and then you leave, and then the anxiety kicks in. "Oh, I never asked them this," or "Oh my gosh, well, what did that mean?" And then the what-ifs start again and you're back to square one. So then, you go, "Oh, no, I didn't try just what they said. I'm going to book another appointment and this doctor is going to be the doctor that reassures me." MANAGING DOCTOR VISITS WITH HYPOCHONDRIA Kimberley: Right. Or sometimes a lot of clients will say to me like, "The doctor made a face. What did that face mean? They made a look and it was just for a second, but were they questioning their own diagnosis and so forth?" And I think that is really common as well. Ken: Well, the doctor will say anything and it could be something very simple like, "Okay, you're all good. I'll see you in six months." And the person will leave thinking, "Why would he want me to come back in six months if nothing was wrong?" Maria: Well, that's interesting that you would say that because I think probably at my lowest point, I was keeping notes about my thought process and what I was feeling when I was actually going to the doctors or waiting for the results. And actually, I thought it might-- if I have a few minutes to read what I actually was going through in real-time, I know it's probably very relatable. Kimberley: I would love that. Maria: I had gone to basically a doctor's appointment, an annual one where I knew I was going to have to have blood tests. And they're the worst for me because the anticipation of getting the results is just almost worse than getting the results, even though-- Ken: Did you write this before we met? Maria: No. While I was seeing you, Ken. Ken: In the beginning? Maria: Yeah. When you'd asked me to write down everything and write down what I was feeling, what I was thinking, and then read it back to myself. And this is what I had written down, actually, when I was going through the doctor's appointment and waiting or had just gotten the results. Kimberley: If you would share, that'd be so grateful. Maria: So, my blood results came back today. I felt very nervous about opening them. The doctor wrote a note at the top. "Your blood results are mostly normal. Your cholesterol is slightly high, but no need for medication. Carry on with exercise and healthy eating." "Mostly," what does that mean? "Mostly"? I need to look at all the numbers and make sure that everything is in the normal range. "Okay, they're all in the normal range except for my cholesterol. But why does she write mostly? Is there something else that she's not telling me? I need reassurance. I'm driving down to the doctor's right now. I can't wait the whole weekend." I go into the doctor's office and ask them, "Is there a doctor who's able to explain to me my results?" The receptionist said, "No, you have to make another appointment." I explained to her, "You don't understand. I just need somebody to tell me that everything is normal." Finally, this nice lady saw the anxiety on my face. She calls the doctor over to look at the labs. The receptionist shows the doctor the one lab panel, and he says, "Everything is completely normal. Nothing was flagged. Everything is completely fine." I thank him so much for looking and walk away. As soon as I get outside, I realize I didn't ask him to look at all the lab panels. What if she meant mostly normal on the other lab panels that I didn't show him? When I get home, I look over each one multiple times and make sure that each one is in the exact number range. After looking over them four or five times and seeing that each one is in the number range except for my cholesterol, I still feel like I need to have her explain to me why she wrote the word "mostly." The crazy thing is I'm not concerned about the high cholesterol. I can control that. I don't know what she meant by the word "mostly." I'm going to send her a message. And I'm going to ask her to clarify. I have to believe that she would tell me if something was wrong. I wish there was an off button in my head to stop me worrying about this. Ken: I remember this now. I remember. And this was in the middle. Maria was really avoiding going to the doctor and she had overdue with some physical exams. And so, we really worked hard for her to stop avoiding that. She got to the point where she felt good enough about going to the doctor. And she really, I think I remember her not having any anticipatory anxiety, handling the doctor very well, host the doctor very well, until she got the email and focused on the word "mostly." And that sent her spiraling out of control. But the interesting thing about that whole experience was that we processed it afterwards, and that whole experience motivated her to try even harder. And then she took even bigger strides forward. And within a couple of months, she was really doing so much better. And I think it's been over a year now since that and continues to do really well. Kimberley: Yeah. Thank you so much for sharing that. I actually was tearing up. Tears were starting to come because I was thinking, I totally get that experience. I'm so grateful you shared it because I think so many people do, right? Maria: Yeah. And there's always and/or. You go into the doctor's appointment, they tell you everything. And because your adrenaline is absolutely pumping, you forget everything. And then you come out and you go, "Oh my gosh, I can't remember anything." Then the anxiety kicks in and tells you what the anxiety is like, "Oh no, that must have been bad. That must have been--" yeah. Ken: And that boost in adrenaline that just takes over is so powerful. You can forget any common sense or any therapeutic strategies or tools that you might have learned because now you just get preoccupied with one word, the uncertainty of that word. Maria: Yeah. I would have to have a family member come in, my husband to come in and sit in the-- it got to that point where he would have to come in and sit in the appointment, so then after the appointment, I could have him retell me what was said, because I knew as soon as the adrenaline kicked in, I would not be able to remember anything. ROADBLOCKS TO HEALTH ANXIETY TREATMENT Kimberley: Right. Ken, this brings me straight to the next question, which would be like, what roadblocks do you commonly see patients hit specifically if they have health anxiety during recovery or treatment? Ken: Well, unlike other fears and phobias, the triggers for health anxiety are very unpredictable. So, if you have a fear of elevators, flying or public speaking, you know when your flight is going to be, you know when you have to speak or you know when you have to drive if you have a fear of driving. For health anxiety, you never know when you're going to be triggered. And those triggers can be internal, like a physical sensation, because the body is very noisy. And everyone experiences physical sensations periodically and you never know when that's going to happen. And then you never know external triggers. You never know when the doctor is going to say something that might trigger you, or you see a social media post about a GoFundMe account about someone that you know who knows someone who's been diagnosed with ALS. So, you never know when these things are going to happen. And so, you might be doing well for a couple of weeks or even a month, and suddenly there's a trigger and you're right back to where you started from. And so, in that way, it feels very frustrating because you can do well and then you can start becoming extremely anxious again. Another roadblock I think might be if you need medicine, there's a fear of trying medicine because of potential for side effects and becomes overblown and what are the long-term side effects, and even if I take it, I'm going to become very anxious. And so, people then are not taking the very thing, the medicine that could actually help them reduce their anxiety. So, that's another roadblock. Kimberley: Yeah. I love those. And I think that they're by far the most hurdles. And Maria, you could maybe even chime in, what did you feel your biggest roadblock to recovery was? Maria: Being okay with the unknown. Trying to be in control all the time is exhausting and trying to constantly have that reassurance and coming to terms with, "It's okay if I can't control everything. It's okay if I don't get the 100% reassurance that I need. It's good enough," that was hard for me. And also, not picking up the phone and Googling was the biggest. I think once I stopped that and I was okay with not looking constantly, that was a huge step forward. Ken: You really learn to live with uncertainty. And I think you start to understand that if you had to demand 100% certainty, you had to keep your anxiety disorder. In order to be 100% certain, that meant keep staying anxious. Kimberley: Yeah. Being stuck in that cycle forever. Ken: You didn't want that anymore. You wanted to focus on living your life rather than being preoccupied with preventing death. SKILLS AND TOOLS TO OVERCOME HEALTH ANXIETY Kimberley: Right. So, Maria, I mean, that's probably, from my experience as a clinician, one of the most important skills, the ability to tolerate and be uncertain. Were there other specific tools that you felt were really important for your recovery at the beginning and middle and end, and as you continue to live your life? Maria: Yes. I think the biggest one was me separating my anxiety from myself, if that makes sense. Seeing it as a separate-- I don't even know, like a separate entity, not feeling like it was me. I had to look at it as something that was trying to control me, but I was fine. I needed to fight the anxiety. And separating it was hard in the beginning. But then I think once I really can help me to understand how to do that, at that point, I think I started to move forward a bit more. Kimberley: So, you externalized it. For me, I give it a name like Linda. "Hi, Linda," or whatever name you want to give your anxiety. A lot of kids do that as well like Mr. Candyman or whatever. Maria: Yeah. It sat on my shoulder and try to get in my head. In the beginning, I would be brushing off my shoulder constantly. Literally, I must have looked crazy because I was brushing this anxiety off my shoulder every 10 minutes with another what-if. What if this? What if that? And I think I had to retrain my brain. I had to just start not believing and being distracted constantly by the "What if you do this" or "What if that?" and I'd say, "No, no." Ken: Yeah. I'd treat a lot of health anxiety . I have a lot of health anxiety groups. And I do notice that the patients that can externalize their anxiety and personify it do way better than the people who have trouble with it. And so, whether it's a child or a teenager or an adult, I am having them externalize their anxiety. And I go into that, not only in my groups, but in the audio program I created called the Anxiety Solution Series. It is all about how to do that. And it makes things so much easier. If now you're not fighting with yourself, there's no internal struggle anymore because now you're just competing against an opponent who's outside of you. It makes things easier. Kimberley: Right. Yeah. And sometimes when that voice is there and you believe it to be you, it can make you feel a little crazy. But when you can externalize it, it separates you from that feeling of going crazy as well. Maria: I felt so much better as soon as I did that because I felt, "Okay, I think I can fight this. This isn't me. I'm not going crazy. This is something that I--" and I started to not believe. And it was long, but it was retraining my brain. And I would question the what-ifs and it didn't make sense to me anymore. Or I would write it down and then I would read it back to me, myself, and I'd be like, "That's ridiculous, what I just thought." And the other tool which was hugely helpful was breathing, learning how to breathe properly and calm myself down. I mean-- Ken: Yeah. There's lots of different types of breathing out there. And so, I teach a specific type of breathing, which is, I call it Three by Three Relaxation Breathing, which is also in the Anxiety Solution Series. And it really goes over into detail, a very simple way to breathe that you can do it anywhere. You can do it in a waiting room full of people, because it's very subtle. It's not something where you're taking a big breath and people are looking at you. It's very, very subtle. You can do it anywhere. MEDITATION FOR HEALTH ANXIETY Kimberley: Ken, just so that I understand, and also Maria, how does that help someone? For someone who has struggled with breathing or is afraid of meditation hor health anxiety and they've had a bad experience, how does the breathing specifically help, even, like you were saying, in a doctor's appointment office? Maria: I've done it actually in multiple doctor's appointments where I've had that feeling of, "I've got to get out of here now." It's that feeling of, "Uh, no. Right now, I need to leave." Before, before I started, I would leave. And now I realized, no, I'm not. I'm going to sit and I'm going to breathe. And no one notices. No one can see it. You can breathe and it really does calm me down, especially in the past, I've had panic attacks and feeling like I can't breathe myself. When you start to realized that you can control it and it does relax you, it really helps me a lot. I do it all the time. Kimberley: It's like a distress tolerance tool then, would you say? Maria: It's something that I can carry around with me all the time, because everyone needs to breathe. Kimberley: Yeah. I always say that your breath is free. It's a free tool. You could take it anywhere. It's perfect. Maria: Yeah. So, it's something that I can do for myself. I can rely on my breathing. And now knowing after Ken teaching me really how to do it properly, it's just invaluable. It really is, and empowering in a way. Now, when I feel like I can't be somewhere, and in fact just not so long ago, I was in a doctor's appointment, not for myself, but I sat there and it was really high up and there was lots of windows around. Of course, I don't like being [00:22:34 inaudible]. And I felt I have to get out. "Nope, I'm not going to do it. I'm not going to do it." I sat there, I did my breathing. I actually put my earphones in and started listening to Ken's anxiety solutions and listened and took my mind off of it, and I was fine. I didn't leave. And actually, I walked away feeling empowered afterwards. So, it's huge. It's really helpful. Ken: Yeah. You just said a couple of very important things. You made a decision not to flee, so you decided right there, "I'm not going anywhere. So, I'm going to stay here. I'm going to tolerate that discomfort, but I'm going to focus on something else. I'm going to focus on my breathing. I'm going to listen to the Anxiety Solution Series." And then by doing that, I'm assuming your anxiety either was contained, it stayed the same, or maybe it was reduced. Yeah? Maria: Yeah, it was reduced. It stayed the same. And then it started to reduce. And naturally, by the end, I was like, "I'm fine. Nothing is going to happen." So, it was great. And the other-- I want to say actually one more thing that really, really helped me. And it was actually a turning point, was that I was in another appointment. The doctor came in and told me I was fine. And it was actually like an appointment where they had called me back medically. So, it was a different scenario. It wasn't me creating something in my head. But anyway, there was a lot of anticipation beforehand and he came in and he said, "You are fine. Go live your life." And I walked away and I went home. And within maybe about 40 minutes, I said, "Maybe he was lying to me. Maybe he was just trying to make me feel good because he saw how anxious I was." And at that point I realized, this is never going to stop, never. Unless I fight back, I will never-- I felt robbed of the relief that I should have felt. When he told me that, I wasn't getting that relief and I was never going to have that relief unless I used-- and at that point, I actually got angry. And I remember telling Ken, I was like, "I'm so angry because I felt robbed of the relief." And at that point, I think I then kicked up my practicing of everything tenfold. And that was a turning point for me. Ken: Yeah. That anger really helped you. And anxiety is a very, very powerful emotion, but if you can access or manufacture a different emotion, a competing emotion, and anger is just one of them, you can often mitigate the anxiety. You can push through it. And for you, it was an invaluable resource, because it was natural. You actually felt angry. For other people, they have to manufacture it and get really tough with their anxiety. But for you, you at that moment naturally felt it. And you're right. You said it is never going to stop. And physical sensations, the body is noisy. People will have the rest of their life. You're going to have a noisy body. So, that will never stop. It's your reaction and your response to those physical sensations that is key. And you learn how to respond in a much more healthy way to whenever you got any sort of trigger external or internal. TREATMENT FOR HEALTH ANXIETY/HYPOCHONDRIA Kimberley: It's really accepting that you don't have control over anxiety. So, taking control where you have it, which is over your reactions. And I agree, I've had many clients who needed to hit rock bottom for a certain amount of time and see it play out and see that the compulsions didn't work to be like, "All right, I have to do something different. This is never going to end." And I think that that insight too can be a real motivator for treatment of like, "I can't get the relief. It doesn't end up lasting and I deserve that like everybody else." So, Ken, how do you see as a clinician the differences in recovery and health anxiety treatment for different people? Do you feel like it's the same for everybody, or do you see that there are some differences depending on the person? Ken: Well, when I treat people with health anxiety, although the content of their specific fears might be different – some might worry more about their heart, some might worry more about shaking that they experience and worry about ALS – the treatment is basically the same, which is why I can treat them in classes or groups because it's basically the same. There are some variations. Some people are more worried about things, where other people feel more physical sensations. And I may have to tailor that a bit. So, some people have to-- their problems are more the physical sensations that they feel and they can't tolerate those physical sensations. And other people it's more mental. They're just constantly worried about things. But in general, they can be treated very similarly. It's learning how to tolerate both the uncertainty and the discomfort and the stress that they feel. Kimberley: Right. And I'll add, I think the only thing that I notice as a difference is some people have a lot of insight about their disorder and some don't. Some are really able to identify like, "Ah, this is totally Linda, my anxiety," or whatever you want to name your anxiety. "This is my anxiety doing this." Whereas some people I've experienced as a clinician, every single time it is cancer in their mind and they have a really hard time believing anything else. Like you said, they feel it to be true. Do you agree with that? Ken: Completely. Yeah. Some people will come to me and they know it's probably anxiety, but they're not sure. And some people, they are thoroughly convinced that they have that disease or that disorder. And even after months and months and months of-- and oftentimes the content changes. So, I have patients who, when I first start seeing them, they might be afraid of cancer. And then two months later, it's their heart. And then a couple of months later after that, it's something else. There's always something that can come up and they're always believing it's something medical. And of course, they go back to, "Well, what if this time it is? What if this time it is cancer?" And that's where they get caught in the trap. So, for them, it's answering that question. For Maria, it's the word "mostly" that she became fixated on to get lured in and take the bait. It's like, what happens to a fish that takes the bait? Now they're struggling. So, now once you take the bait, you're struggling. Kimberley: Right. And I would say, I mean, I'll personally explain. A lot of my listeners know this, but I'll share it with you guys. I have a lesion on the back of my brain that I know is there. And I have an MRI every six months. And I have a lot of clients who have a medical illness and they have health anxiety, and it's really managing, following the doctor's protocol, but not doing anything above and beyond that because it's so easy to be like, "Well, maybe I'll just schedule it a little earlier because it is there and I really should be keeping an eye on it." And that has been an interesting process for me with the medical illness to tweak the treatment there as well. Ken: Yes, absolutely. I have a patient right now and she has a legitimate heart issue that is not dangerous. They've had many, many tests, but all of a sudden, her heart will just start racing really fast, just out of the blue. And it happens randomly and seems like stress exacerbates the frequency of it. But it's not just irritating for her, it was scary because every time she would experience it, she thought, "Maybe this is it. I'm having a heart attack." But she really had to learn to tolerate that discomfort, that it was going to happen sometimes and that was okay. It happens and you just have to learn to live with it. Kimberley: Right. So, Maria, this is the question I'm most excited about asking you. Tell me now what a doctor's appointment looks like for you. Maria: It looks a lot better. You can actually pick up the phone and book an appointment now without avoiding it. I practice everything that I've learned. I'm not going to lie. The anticipation, maybe a couple of days before, is still there. However, it's really not as bad as it was before. I mean, before, I would be a complete mess before I even walked into the doctor's office. Now, I can walk in and I'm doing my breathing and I'm not asking multiple questions. I'm now okay with trusting what the doctor has to say. Whereas before, if I didn't like what he had to say or he didn't say exactly the way I wanted to hear it, I'd go to another doctor. But now, I'm okay with it. And it's still something I don't necessarily want to do. But leaps and bounds better. Leaps and bounds really. I can go in by myself, have a doctor's appointment, ask the regular questions and say, "Give me the answers," and leave and be okay with it. GETTING TEST RESULTS WITH HEALTH ANXIETY Kimberley: How do you tolerate the times between the test and the test results? How do you work through that? Because sometimes it can take a week. You know what I mean? Sometimes it's a long time. Maria: Yeah. I mean, I haven't-- so, obviously, it's yearly. So, I'm at that point next year where I will have to go and have all my tests again and get the results and anticipate. But I think for me, the biggest thing is distraction and trying not to focus too much beforehand and staying calm and relaxed. And that's really it. I mean, there's always going to be anxiety there for me, I think, going to the doctors. It's not ever going to go away. I'm okay with that. But it's learning how to keep it at a point where I can understand what they're telling me and not make it into something completely different. Ken: I think you said the keywords – where you're putting your focus. So, before, your focus was on answering those what-if questions and the catastrophic possible results. And now I think your focus is on just living your life, just going about living your life and not worrying or thinking about what the catastrophic possibilities could be. Is that accurate? Would you say it's accurate? Maria: Yeah. Because if you start going down that road of what-if, you're already entering that zone, which it is just, you're never going to get the answer that you want. And it's hard because sometimes I would sit and say to myself, "I'm going to logically think this out." And I would pretend. I mean, I even mentioned to Ken, "No, no, I'm logically thinking this out. This is what anyone would do. I'm sat there and I'm working out in my head." And he said, "You've already engaged. You've already engaged with the anxiety." "Have I?" And he said, "Yeah. By working it out in your head, you're engaging with the anxiety." And that was a breakthrough as well because I thought to myself after, "I am." I'm already wrapped up in my head logically thinking that I'm not engaging, but I'm completely engaging. So, that was an interesting turning point as well, I think. Kimberley: Amazing. You've come a long, long, long way. I'm so happy to hear that. Ken, before we wrap up, is there anything that you feel people need to know or some major points that you want to give or one key thing that they should know if they have health anxiety? Ken: Oh my gosh, there are so many. There is a tendency for people with all types of anxiety to really focus their attention on the catastrophic possibilities instead of the odds of those catastrophic possibilities happening. The odds are incredibly low. And so, if you're focusing on the fact that it's probably not likely that this is going to happen, then you'll probably go through your life and be okay if you can focus your attention on living your life. But if you focus on those catastrophic possibilities that are possible, they are, then you're going to go through life feeling very, very anxious. And if you focus on trying to prevent death, prevent suffering, then you're not really living your life. Kimberley: That's it right there. That's the phrase of the episode, I think, because I think that's the most important key part. I cannot thank you both enough for coming on. Ken: This is fun. This is great. Maria: It was fun. Kimberley: Maria, your story is so inspiring and you're so eloquent in how you shared it. I teared up twice during this episode just because I know that feeling and I just love that you've done that work. So, thank you so much for sharing. Ken: Yeah. She's really proof that someone who's suffered for 15, 20, some odd years with anxiety can get better. They just have to be really determined and really apply the strategies and be consistent. She did a great job. Kimberley: Yeah. Massive respect for you, Maria. Maria: Oh, thank you. Kimberley: Amazing. Ken, before we finish up, do you have any-- you want to share with us where people can hear from you or get access to your good stuff? Ken: Yeah. So, quietmindsolutions.com, I have a whole bunch of information on health anxiety. I have two webinars in health anxiety on that website, as well as other webinars in other specialties I have. Also, I have the Anxiety Solution Series, which is a 12-hour audio program, which focuses on all types of anxiety, including health anxiety, as well as others. And you can listen to a few chapters for free just to see if you would like it, if you could relate to it. And there's other programs, other articles, and videos that I produced. I have a coloring self-help book, which is basically a self-help for people with anxiety, but every chapter has a coloring illustration where you color. And the coloring illustration actually-- what's the word I'm looking for? It's basically a representation of what you learn in that chapter. It strengthens what you learn in that chapter. Kimberley: Cool. Ken: Yeah. And then a book called The Emetophobia Manual, which is a book for people who have fear of vomiting. Kimberley: Amazing. And we'll have all those links in the show notes for people as well. So, go to the show notes if you're interested in getting those links. Ken: Ken Goodman Therapy is the other website. It has similar information. Maria: I wanted to mention as well that I actually watched one of Ken's webinars quite by accident in the beginning before I realized I had health anxiety. And after watching it, I thought, "Oh my gosh, I've got that." And so, it was hugely, hugely helpful because I think that having this for so many years and not realizing, there's a lot of people that still don't realize that they suffer from health anxiety. For me, as soon as I could label it as something, it was a relief because now I could find the tools and the help to work on it and get that relief. Kimberley: Amazing. Okay. Well, my heart is so full. Thank you both for coming on and sharing your overcoming health anxiety story. It's really a pleasure to hear this story. So inspiring. So, thank you. Ken: Yeah. Thank you for doing this, Kimberley. Maria: Thank you. Ken: And thanks, Maria. ----- Thank you so much for listening. Before we finish up, we're going to do the review of the week. This is from kdeemo, and they said: "This podcast is a gift. I just found this podcast and I'm binging on the episodes. I learn something through each episode, and love her practical advice and tools. I feel like part of a community-what a gift!" Oh, I'm so, so grateful to have you kdeemo in our community. This is a beautiful, beautiful space. My hope is that it's different to every other podcast you listen to in that we give you a little bit of tools, a little bit of tips, but a huge degree of love and support and compassion and encouragement. So, thank you so much for your review. I love getting your reviews. It helps me to really double down in my mission here to give as many practical free tools as I can. It is true, it is a gift to be able to do that. So, if you could please leave a review, I would be so, so grateful. You can click wherever you're listening and leave a review there. Have a wonderful day.

Mar 11, 2022

SUMMARY: Many people ask me, "Why do I have anxiety?" and the truth is, there is no clear-cut answer. However, in this week's episode, I give you nine possible causes of anxiety and what you can do to manage anxiety in your daily life. Some causes are in your control, and some are not. Either way, it is important that you are super gentle with yourself as you explore some of the reasons for anxiety in your life. In This Episode: NINE possible causes of anxiety for you in your life What you can do to manage your anxiety How to overcome anxiety by changing small behaviors Reasons you experience anxiety may include Genetics Caffeine Distorted Thoughts Behaviors Trauma Environment Stress Management Lack of Tools Isolation (lack of community) Links To Things I Talk About: Time Management for Optimum Mental Health https://www.cbtschool.com/timemanagement ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 225. Welcome back, everybody. Today, we are talking about the causes of anxiety, why you are anxious and what you can do about it. This is a topic I feel like keeps coming up with my clients like, "But why? Why is this happening?" And I totally get it. Now, a lot of the times, I encourage my patients the end goal, jump straight to the end goal is we don't want to spend too much time trying to solve why we're anxious. That in and of itself can become a compulsive problematic behavior. But I wanted to just address it because I don't think I have addressed it yet in the podcast. I thought now is a good time to really just look at some of the reasons we humans are anxious. I'm an anxious person, my guess that the fact that you're listening to Your Anxiety Toolkit means you or someone you love is an anxious person. So, let's talk about why we're anxious. What are the causes of anxiety and what are some of the reasons we are anxious. Now before we do that, we want to, of course, do our "I did our hard thing" segment, and this one is for Bradley. Bradley wrote: "I was at a family event and had to see a family member I haven't seen in four years. I said a firm, no contact boundary with her since she was so toxic. And as much as I tried, I knew I could not control whether she came or not. Seeing her was very hard, but I gave myself loads of self-compassion and allowed that moment to be very difficult." Oh, Bradley, this is so good. "I was pleasant to her, but I did not engage beyond what was necessary. I took multiple moments throughout the event to check in with myself and see what my body needed." This is so good and this is such great modeling of how we can regulate and monitor ourselves, giving ourselves kindness as we do hard things. I love this. Thank you so much for sharing it. This is really super inspiring. I think we all need to practice this one a little better, myself included. I hope that that brings you some inspiration before we move on into the episode. Thank you again, Bradley, for submitting that. I love hearing the "I did a hard thing." Let's talk about why you and I, and we might be anxious. 1. Genetics Reason number one is genetics. I think that if I'm with a client and they ask me, this is usually the spiel I would give them, which is, genetically, a lot of us are set up to have anxiety. What that means is somewhere in our lineage, our parent, our grandparent, someone had anxiety and it is quite a genetic trait to have. As we go through these, I'm really wanting you, just as a side note, to think about these things, but we don't want to use these as an opportunity to blame other people. We don't want to blame, of course, our parents or our grandparents. It wasn't their fault. Obviously, they probably had it passed down from somebody else as well. But as we move through some of these, I also don't want you to displace blame onto yourself, and we can talk about that as we go. But genetics is a reason that some of us are anxious. I'll give you a little bit of a piece of my personal experience here, is I often-- I mean, I know every anxiety tool in the book and there's been many times where I've visited doctors or psychiatrists and they ask me about anxiety and I'll say, "Yes, I have anxiety." They'll say, "Well have you had therapy? Have you tried medicine?" "Yeah, I've tried all of those things and I'm highly functioning and I have a wonderful life." But I also have to accept that some degrees of anxiety are just genetic. I'm not going to get rid of them all. In fact, I don't want to get rid of all anxiety. I want to use this as an opportunity to remind you that this is not meaning that it's a list of things you now have to go and fix. Not at all. This is about just being aware of what's going on. Hopefully, at the end, we'll talk more about this, is you can then acknowledge what might be bringing the anxiety on, but then go straight to your toolkit. The tools are the most important part here –acceptance, not judgment, willingness, compassion, being mindful. Go straight back to your tools once you've listened to this podcast because that's going to be the most important piece. 2. Caffeine The second reason you might have anxiety is because of caffeine. A lot of people report that if they have too much caffeine, they get jittery and it sets off a nervous response in the body where the brain then sends out a whole bunch of anxiety hormones and chemicals in the body. Caffeine mimics anxiety, which then means that now you have more anxiety, because when you have anxiety and you experience something like it, usually, if you go, "Oh my gosh, yeah, something must be wrong," your body proceeds to send out more and more and more and more anxiety. Caffeine can be one, but I will also tag on additional one here, which is alcohol. A lot of my patients have reported that if they're drinking too much alcohol, they do feel that same jitteriness the next day, which then causes their brain to think something is wrong. Therefore, again, send out more anxiety, chemicals and hormones, something to think about. 3. Distorted Thoughts Now, the third is really important. I've done podcast episodes on this before, and it's distorted thoughts, catching your distorted thoughts. If you are at the supermarket and the man or woman next to you drops the cereal box all over the floor or they drop a can or a glass bottle, and it shatters everywhere, you are naturally going to have anxiety. Normal. Anyone would have anxiety. It's a big shock to the system. But if you then have distorted thoughts about that, like that means it's bad luck, I did something wrong, I've humiliated myself, they're going to be judging me – there are so many different distorted thoughts. I'm just using this as an example. Or another example would be you are interacting with someone at the bank and you have then following the distorted thought of like, "They are judging me. They think I'm stupid. I I didn't handle that well." Maybe you have the thought bad things are going to happen and you're catastrophizing. Those thoughts will create anxiety. Now again, if you go back and listen to those episodes back a few weeks ago, you will remember me saying, we cannot control our intrusive thoughts. I want to make that really clear. There are a lot of thoughts you are having right now that you have no control over. What I'm talking about at distorted thoughts are the thoughts on how you appraise a situation. Let's say you have a thought, let's say you have harm obsessions, and you have a thought like, "What if I wanted to hurt somebody or so forth?" That you can't control. But if then you appraise it going, "I'm a terrible person for having that thought," that's the distorted thought that you can actually work on. Those distorted thoughts can cause anxiety as well. 4. Behaviors Sometimes our behaviors can create anxiety. Avoidance is one of them. You would think that avoiding your fear makes anxiety go away. Makes sense, right? But actually, it's not true. The more you avoid things, the more you actually increase your anxiety about that thing. If you've avoided something for a very long time, let's say you avoided flying. Now, even the thought of flying is going to give you anxiety. So, behaviors can cause anxiety as well. Now, this also includes compulsive behaviors. It includes reassurance-seeking behaviors. It includes rumination in your mind, mental compulsions. Behaviors can increase the degree in how your brain responds. People pleasing, this is a big one for me. If I'm people pleasing, trying to make everybody happy, no one upset, you would think, oh, that's a good thing. You're being a kind human being. Well, yeah, except it then creates a lot of anxiety at the idea that someone doesn't like something you did or that they're upset with you about something that you did. Now, you haven't built up a tolerance to just the fact that we can't please everybody. These are ideas on how behaviors can actually cause anxiety. 5. Trauma In the mental health field today, everybody is saying everything is trauma. It's like, "You've traumatized me. I was traumatized by this." It's important that we-- and this is for another conversation, but I'm going to slide it in here. When we talk about trauma, where I'm actually talking about life-threatening trauma. Not to say that we call it little "t" trauma. There's big "T" trauma, which are life-threatening events, war, assault, witnessing a death, and so forth. There's some examples. It doesn't include all of them, but that's what we call capital "T" trauma. There are little "t" traumas. We all have little "T" traumas and they can cause anxiety. I'll give you an example. When I was a kid, we went through, in 1992 I think it was, this devastating drought. I grew up on a farm. We really needed water and the whole environment was just desperate for water and we didn't have enough water. We had to pay to have a truck bring water just so that we could have baths. It was really scary as a very young child to be afraid of not having enough water to drink. It was scary. We could call that a little "t" trauma. Still to this day, when my kids, my son just spends forever in the shower, I start to notice I get anxious when he's in there for a long time because my brain is telling me we're going to run out of water. That's an example of why you may notice some anxiety show up. Now I can correct that and remind myself that I live in times where there's no drought or that we have excess water and so forth. And that's where I check those cognitive thoughts and errors of my thinking. But the trauma itself can cause the anxiety. Again, I want us to be really careful around the word "trauma" because I don't want us to be using "trauma" about all the things, because that actually isn't good for our brains either to keep telling ourselves we were traumatized. That actually can create anxiety in and of itself. 6. Environment You all have experienced this. Even though I don't know you and your beautiful face, this you would have experienced in the last few years – the environment of COVID creates anxiety. Seeing people with the mask at the beginning of COVID, I'm guessing you would've had a bout of anxiety. Being around loud noises can create anxiety. Being in countries or regions where there are discord, conflict, war, they can create anxiety. Being in an abusive household, the environment of abusive household can create, of course, anxiety. Having someone around you who yells a lot and screams and throws things can create anxiety. There we're going into the line again of trauma, but we want to consider environment. 7. Stress Management A big one for right now as well. If you have an incredible amount of stress on your plate, you will naturally have anxiety. If this is you, I'm going to encourage you to consider taking some of the stress off your plate, if possible. I know it's hard. Some of you have double jobs and family and chronic illnesses and medical, mental illnesses. It's hard. But anywhere you can, ask yourself, is there a way I can make this easier or simpler so that I can reduce my stress? 8. Lack of Tools Now this is a big one for me because I get really grumpy and cross. That's an Australian term for everyone who is an Australian. When you say you're cross, it means you're angry or very grumpy about something. I get really cross when people who claim to be anxiety specialists give these strategies that actually make anxiety worse. Sometimes people do have generalized anxiety, but the tools they've been given can actually make it worse. Telling people just to use oils – oils are fine. I have nothing wrong with oils. I actually, PS, love oil. But if that's your only skill and only tool that you have and your only agenda for recovery, that's not going to help. It's actually going to create more anxiety because you're going to keep getting frustrated on why it's not working. If your only tool is to, again, another gripe I have that makes me very cross – ah, so funny that I get so upset about it – is people who talk about thought-stopping, like just think about a big red stop sign. That is not a helpful tool. Sometimes it works for some people. But if you have a repetitive intrusive thought, that is not going to work. It's actually going to make your anxiety worse. Lack of tools is an important one. I'm even going to say be critical, even of me when I'm giving tools. Really stop and ask yourself, does this work for me? Because I don't know each and every one of you and all the intricacies of what's going on for you psychologically. Always stop and ask yourself, is this helpful? I like to give you as many science-based tools as I can. I try not to just decide of a strategy that I use and just use it. But I want you to be really critical of everybody. Be very wise in your selection of who you choose to get advice from. That's just a little piece to think about. Like I said, I always say this, take what you need and leave the rest if it's not helpful. 9. Isolation The last one is important. It's not last for any specific reason, but it's isolation. If you are in isolation for too long, meaning that you're alone, you don't have community, you don't have connection, your brain will naturally get anxious. Sometimes people love isolation. I myself love isolation and quiet and to be by myself. Oh, it's so good. I just love it. I just can sit and be still. It's good for some people, but too much isolation, prolonged periods of isolation often can cause anxiety, because we are community humans. Humans are built on community and tribe and needing each other. That goes back thousands, millions of years. For those who are struggling, they're like, "Everything's fine. I don't know why, I'm in my safe house." It's like, "Well, when's the last time you saw somebody?" "Oh, it was months ago." "Okay, well, that makes sense. You haven't had any of that." There is some science to showing that your parasympathetic nervous system slows down when you're in connection and even physical touch with somebody. That's just something to think about as well. There you have it. Those are the nine reasons, 10 if we include alcohol. They're the reasons that you might feel anxiety in your life or in your lifetime. I hope that this brings you some insight and you had a few aha moments about maybe why your anxiety is showing up again. I promised I would say at the end, this is not to say that now you have to go and fix all of those nine things. Actually, quite the opposite. We don't fix anxiety. In fact, the more ideal option would be to practice befriending and allowing and not judging anxiety. But if this is helpful for you to maybe make some tweaks in your life, change your distorted thoughts, reduce your caffeine, manage your stress, change your environment, get some connection, get some helpful tools, that would make me so, so happy. Before we finish up, we are going to do the review of the week. This one is from Tennessee Lana. She said: "Game changer. I found this podcast four years ago and it has been monumental in my anxiety and OCD recovery. Many podcasts led to new content that I could follow and learn. I could write about this and never stop but instead I'll leave a few adjectives that I think adequately describe this podcast. Kind, insightful, intelligent, easy, interesting, practical, helpful, uplifting, and LOVING." Oh my goodness, Tennessee Lana, do you know the word I love the most? Practical. If I can be practical in helping you, I feel like I am winning in my career. All of those adjectives make me so overjoyed, but I love these. Actually, Tennessee Lana, I'm going to steal them from you. Copy and paste them. Maybe put them on my desktop just to remind me of the goals of the podcast. Love it. I hope you found this helpful. Have a wonderful day. Please go to leave a review if you can. Those reviews allow me to reach more people from people who trust the show, which is key. If someone can see that other people are enjoying it, that means they can trust us quickly, which is the goal. And then from there, I hope that this episode was helpful and gave you some insights. All right. I will see you next week. Have a wonderful day.

Mar 4, 2022

SUMMARY: In today's podcast episode, we have Dean Stott from DLC Anxiety talking about his experience with Panic Disorder and Overcoming Panic Disorder. In his upcoming book, Greater Than Panic, Dean talks about what it was like for him to experience agoraphobia, panic disorder, and other struggles after the death of his father. Dean spread an inspiring story about overcoming panic and how he is Greater than Panic. In This Episode: What it was like for Dean Stott to have Panic Disorder How he overcame panic disorder using CBT and Mindfulness How Dean created DLC Anxiety, an online platform that helps millions with panic, anxiety and other mental illnesses. Tools that he found helpful to manage his Panic Disorder while also grieving the loss of his father. Links To Things I Talk About: DEANS BOOK GREATER THAN PANIC Amazon link Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 224. Welcome back, everybody. We have an amazing guest, a very, very sweet friend of mine. I am so excited to have on with us Dean Stott from DLC Anxiety. He is a true legend. Dean is on the episode today to tell his story about going from having a fairly severe panic disorder to then creating a mental health platform with over 1 million followers. He's now all about creating mental health awareness sharing with people. He's such a cool human being. And I'm so honored to have him on today. We talk about his recovery, which you will get a lot of hope from because, like everyone who comes on the podcast, he really did the work, which is so cool. But then we also talk about the role that social media can play in mental health recovery, things to look out for, how to handle trolls, the benefits of being online, especially social media. If you have a mental illness, we go through it all. And it's such a great episode. So, I'm so excited to have Dean on today. Before we get into the episode, I want to give you the "I did a hard thing" for the week. This is from Nicole, from the Netherlands, and she said: "I did a hard thing and I get very anxious when I have to call my doctor. My heart rate goes up and I get all trembly. So, I tend to avoid calling the doctor. But because I had been feeling dizzy, I had to get my blood checked. Afterwards I would have to call the doctors for the results, except I didn't. I told myself if there was anything serious, surely they would call me. I kept this up for almost two weeks and then I suddenly thought I really should call for the result. So I pushed in the numbers to the doctor's office, feeling all kinds of nervous. I was very tempted to just hang up. While I was waiting, I thought, why did I do this? What if I get bad news? But then I had another thought, if it's bad news, all the more reason to hear it. So I hung on and I faced my fears. Turns out I have a vitamin D deficiency. It's not very worrisome, but important to fix. I'm so glad I phoned the doctor, even though I REALLY DIDN'T WANT TO. Nicole from the Netherlands." Nichole, I love this story. And the thing I love the most, and for those of you who want to submit for this, please do go. I'll leave a link in the show notes. But Nicole, I love that you detailed what got you to do it, how you did it, what thoughts you had to shift up to get yourself to do the hard thing. You walked us through step by step and it makes my heart want to explode with joy. Thank you so much for sharing it. Amazing, amazing, amazing, amazing, amazing work. I am so, so impressed. So, thank you, Nicole. I love it. Let's get over to the show where we can hear all about Dean's recovery. ----- Kimberley: Welcome, Dean. I am so happy to have more-- actually, as much as I'm happy to have you on the podcast, I'm just happy to have chats with you. Welcome. Dean: Thank you so much. Thank you for inviting me, Kim. Kimberley: Yeah. So, I feel like I know you and your story pretty well. But I would love for you to share your story with my listeners because I think you have some really great stuff to share. So, can you share whatever you're comfortable about your recovery? Dean: Yeah, sure. So, basically, once upon a time, I was going through a panic disorder. So, dealing with four panic attacks, maybe four or five panic attacks every single day, where I get the worst period. And yeah, I went through a panic disorder, did my own research, a lot of science research, CBT research, mindfulness meditation, and curated my own plan out of recovery with the guidance of a really good support network, friends, and mentors, who'd been through an anxiety disorder and come out the other side and fully recovered from the panic disorder. I then wanted to take that feeling of the support that I was given from my older mentor, the friend that had been through it. I wanted to share that with as many people as I possibly could. So, I came up with DLC Anxiety. So, at first, I remember sitting down and I was like, "How can I get this message out to as many people as possible?" And I was thinking of local support community groups, like the Alcoholic Anonymous groups where people go and it's a supportive network between each other. But then I was just so eager to try and get it even more on a global stage. And I saw what Instagram does and I just thought it would fit nicely in there, because I did see that there wasn't many mental health communities when I first started. So, I thought there was definitely a nice place for it to fit there. So, yeah, I started to tell my story on Instagram. People started to relate, and it was a snowball effect from there. And now we're over a million followers in the community, which is fantastic. Kimberley: So cool. So, I think that the whole concept here is really to look at what-- let me backtrack a little bit. So, in your recovery, did you do it all on your own? Did you have a therapist? What was that process like for you? Dean: Yeah. So, my father passed away. Like any people, any male in that situation, I bottled up the feelings that I was going through and tried to carry on with going to work and trying to get back into my daily routine. Almost putting it to the back of my mind because I wasn't-- well, I didn't have the techniques to cope with that and I'd never cope with loss before. So, it was from that bottling up of the grief that the panic attacks started and occurred. So, when I first started having panic attacks, the first thing I did was go to the doctors who then referred me onto a grief counselor, but just specifically to address the grief side of things and not the anxiety, not the panic attacks. Regarding the anxiety and panic attacks, that was me curating, delving into a lot of psychoeducation, which I found very useful, learning about the system and the symptoms of anxiety. Now I'd done Psychology at university and done CBT before. So, it is like not I'd never--I knew the basic concepts of anxiety, but learning more about it and learning about the scary symptoms where you think-- firstly, when you have a panic attack, you really think that you're going to die. It's a really, really scary thing to go through. And yeah, to start learning about that was super important for my recovery. Kimberley: Right. And so, let's talk about community, why do you feel the community aspect was so important for you? Tell me about the idea of creating a mental health community for someone, let's say, who's suffering with panic disorder or grief or OCD or anxiety. What's your thoughts on that? Dean: Yeah. So, when I was going through panic disorder, I felt isolated, I felt alone, and really, I didn't really want to bring it up to people around me because I just didn't think they'd be able to relate to me. I thought these symptoms was just something that I was going through and something that I'd have to stick with for the rest of my life. I thought that was me, that I was going to be Dean who has these panic attacks. And I was going to have to navigate my way through my daily routine. And I think when I opened up to my mentor, a close friend of mine, who was working with me at the time – when I opened up and he shared his experience, it was the biggest weight off my shoulders, knowing that someone else had been through not the exact same story, but it experienced all these scary symptoms that felt isolated, felt alone, but more importantly overcome an anxiety disorder. And I think it was that inspiration and motivation that really helped me in my recovery. So, yeah, having an important-- so, DLC is Dean's Like-Minded Community. So, it's a community full of like-minded people on anxiety recovery journeys. Some people are at the end, like myself, I don't deal with panic attacks anymore, but some people are at the start, some people are in the middle. And they can all relate to each other no matter where they are on that journey. And then what's beautiful about the community is where you see them sharing tips and experiences that work for them. And I know you speak about it highly as well, having an anxiety toolkit, because some tools might work for one person, but then might not work for another. But I think it's very important to get as much information out there about all the different range of tools, so then each person can individualize their own recovery. Kimberley: Yeah. So important more now than ever, I think, given that the degree of mental illness is so high given COVID and isolation and everything. Okay. So, you have this platform. I love it. Very much, I loved being a part of your community. Why do you think that that is the most important piece, the community aspect? Can you share a little bit about what you see and hear from your community and why that's so important? Dean: Yeah. So, again, so many DMs from people saying that they just feel connected. They feel hope, they feel inspiration, they feel motivation. Not only for me, who's at the head or the founder of the community, but of all these people that are going through it, jumping over a million people worldwide. We know mental health. It doesn't have a face, it doesn't have a color, doesn't have a social structure, it doesn't matter what you're working as it can affect anyone. And I think that's why it's really important and became an integral part of the community, was the interview series that I started doing with firstly mental health professionals from around the world. So, CBT professionals like yourself, Kim. Then we've had psychiatrists, psychologists, doctors. And having just as much information about anxiety and anxiety recovery, I think has been a super important part. So, again, it's not only having this community, it's having the psychoeducation and real good-- I'm in a real good place now where I can guest on who I've joined a world-renowned within the space of anxiety. And also, we've had so many celebrities, musicians, actors, actresses come on and tell their own mental health stories where they struggled or where they've been vulnerable. And that's really related to the community as well. Because obviously, people work at celebrities, people work at musicians and they might not know that just too, they're going through a mental health disorder. So, yeah, having people like that come on and tell their own stories has been super, super beneficial for everyone as well. Kimberley: Yeah. See, the cool thing is that the science, this is why I'm really fascinated in, is the science of self-compassion says that there are three components of self-compassion. One being mindfulness, the second being common humanity in that reminding yourself that you're not alone in your struggles is the second most important part of self-compassion. The third being self-kindness. Now the reason I love this is I know for myself in the areas that I struggle, if I look at an account and I can see that a million people follow a mental health account, it gives me a sense of common humanity that there are a million people struggling with something. If you see an OCD account and it's got 60,000 followers, you're like, oh my God, that's a lot of people. I must not be alone in my struggle or an eating disorder account. Or I love some of the autism accounts. I think it shows that it gives you permission to see that you're not alone. And I love that. It's such a beautiful piece of the work. Dean: Yeah. And especially where you just mentioned self-kindness as well. I think that's an important subject just to speak about, is that when you're going through an anxiety disorder, you have this inner critic that's telling you that you're never going to come out of it, that you're not good enough, that maybe this is happening to you for a reason. When you come across these communities of people who are on their own journey of recovery might be a little a few more steps ahead than you, and you see that they have a positive outlook, some of them, on recovery and they are making steps. I think knowing to change that in a narrative and have that self-love and compassion is super important when it comes to anxiety disorders. Kimberley: Yeah. And that's the benefit of social media right there. I think social media gets a really bad rep, but we have to weigh the pros and cons because there are lots of pros, right? Dean: Yeah, no, 100%. What I'd say is this is how I define it, is that if we just take Instagram and our mental health community so all the mental health accounts that are doing great, I see just like a safe haven corner of Instagram where people can go to and feel supported and connected and learn more about mental health in general. An app, like you say, can have a negative effect on people. And I think people speak about the algorithm and obviously, it's all guessing what the algorithm's going to do next, but I think we can actually use the algorithm in our favor. And if you just bear with me on this, if you think about all the accounts that you're following, so if you're following all positive mental health accounts or self-compassion or self-care, self-love, then the algorithms are going to spew that out to you in your own feed. So, what are you doing? You're starting to change that in a narrative like in your digital world, because you open up your app and you start to see all this self-love and positivity. So, you can definitely use the algorithm. So, I think it's super important in taking a look at who you're following and seeing, does that benefit your mental health? And if it doesn't, then I don't think you should be following them. Kimberley: Yeah, I agree. Actually, I just was saying yesterday that I was just scrolling my-- I'm rarely on social media just to scroll. I'm usually there to do the work I do. My son was sick. I was sitting there wasting time. But the cool thing is the suggested was all cool stuff. It was really cool. I was like, "Oh, I love all these new ideas and these new looks." And I was really appreciating what was being suggested to me, even though I know there's some controversy around that. It was very cool. Dean: And you can imagine if somebody's just starting or at the beginning of anxiety disorder and they've got this negative outlook and they're isolated and they haven't connected, then the algorithm may be spewing them not the right information. So, I think it's important to really highlight the best we can our corner of Instagram, this mental health community that's doing so great. And it's a new wave of mental health support really and much needed, like you say, with COVID and everything that everyone's still going through. I think over the next five, 10 years, it's going to be more needed than ever. Kimberley: Right. Absolutely. I can't agree more. I don't even think we have the stats yet on what mental illness is like from COVID, mostly the isolation of COVID. So, I 100% agree. So, let's step outside of the online world and let's talk generally, how did you find this community? Not the online community, but as you were going through recovery, did you tell them about your struggles? Did they come to you? How would you suggest people tell somebody about their struggles? Do you have any thoughts on that? Dean: Yeah. So, my body and my mind and everything was telling me not to open up about anxiety and not to speak to anyone and to keep it as an inner struggle, because everything with anxiety, we know it's all internal, it's all inwards. We're ruminating on our thoughts, feelings, and sensations. So, it doesn't make sense to then speak to other people. It's not natural to do that. So, I had to go against that and I just started to open up and not feel ashamed to tell people what I was going through. I think I got to a point where it felt like I was struggling too much for me to be going through it, so I felt like I had to. So, my advice to people would be, speak to the people around you, have a support network. You may come across people who dismiss your anxiety [00:15:20 inaudible]. And it's super important to know that just because they dismiss it doesn't mean anything. It's just, they may be their views. They might not have the education on mental health. So, yeah, if you get dismissed, that shouldn't stop you from opening up, because I know that people often, especially in my community, say, "Well, I feel like I can't tell people because if I tell my parents, for example, they just tell me to continue to get on with it that I don't have these issues." So, I think that when that happens and you have parents and it's important to put mental health boundaries in place, obviously, especially if we're living with our parents, we can't just move out or whatever or if we're young. So, we have to put these boundaries in place and have a support network around us. So, if you are younger, it could be someone in your education system, it could be a support worker, or it could be the online communities like we mentioned. Kimberley: Yeah. That's interesting because what's been on my mind lately, particularly in the online space, is what to do when you have been dismissed. Now that happens from parents and loved ones. But I think it does happen on social media as well, right? You will have-- the message I've been trying to give is, if it's helpful, take it. And if it's not helpful, leave it. Because a lot of people will come to my platform and say, "I'm freaking out because I just read this, which goes against what you're saying. And I don't know who to believe." And they're doing the best they can with what they've got. So, I think that it's important for people, even on the online, to also dismiss bad advice online, right? Dean: Yeah, definitely. So many people get dismissed online, don't they? But I think you gave some great advice, Kim. And that was, anybody can write anything on social media doesn't mean that it's true, does it? So, we need to take in what someone's saying to us, but if it doesn't fit our way of thinking or it doesn't benefit us, then it's okay to reject it. Just like if we think of anxiety and thoughts and you get these irrational thoughts. We get this irrational thought and we don't believe it. What do we do? We don't accept it. We can reject and replace it. And that's what we should do with the information around us. So, if we see a negative comment towards us, it's so easy, isn't it? It is so natural for us to react in a negative way because that's the way we're built. You know what I mean? It's our protective system there to try and protect us. But yeah, if it's not benefiting you, then it's okay to step away and move away from it. Kimberley: Okay. So, let's talk about the dreaded trolls because that's the perfect segue. So, what I would love for you and I to talk about, and if it's okay, be as open as you can, but let's talk about the mental impact of having a troll, because I think you could have a bully at school and you could have a bully for a boss or you could have a bully online. And I think it's similar in how we can internalize it. So, I have had a troll for over a year now who's pretty aggressive. And most of my people know aggressive and awful. And in the beginning, I took it completely personally, right? Completely personally. I thought everyone was just going to hate me. And it was the most-- you know the whole thing about you have to break something to put it back together the right way? Dean: Uh-hmm. Kimberley: That's how it felt for me, because obviously, I had built my platform and what I do, my businesses on this idea that if I just do good and I'm kind all the time, no one will ever hate me. It's impossible to hate me if I'm kind. I think it was this belief system that I had. And that got shattered into millions of pieces because there were people who really didn't like me. And so, I think that I'm glad it broke and it got shattered because I got to put it back properly of I had to restructure that belief. But that was really, really hard. And having someone online say things, such horrible things, I really, really had a difficult time of not taking it personally. So, can you share what your experience of online trolls and that kind of thing has been? Dean: Yeah, sure. So, with the DLC Anxiety community, especially when the first lockdown happened and we had the celebrities and musicians, they all started to gain control back of their own social media accounts. So, we saw a lot of celebrities sharing mental health stuff, which is amazing because it's shining a big light on everything to do with mental health. So, I saw an exponential growth within that period of the community. And yeah, I remembered it was on either speaking on interviews with people or just on lives. Again, your mind zones in. Doesn't matter how many positive messages you see on your Instagram lives, for example. It's only natural if you see one negative comment for your mind to then just zone in on that. And I remember the first time that happened to me. I was really taken back because I was putting 23, out of 24 hours into being in this community and helping the best I can, sharing a very vulnerable story to do with my father passing and then an anxiety disorder. And I thought I was being vulnerable and open and honest, and like you say, just trying to give as much love and support for people as I could. And then to see that someone else, some people were being negative towards this, it was dismay. I couldn't believe it. It didn't feel real. It was like, "Why are they saying negative things towards me?" So, it was definitely a learning curve. I always remember the first time that happened. Over time, it has got better. Like you say, you managed to structure and rearrange things and you managed to not take these things personally and look from the outside, that the people that are spreading hate or being negative, they may be hurting themselves. My take on it now, Kim, is that even if these people are spreading hate and being horrible on my community, especially towards me, is that hopefully, they may get some good out of one of the other interviews with someone else, because I know that these people, they're in need of mental health support themselves. And for whatever reason, they haven't been able to get it. And I always think that if they're giving me hate, I can now take it. And hopefully, they might see something that benefits them. But it has been very hard to change my perspective on that. It was not an easy road. Kimberley: Yeah. That's hard for me. I think on my end, I just had to keep reminding myself that, well, all the words are about me, it's really not about me. It's a lot about them and their struggle. The way I work through it-- and maybe you could tell me what you think as you see the troll, like how do you think about it. For me, when I see really awful, hurtful, hard comments, I first remind myself, this person had to suffer a great, great deal to be spreading this much hate. To understand that they had to-- no one who's had a really easy life is jumping onto the internet and spending hours spreading hate on people. It's usually that they've been through an immense. And that was really helpful for me, compassion-wise, of just to be like, "I actually have compassion for you. You've obviously been through the wringer." And then the second piece for me, and this was the hard part and I'm curious, I really want to know your thought, was to start to trust that people will trust me, that people will see the real me, not me that that person is saying I am by me being consistent and showing up as me. And that was a hard piece because, at the beginning, I was like, "But what if they don't trust me?" The consistency has been really helpful for me. But I think the truth is, that has also been really helpful for me to translate it into the real world. Dean: I was just going to say, yeah, because if your inner critic, like you say, is wanting for everyone to relate to everything that you're putting out there, all the amazing stuff that you're putting out there, the last thing you want is somebody trying to discredit that because, you know what I mean? All we're trying to do is help the people around us. So, yeah, it's that inner critic and working on our inner ourselves. When I see a troll online now, I just tend to leave them be. I think just leave them to do what they want. I think we know that our communities know what we're about. They know how much we give to our communities, they know how much support and wealth that we give everyone on a continuous day. And like you said, you can't stop these people, but also, just because they're writing something, it doesn't mean that it's true, which I thought was beautiful for you to say. Kimberley: Yeah. It's tough. I mean, I think that that is a huge part of our mental wellness, is how we relate to people, right? And we're in relationships. So, even if we've got a panic disorder, I was thinking about this the other day, is we've had a really, really rough house here in the Quinlan house this week. It's been pretty chaotic, lots of sickness, lots of scary COVID scares, and so forth. And there was a time where I would've lashed out because of my own anxiety. I would've been really snarky to my husband because he goes to work and he doesn't have to handle it. And I would often displace my anxiety and anger, just snotty. And that happens a lot. I hear a lot of people talking about just in daily life like, "I'm really struggling because my partner and I aren't getting along because everyone's anxious and so forth." So, I think it is helpful to be in relationship with people who do have their own struggles. Like I said, it happens online, but it's also happening at home. Dean: Yeah. It can just happen on a day-to-day basis. A lot of people say that they can't deal with people when they're being negative towards them in real life. But it's about taking a step back and knowing that the person who's spreading that negativity towards you, that maybe they're having a really rough time at home with their partner, that maybe they've got troubles with their job, money. It could be anything. Maybe they were traveling to work and they got caught up. And we're all a product of our emotions at that time. And emotions, as we know, they come and go and it doesn't curate who we are as a person. So, if someone's being angry towards you and negative towards you, it's about taking a step back and knowing that it's more on them again and it's more on what their experience and the feelings and emotions and putting the correct boundaries in place. But it is really hard to do. I'm not saying that it's easy to do. It is super, super hard, especially when someone's coming at you with negativity. Your first line of defense is, you know what I mean, to attack normally, isn't it? Or to take a massive step back. So, yeah, it takes a lot of practice, but it can be done. Kimberley: So, talk to me about, you're probably the one person who would know the answer to this, can you share with us about managing mental illness with social media? How might someone have a healthy relationship with social media and the use of social media? Dean: Yeah. I have to put boundaries in myself because I say everything that I do is on Instagram, 99% of it. And if I'm not working on Instagram, I'm working on my website, which again is online. So, yeah, putting boundaries in place is super important, having rest away from social media, what we mentioned earlier about following accounts that really benefit you and have a positive impact on you and just getting rid of the negative accounts that are not making you feel good. You don't want to go onto social media and not feel good because we all know we spend way too much time on social media. And if we're spending that time looking at negativity, then that's what it's going to do. It's going to put our mood in that sense. And we could really spiral into a state of being in a negative state just by what we consume. It's like when people speak about the news and say, "Oh, well, I can't watch that because it affects my mental health." Social media is exactly the same, but probably more so, because we're spending more time on it and it's literally part of who we are now. Kimberley: Right. What would you say to someone who uses social media to cope with their anxiety, meaning to distract against it or to get them through their panic? Do you have any thoughts on managing it for anxiety? Dean: Yeah. It's a very good question. So, I always go back to thinking, at the start of my panic disorder, if there were communities like ours out there, would it have been beneficial for me? And the number one answer is yes, 100%. It would've been an eye-opener. I would've felt I wasn't alone. I would've felt motivated and encouraged that I can continue. But if you're using anxiety communities as a way to not do the hard work, then I think it can be detrimental. I think anxiety recovery is about doing the hard work. Now, a lot of people, and I've just done a post on this, unfortunately can't have the access towards therapy, which we know has a massive benefit on mental health. We speak about anxiety, the latest sciences, the medication and a combination with CBT therapy has the best results. Now, that doesn't mean for everyone, but some people may do better with medication, some people may do better with therapy. So, I think that having a community to help you and understand the psychoeducation behind it is great. But if you're using it as a distraction to try and distract you from feeling anxious and dealing with the anxiety head-on, that's when it can become detrimental. I often say that there's so much information-- and you can obviously maybe shine away on this, Kim, but what would you say to people who say that they can't access therapy? Maybe it's a money thing. Maybe it could be anything, couldn't it? Do you believe that these people can still recover? Because there seems to be a narrative online that therapy is the only way forward. I think that's an unhealthy way of looking at it because we know that anxiety recovery, there's so many different routes out of it, and it all leads to the same angle, doesn't it? Which is anxiety recovery. So, what would you say to the people that can't access therapy? Would you be still giving them hope? Kimberley: Well, to be honest with you, 1000% I would give hope. I myself have had therapy for some things, but I really didn't feel like therapy for other issues were helpful. And I felt it was better for me to actually work through a workbook, listen to a ton of podcasts. I'm a real mix. I've been blessed and privileged to have some amazing therapy, but some of my mental illness, I really needed to do on my own. But I did them through, like I said, a workbook, a support group, some were online courses. I mean, that's why I created ERP School, was because people didn't have-- that we're turning them away to nothing. But what was really interesting about ERP School and CBT School is just recently, out of the blue, a bunch of people have reached out to me and said, "I wanted just to let you know that that got me right back on my feet." It's so wonderful to hear those stories, because otherwise, you'd don't know them and you didn't realize what an impact. So, no, I absolutely believe, I'm a real big believer in workbooks. I struggled with workaholism and that workbook for workaholism was huge for me and perfectionism. These are two really, really important things that I use that did not require therapy at all. Dean: Yeah. So, like you, Kim, I like to be guided by the science. So, I know obviously how important therapy and how life-changing it can be for some people with anxiety. But also, I think there's still a lot of stigma around medication when it comes to anxiety, especially online. And yeah, I think we need to do a little bit more work on that because I think anxiety medication is being dismissed more so. Maybe that's another conversation that we can have in the future. But I didn't go through therapy with my own anxiety disorder, with the panic attacks. Mine was going online. I think you have to go to a trusted site. So, over here, you have the National Health Service, which has a ton of resources, all scientific, proven, all credible from the correct sources. And I think if you're researching and looking at all the correct things, I think that can be really powerful for you. So, if you can't access therapy, of course, there's still hope. Of course, you can still recover. And that my message to everyone is I did it. So, if I can, I'm just a regular guy, you can do it too. Kimberley: I love that. Just because I know, and thinking of the person listening here, like how did you do it? I know we haven't got a ton of time, but could you just say, how did you muster up the courage on your own to face your fears? Dean: That's a great question. And I do have my book coming out, which is-- Kimberley: All right. Dean: Yeah. So, the book is called Greater Than Panic . It's the number one question that I've been asked since day one of starting out the anxiety community, and that was, what is your story and how did you get from four panic attacks a day to be in the head of DLC Anxiety and be in the face of the interviews and not having panic attacks? Obviously, I'm still having anxiety. That's a message that I think isn't hammered home enough, whereas the goal of anxiety recovery is not never to feel anxious again. I think people often are misguided and have misinformation, especially at the start of an anxiety disorder, thinking that the goal is to never feel anxious again. The goal is to change your behavior to when you're feeling anxious and make sure that it doesn't have a detrimental impact on your day-to-day. I go right back to the basics. I go back to speaking about my father's death, which was obviously a really terrible time, and it brought out a lot of emotions but also, I think it was important for me to go back and just explore it again. And I speak about my relationship with the doctor. It's again another message that I like to hit home, is that if you're dealing with any physical symptoms to do with emotional symptoms, to do with anxiety, your first port of call has to be the doctor, because we know that anxiety disorders can mimic other things. And so, it's super important for a medical professional, a GP, a doctor, to run diagnostic tests to make sure that everything else is okay. And then when they tell you that it is okay, you can sit down with the doctor and you can start to plan your journey of recovery, which may be therapy, maybe self-help, maybe meditation, mindfulness, exercise, medication, so many different routes. But yeah, my number one message is, if you're dealing with physical symptoms and you haven't had them checked out, you have to go to the doctor. So, I speak about my relationship with the doctor. I speak about curating my own anxiety toolkits. So, what worked for me and the research and the science behind each thing that I was trying and how it had a benefit impact for me. And I speak about exposure therapy and how that was really beneficial for me, but doing it not guided by your therapist. Now, if you look at the science, you would say that the best effects of exposure therapy is guided with a therapist, but I didn't personally have a therapist in my journey. But if you can have a therapist, I definitely recommend that that's the best route to go down. But I speak about how exposure therapy worked for me and I speak about the hiccups on that road to recovery and what recovery looked like, what it meant to me. And then I speak about the anxiety community and how I wanted to spread the message and get that message across to as many people as I possibly can. And yeah, it takes me to the present day. Kimberley: I can't wait. That's so exciting. So, tell me about the name of the book. Dean: Greater Than Panic . So, that's the message that you are greater than panic. Just because you have feelings of panic, if you're up in panic attacks or panic disorders, it doesn't mean that you're broken, it doesn't mean that you can't be fixed. There's nothing to fix because you're not broken. So, you are greater than panic at all life, things, all the dreams, aspirations, careers, travel, love, money, whatever it is that you want, you can get. Doesn't matter that you're going through panic or have panic attacks. O if you've been through panic disorder, the other message is that you're greater than panic. Kimberley: Amazing. Okay. So, I'm going to leave you. I feel like that's the perfect way for us to end out. Is there anything else you want to share with us, any links, or how people can hear about you? Dean: Just DLC Anxiety over on Instagram and the website, www.dlcanxiety.com. I'd just like to thank you, Kim, for obviously inviting me on here. And I'd like to thank you for everything that you're doing in the mental health space. CBT is super important to me. It's an integral part to my recovery. And yeah, I'm just super grateful for our connection on Instagram and just everything that you're doing. Kimberley: Thank you. I feel so blessed that we randomly got to meet. You know what, it's such a blessing. So, thank you. I'm so grateful. Dean: Thank you. ----- Thank you so much for listening. I'm sure you got so much from that. Before we finish up, let's do the review of the week. This is from Disc Golf Nate. They gave five stars and they said: "As Kimberly would say, this is not necessarily a substitute for in-person therapy. But it is still a very powerful tool. I've used this podcast in conjunction with my therapist and some books, but this podcast brings me the most peace." Thank you so much, Disc Golf Nate. I am so honored for that amazing review. And yes, this should not substitute therapy, but my hope is it gives you some tools, some skills, some hope, some support, some joy, and compassion into your recovery. So, I'm so honored to have this time with you. I will see you all next week.

Feb 25, 2022

SUMMARY: We all know that self-compassion is am important tool for anxiety recovery. In this weeks episode of Your Anxiety Toolkit podcast, I address a common concern; "What if I dont deserve self-compassion?" This is such a common reason people do not provide themselves with compassion. In this episode, review the reasons YOU DO DESERVE SELF-COMPASSION and some key concepts and self-compassion mediations to help you practice self-compassion. In This Episode, we cover: Self-Compassion Definition Reasons people feel they do not deserve self-compassion Ways to manage feeling unworthy of self-compassion How to practice Mindful Self-Compassion Links To Things I Talk About: Self-compassion Mediation: Here is a link to several self-compassion meditations from previous episodes. https://kimberleyquinlan-lmft.com/episode-2-lovingkindness-meditation/ https://kimberleyquinlan-lmft.com/ep-134-giving-and-receiving-meditation/ https://kimberleyquinlan-lmft.com/ep-110-this-compassion-practice-tonglen-meditation-for-anxiety-will-change-your-life/ Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 223. Welcome back, everybody. It is a joy to be with you again. Thank you so much for being here with me. Thank you so much for putting aside your valuable time to spend it with me. I feel so honored. Today, we are talking about a question. And in effort for us to respond to this question, we're actually going to ask ourselves some questions and I'm going to have some questions for you, and you're going to think about them, hopefully, and then make some changes if you think that is what you need. The big question of the week is: What if I do not deserve self-compassion? Now, one of the most common questions I get is this question, particularly when I'm with patients and we're discussing the idea of practicing self-compassion or kindness towards themselves. Often, that is a question they ask, what if I don't deserve it, or they may even make a statement like, "I don't deserve self-compassion." Now, this is particularly true for those who are very self-critical and blame themselves for certain things that have happened either to them or that they have done. Like I'm saying, it's like things that were accidental, things that they didn't have control over, or maybe some things and mistakes that they did make. This is a really important question for us to explore. I'm going to hopefully get to explore it with you. Before we do that, I would like to do the "I did a hard thing" for the week. This one is from Sophia. Thank you, Sophia, for writing in and telling us your hard thing. Sophia said: "I suffered from OCD starting when I was 19. My hard thing I did was I reported my stepfather in for sexual abuse that occurred when I was nine when I found out I wasn't the last victim. It took me 28 years to get to this place. And let me tell you, OCD really played into my intrusive thoughts. It made the process so much harder. But I did it and I feel like I'm out of the web of manipulation from my stepdad. This podcast helps so much and the book for self-compassion and fear workbook my OCD therapist recommended to me. I saw your podcast listed in the first few pages. Thank you for being a part of my support system without even knowing." Wow, that was an amazing "I did a hard thing." Thank you so much, Sophia, for sharing that amazing hard thing. You are showing up and facing fear and pulling your shoulders back and living your life according to your values. That is impressive. I'm so honored to have you share that with us and really do wish you the best. You are doing amazing things. Okay. So, let's move into the bulk of the podcast in terms of let's talk about what if I don't deserve self-compassion. This is so important. I'm going to first pose to you the first question I have for you, which is, who actually deserves self-compassion? If someone says to me, "Well, I don't deserve it." I'll say, "Well, who does? What do you have to do to be warranted of compassion? Who does deserve it?" I really pose this question. I really hope you answer it. I would like actually you to sit down and ask yourself, "Well, then who does?" And you will begin to see very quickly, I'm guessing, the rules in which you have for yourself that keep you stuck. Oh, the people who don't have these thoughts, the people who don't make mistakes, the people who are perfect, the people who look like they're happy and are doing well. Or often people will say, "Everybody else is off the hook. It's just, I'm not off the hook. Everyone else can be imperfect, mistake makers, but not me." You'll quickly learn the rules of your life. I want to ask you, do you want to live by those rules anymore? Because this is not playing games. This is your life. Do you want to keep holding yourself to those rules that you just listed off? How does it benefit you to continue to hold yourself to that high, high standard? Often, we say, "I shouldn't have these feelings. I don't deserve it because I'm weak. I don't deserve self-compassion because I'm not valuable. I don't deserve self-compassion because of the content of my thoughts. The content of my thoughts is too heinous." Okay. So, there you might want to look at, again, what are the rules and do you want to live by those rules? Because the truth is, you can't control your thoughts and you can't control your feelings and you can't control life a lot of the time, almost all of the time. And so, again, do you want to live by those rules? Next question: Are you beating yourself up for something that's not your fault? Meaning can you control your thoughts? Because my thoughts aren't my fault. I know my feelings aren't my fault. I know how I interpret things aren't my fault. That's usually coming from years and years of being trained to think that way. I know my beliefs aren't even my fault. I actually think we're just creatures of habit and we were raised to believe certain things and we are going to make mistakes. I'm going to say this again: What would you have to do to warrant deserving self-compassion? Often when we actually explore this, I really, really hope you start and actually write your answers down to these questions because when we stop and we look at like, okay, so if you don't deserve self-compassion, we really know the benefit of you practicing self-compassion so much so that I am in the process of creating a course that will teach you. I've already written a book for people with OCD, but I'm creating a minicourse on how to practice self-compassion. It's that important. I want everybody to have access to it, not just those who have OCD. That is a big part of my mission, is to get everybody to be practicing self-compassion. Let's say we really understand the benefits of it. We know it's important. We know it can increase motivation, make you more successful, decrease procrastination, make you feel like a better sense of self. It can help you achieve your goals. So many benefits. It actually reduces inflammation. It gives you better wellness and health. It increases life satisfaction. So many benefits. Let's say we want you to do it because it's healthy, just like you would exercise because it's healthy, or you would go get it to the dentist because it's healthy. What would you have to do then to be warranted and deserving? And often then, again, you're going to be very clear in terms of this list of things. I'm going to ask you, are the list of things even realistic? Really, if you said, "Okay, I'd need to no longer have these thoughts and I would have to have changed the past and done something different. I'd have to regulate my emotions all the time. Never snap at my children and never say something silly at a party." Is that even possible for any human? Really for any human, is that realistic? Do you actually think you can actually achieve that really honestly? This is a question. This is not rhetorical. This is an actual question. The chances are, when you really answer it, the truth is, you're not giving yourself self-compassion because you don't feel like you deserve it. But the truth is, you will never be able to meet these rules that you've created for yourself. I don't want to say that as if I'm blaming you. We've all done this. But I want you to be really honest with yourself in regards to, you're never going to get to the place where you practice self-compassion if you keep those high level of rules, those perfectionistic rules. And then you miss out on this wonderful opportunity for your mental health and for your physical health, and for your wellbeing. Here is another question: What would you have to feel in order to offer yourself self-compassion? Meaning how would you need to feel about yourself? What emotion would you need to feel in order to feel like you deserve it? What would you have to experience about yourself? Not the rules, but like would you have to. Some people say, "I don't feel like I deserve it." It's a feeling. The reason I ask this question is because often people will say, "It's just a feeling I get. Sometimes I feel like I do and sometimes I feel like I don't, usually depending on whether I've checked off all of these boxes." But it's still a feeling that you're going off because it's different. It's not like you get your notepad out and you check the boxes. It's a feeling. I might pose to them, could you actually offer yourself self-compassion without the feeling and just do it anyway? It's a very, very radical thought. What a radical idea that you might offer it to yourself even though you don't feel like you deserve it. Could you offer it because of what you've been through or because of the checkboxes that you haven't checked? Meaning I believe, and I've said this on the podcast before, and I'm going to say it very, very clearly here for you, I believe the more that you suffer, the more you are deserving of self-compassion. It's not the more mistakes you've made and the more you've suffered, the less you deserve it. It's actually the more you deserve it. "Oh, I've made a lot of mistakes today." Oh, you're even more deserving of self-compassion. We want to offer more to you. Oh, you are having a really hard day with some really hard emotions and some strong emotions. Oh, even more of a reason to offer compassion. Now, usually when we talk about this, clients will say, "No, that's just letting yourself off. That's just getting out of jail free card." I'm going to offer to you, like let's trick this belief and check made it a little bit if we were talking chess, is self-compassion is not a get-out-of-jail-free card. It doesn't mean you stop holding yourself accountable. It's actually what helps you towards change. You are saying, "I don't deserve self-compassion. I need to suffer and be criticized and punished because of something that happened." Does that actually move you towards perfection? No, it doesn't. It doesn't create any change. In fact, it keeps you now doing behaviors, like I said, self-criticism, self-punishment, which keeps you stuck in a cycle of feeling bad and negative thoughts and feeling depressed and feeling hate towards yourself. Very little good comes from that. That is not getting you out of any problem. It doesn't lead you towards being the best version of yourself. In fact, it leads you towards more and more suffering. Mindful Self-Compassion Offering mindful self-compassion doesn't absolve you from what happened in the past. Ideally one day you will forgive yourself, but that's a different topic. Forgiveness is not self-compassion. You can do both. You could forgive yourself as a form of self-compassion and you could be self-compassionate, which could lead you towards forgiveness. But here, what I don't want you to think of is that people who are self-compassionate are just like, "Oh no big deal. I just totally did a terrible thing, and it's not a big deal. I don't have to beat myself up because that would be unkind." No, that's not what we're talking about. And no one does that. If that's the case, you're not practicing self-compassion at all. Self-compassion is just simply offering kindness towards suffering. That's it. It's not ranking you higher or lower and the good or bad person. It doesn't mean that you don't matter. It doesn't mean that your pain doesn't matter. It doesn't mean that you can't hold yourself accountable and take responsibility. It just means the absence of beating yourself up and meeting your pain with kindness and compassion instead of criticism and punishment. The thing you've got to run mind yourself, and this is a huge thing I'm doing this year, is really trying to identify what's working and what's not. I do a lot of therapy. I think a lot. It's one of my best skills and one of my biggest flaws, is I think a lot, I feel a lot. And it's not a bad thing, but I'm really trying to be more efficient and effective. Meaning, okay, what's the right amount of being responsible and taking responsibility? Because you could do a little bit, which is really responsible and very helpful. But then if you do too much of that, that doesn't make you a super responsible person. It means now you're moving into self-punishment. So, too much of one thing can be good and too much of one thing can also be bad. It gets you into trouble. So, how can you be effective with the behaviors that you engage in, is the amount of criticism or self-punishment or deprivation of compassion, which is what we're doing here and talking about, does that bring you benefits to your life? It's an important concept for you to think about. Whether you think you deserve it or not, or whether you feel you deserve it or not, is it effective? We'll come right back to one of the first concepts, which is, just because you think it, still doesn't make it true. So, just because you think you don't deserve it doesn't mean you don't deserve it. It just means you're having thoughts that you don't deserve it and thoughts aren't always right. We recently did a whole episode on guilt , quite a few months ago, but the whole concept was just because you feel guilty doesn't mean you've done something wrong. Our brains make mistakes all the time. So, just because you think you don't deserve it doesn't mean you don't deserve it. We think messed up, scary, wrong things all the time, and the truth is, anxiety lies. Depression lies. OCD lies. Panic lies. Chances are, a lot of these beliefs you have around self-compassion are also just lies. We want to move you towards recognizing that everyone deserves compassion. So, that's the final where we land here, which is everyone deserves it. Everyone. Really to be honest, even when I say the more you suffer, the more you deserve it, that's actually not completely correct too, because that would still be buying into this idea that certain people deserve it more than others. Everyone deserves it equally every day, 24 hours. It's just a done deal. You don't have to give yourself self-compassion. But what are the negative impacts of your life, if you don't, and what are the positive impacts in your life if you do? Think about how much good you can do in the world if you did. That's the point I want to make. Keep an eye out. We have a whole course on self-compassion coming. It will be for everyone. It will be $27. I'm in the process of making it. It will probably be available when this comes out, but just in case it's not, keep an eye out in future podcasts. I will have a link on CBT School. You can go there and check it out. I cannot wait to share that with you. It'll be a lot of these concepts, but actually more applicable skills for you to practice. Head on over to CBTSchool/self-compassion. I'm sure it'll be there by the time we get to this episode and I am so excited to share it with you. Before we finish up, let's do the review of the week. This one is from Kanji96 and it says: "This podcast is very helpful for me, especially when I'm going through hard times. Right now happens to be one of those hard times and here I am back listening to Kimberley. Thank you." Thank you so much, Kanji. Your reviews mean the world to me. Please, please, please go and leave a review. I mean it. If you get any benefit from the podcast, this is one way that if you feel at all so inspired to leave a review, it really helps me. It helps me to reach more people. It helps people to feel like they can trust the information here. I would love your honest review. So, go over to podcast app or wherever you listen and leave a review there. I am so grateful. Have a wonderful day, everybody, and I will see you next week.

Feb 18, 2022

SUMMARY: This week's episode is incredibly inspiring, with Lora Dudek talking all about getting real about OCD recovery. Lora shares her experience of having harm obsessions and harm OCD and how she managed being a mom during ERP. Lora also shared some wonderful ERP activities she did to help her keep track of her exposures. In This Episode: What OCD Recovery looks like for Lora Her experience with Harm OCD What kind of Exposure and Response Prevention (ERP) Lora used for harm OCD How she used ERP and recovery to decide what her values were (starting a career in ERP) Links To Things I Talk About: ​​Lora Dudek OCD Contact info: https://www.psychologytoday.com/us/therapists/lora-dudek-lockport-il/935049 https://www.graceandgratitudecounseling.com/ourtherapists ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 222. Welcome back, everybody. I am so happy to be with you today. Oh my goodness, I'm going to tell you a story, totally off-topic. But today's episode is number 222, and coincidentally, it's coming out just by coincidence the week of February 22, 2022. The reason that that is special for me isn't because I have any kind of affiliation with numbers, it's that I have this amazing memory of when I was very young. It was the 9th of the 9th, 1999. My mom, who is the most amazing human being in the whole world, had a 9/9/99 party, and everyone had to bring nine of something, nine flowers, nine chocolates. You could bring whatever you wanted. Nine of... We had nine of everything – nine shrimp on the plate, nine prawns. In Australia, we call them prawns. It was such an amazing memory. I told my children that we were going to do something similar because I just feel like that was such a beautiful memory. And so, I feel like I'm beginning that whole celebration with you because coincidentally, it's episode 222 on the week of 2/22/2022. Oh my goodness. I'm sorry. I know that has nothing to do with the episode, but it is a story that is so near and dear to my heart and I just wanted to share it. It isn't actually an off-talk topic because I really do want to bring some more joy to this episode and I really do want to slow down and enjoy with you all. It is a huge part of my goal for this year. So, thank you for sitting in that joyful story with me. If you would like, I hope you do something with twos, if you can, on that day, something fun. Buy yourself 22 flowers, say 22 nice things to yourself, whatever it may be, because these are very much once in a lifetime experiences and memories. Today, we have Lora Dudek with us on the podcast. Now, to say that I am a Lora Dudek fan is an understatement. I love this human being. She is such a shining light, especially for people who have OCD and want to feel like there is hope. She has such a beautiful story, such a hard, but beautiful story, and a real authentic, genuine story to share. I am honored to have her on the show like I am to have so many people come on who have a recovery story to tell. I particularly love when I can be a part of it and I was a part of their story, or CBT School was a part of their story or ERP School was a part of their story. And so, it is just such an honor to have Lora on here. She's talking about what recovery looks like for her. The reason I love this idea is, recovery is different for everybody. I really wanted you to get an experience of what it looks like for someone who has really done the work. Like I said, so many of our podcast guests have done the work and Lora is no exception. So, I'm going to head over and let you guys listen to that. Before we do that, I first want to do the "I did a hard thing." This week's "I did a hard thing" is from Fabian, and they said: "Hi, Kimberley. First of all, thanks for creating the room to write about my anxiety. I am recovering from OCD, and today I was at the dentist for a tooth filling. I don't like it because my mouth is blocked and I'm scared of getting enough air. And moreover, I do not like to get injections." Oh my goodness, Fabian, I feel you on this one. "I was able to face both and stay very present with the body sensations like cold hands, many, many thoughts, high heartbeats. It was a hard thing to finish the week and I'm happy that I did it. I will have to face it again in February 🙂. All the best to you and your team." Amazing, Fabian. I feel you on so many levels. The dentist is so hard for me. No matter how many tools I use, it's always going to be hard, but you did the hard thing. And that is what I love. So, thank you so much for contributing your "I did a hard thing." I am honored and major props to you. Okay. Let's get over to the show. Kimberley: Welcome, everybody. I am so excited about this episode today. We have Lora Dudek. She is now a Licensed Professional Counselor, but when I first met her, she was going through her own journey, and I wanted her to share her journey with you today. Welcome, Lora. Lora: Thank you so much. I'm so excited to be here. Kimberley: Oh my gosh. Okay. So, we've already pretty much cried before we even got on today together, which is beautiful. And so, I can't wait to get into this whole conversation together. You and I met online many years ago, and now you're a therapist, which just blows my mind, helping people. Can't believe that. So, that's amazing. Do you want to share with us your full-circle story? Lora: Yeah, absolutely. So, one of the things that we were just talking about was that I started listening to Kimberley's podcast back in 2017, somewhere around then, when I had been newly diagnosed with OCD. This is a total full-circle moment for me because she was such a-- I just called her a 'lighthouse' back in the day. My own story really started when I was just a kid. I mean, I was a little girl and was having intrusive thoughts. My intrusive thoughts have always been harm-related. As a kid, I didn't obviously really didn't know what that meant. I had a big obsession with death. I was very, very scared to die and other people around me dying or me somehow hurting them. But when I was little, it always just manifested as telling someone I was scared that they were going to die, and then them reassuring me that they weren't going to die, which is such an interesting thing to look back on. No one ever knew that. But that's where the reassurance started. I was looking back. I can see these areas of my life that were impacted from the get-go really. And then when I had my daughter in 2014, the anxiety just became absolutely overwhelming. From the moment that I knew that I was pregnant, there were just basically constant thoughts about something bad happening. I felt the entire time that I was pregnant like, I don't know how to describe it really. Maybe nine months of almost getting ready to attend a funeral truly is how I felt, because it just seemed so heavy, already knowing I was going to be really responsible for this life. While I was pregnant, I even got one of those sonogram machines or the fetal heartbeat machines. I would be sitting at the office and have an intrusive thought that something had happened to her, and I would rush home and I'd make sure that her heart was still beating. My doctor knew me very well because I was basically calling every other week with something that might be wrong, that never was. And then once she was born, it really manifested as just constantly checking on her. These intrusive thoughts that something really bad was going to happen to her, that I wasn't going to be able to take care of her, and constantly asking my husband at the time that I'm an okay mom. I can do this. I'm able to do this. Those went on really. These thoughts and that heightened anxiety went on for-- she was 16 months old at her first Christmas or her second Christmas, sorry. We traveled with family to go see family, and I was putting her down for her nap and ended up laying down beside her. She fell asleep and I fell asleep next to her. It was in a bed. When I woke up, my first thought was, oh my God, is she breathing? I thought I had smothered her. And so, I put my hand on her chest and I could feel that she was breathing and I went to get up and walk away. I had the thought, what if she's not? I was like, "Okay, let me check one more time." That is where I say the walls came down, because from that moment on, it was like, there wasn't any-- the checking just got out of control and it flipped. It got into this area where I was scared that something bad was going to happen to her, but now, I was going to do something bad to her. It just changed flavors really quickly. We got home from that trip and I told my husband. He had to go on a business trip for two days. I basically didn't sleep for two days. "I thought I'm going to hurt her. Something awful is going to happen to her. I can't take care of her." Just going out of my mind. I used to get up and check on her, probably 10 times a night, to make sure she was still breathing. At this point, I became so scared of myself that I would block my bedroom door at night with my dresser to make sure that I wasn't going to get up and do something to her. I was like, "Whoa, something's really wrong here." So, I looked up an Anxiety Specialist and went and saw her. It took me about a couple of months seeing her and building rapport with her to actually let her in on some of the thoughts that I was having. I remember very vividly. It was an early morning appointment. It was a 7:00 AM appointment. The night before I barely slept, because I really did think like, this is it. I'm going to get hauled away tomorrow. I'm going to tell her these thoughts I'm having, and this is going to be the end of me. And so, that morning, I kissed my daughter, I kissed my husband. I walked out the door and got in my car and I was like, "All right, that's the last time I see him for a while." But I got into my therapist's office and I broke down. I'm like, "I have these thoughts that I'm going to hurt my daughter. It's the worst thing in the world." She was like, "Do you want to?" I was like, "Oh my God, how could you even ask me that? She's the most important thing in my life." She asked me a couple of other questions. But then she said, "Do you know anything about OCD?" Through my tears, I was like, "Yeah, I do. I know OCD. I'm not clean. In fact, I'm really messy. I don't even know why you're asking that." I was frustrated. And then she told me about intrusive thoughts and compulsions, and it was the biggest light bulb moment of my life. Everything just started making sense really from some of my earliest thoughts. I do have to say it was a bit of a relief at the beginning. So, that's the story. That's how I got diagnosed, and it started a whole new part of my journey. Kimberley: Yeah. So you had relief. Lora: Yeah. Kimberley: And then what was your emotion? Lora: Yeah, I mean, the relief was like, I'm not crazy, that it was so like something has got to be really wrong with me. And then it was just like, whoa, I checked the box for everything she just talked about with this disorder. And then the emotion, after a little bit, the emotion became like, this is going to take a lot of work. This is going to be a level of acceptance that was like, I started getting acclimated to what exposure therapy was. She didn't practice exposure therapy, but she was amazing in the sense that she was like, "I have the person for you." She knew enough, which is so important-- Kimberley: Yeah. Thanks for that. Lora: Yes. To send me to an OCD Specialist. That therapist was amazing. She laid out for me how this was going to work, what we are going to do. It was a relief at first. And then there was a lot of grief. There was a lot of heartache, realizing how much this disorder had taken from my life. Ignorance can be bliss sometimes. I think that I dismantled that notion through doing ERP and exposures, and it became a very interesting part of the journey. Kimberley: I know, I was thinking about you. You were saying you got in your car, you said goodbye. And then you had to walk back to your car and drive back to your house, right? How is that? Lora: It's like, I mean, I have some health anxiety too, so I always liken it too. I walk into a doctor's office thinking this is going to be cancer. And then I walk back like, "Okay, now I just go back to life." Kimberley: Right. I can just have this image of you, walking back to your car, going, "I guess I'm going home now." Lora: Yes. And I got back. My husband was like, "Hey, you doing okay?" I was like, "I got to tell you what just happened. This is what they said. Did you know that obsessive-compulsive disorder is like this?" And he is like, "No, but I mean, makes a lot of sense." Kimberley: Yeah. How crazy. It's so amazing that you had that opportunity. Again, we know that that's not a lot of people's stories, so I'm so happy that you had that experience. Lora: The thing, Kimberley, is that I do want to point out that I had been seeing someone for anxiety almost my entire adult, different therapists. This is the first time. Like, I said, I would have these harm thoughts, but I was just like, push them away, get rid of them. This was the first time I'd ever come head to head with being actually like, "I'm responsible for a little life. This is all on me." It felt like I wasn't going to be able to live the life I truly wanted to live. Other times, it was just like, okay, I can walk away from it. I can find some way to not be around it. Now I'm talking about my daughter who means more to me than anything in the world. Something has got to give. Kimberley: Yeah. That's really helpful to know that you have been in therapy. Lora: Yeah. Kimberley: When I had previously done a presentation with you through the International OCD Foundation, and you shared about your exposure board, this whole idea blew my mind. The reason I really want the listeners to understand, when I teach ERP, I'm literally just teaching my way of doing it and I love hearing other people's way of doing it. It's the same, but it's different. And so, I'd love for you to share about that as an idea for people. Lora: Yeah. Well, what started as one of the biggest, I felt like, almost hindrances of my pregnancy was that at the time I was pregnant, there were seven other women at my work that were also pregnant. I remember seeing them all being so happy. And then they had their babies and they were so happy, and they were-- obviously, it wasn't like, we're not going to blow this up like some kind of blissful totally time. They were new moms too, but they were going out and doing stuff. And that's all I wanted. That's what I wanted so badly, was to have those experiences with my daughter. So, my therapist and I started with imaginals and started with some really small things. I mean, I laugh about it now, small. Back then, it was like, no way. I did one where I was going crazy, where this wasn't really OCD, the timeless tale of it's not OCD. Such a classic. So, we started with imaginals and then even imaginals into sleepwalking at night, hurting my daughter, things like that. So, we worked our way up then to one day I was sitting in her office and she said, "What do you want to do?" I was like, "I just want to do normal stuff. I want to go to the zoo." And she's like, "All right, we're going to the zoo." And I was like, "What?" Kimberley: You're like, "Take it back." Lora: "I don't say zoo." Kimberley: "I meant Zoom." Lora: "I want to have a video conference in the safety of my own home." So, we started putting together this hierarchy based off things that I wanted to do with my daughter. And then she said, "I think a really good idea would be to take some pictures while you're doing these and we'll see what happens." And I was like, "I'm absolutely not doing that." There's no way I'm taking pictures, because as I'm sitting there and having this conversation with this OCD on my shoulder, telling me, "You're going to bring pictures back in here of you dumping your daughter into a tiger cage. Great. Let's do that." But we talked about it and I was like, "Okay, I'm going to do it." So, that was the first real exposure I did when I went out on my own. We start actually-- I should back up, we did start with driving, because I had this thing with my daughter not actually being in the car. I had left her somewhere. So, we drive and I wouldn't look in the rear view. That was a whole exposure. When we got past that, then we went to the zoo. We went to the mall to have lunch. We went to the swimming pool, which was just like the death pool as far as I was concerned. Let's see, I have the whole exposure board still on the side of my wall. I mean, we went and got pedicures and manicures. We did things that I wanted to do with my daughter. We got flu shots. That I wanted to do with my daughter that OCD told me was absolutely not possible, without having someone to tell me the whole time what I was doing. My reassurance came in the form of calling my husband, texting my sister pictures because then everything's okay. They can see what I'm doing. And so, doing these exposures without engaging in calling anybody the entire time, without texting anybody the entire time. Just me and OCD and my daughter and here with the three Amigos. Here we go. Kimberley: Mom and daughter and the third wheel, right? Lora: Yeah. So, that's how they looked. It was like, I really, really hit it hard over a summer, the summer of 2018. I called it my summer of ERP. Once I got going, I just wanted to keep going. It was terrible at the beginning, terrible because I would complete an exposure and I'd get home and then the rumination would want to start. It was difficult not to engage in that. It was difficult to just watch it. But through the exposures, I said at one point that the butterflies were my yellow brick road. Whenever I'd think about something and I got that feeling like, oh, it was OCD being like, "Really, are we?" And then I was like, "Ah, okay, here we go. Follow, follow, follow, follow." Kimberley: Isn't it that in and of itself is beautiful? I always say with my staff, is you follow the smell. Meaning wherever it's smelly and you don't want to go, you go there. And that's what you were doing, is just wherever you felt butterflies, if I'm right, you would go and do that thing. Lora: Yeah, absolutely. Because it became that-- my therapist phrased it in a way where she was like, "We're going to play scientist." That's what she'd tell me. "We're going to go try this out. Let's just bring back what we find." It was such a compassionate way to do that. It wasn't like, "Here's your exposure, do it. Go. Boom," which sometimes I think can be a little helpful. But for me, it worked to be like, "Let's go see about this." Kimberley: Yeah. "Let's be curious." I love it. Now I've seen this exposure board and it is so beautiful. You would have no idea you're doing exposures. You look delighted most of the time. I wonder if you could even send me a photo and maybe we could show that in the show note, that would be wonderful. Lora: I would love to. Kimberley: Yeah. I'd love to be able for people to click and actually see what it looks like. Maybe we could even say-- I try to give homework during the podcast. We could even say, "If you have anxiety, you could create your own." Lora: Yes. That would be awesome, because I'm telling you, whoever's listening to this right now, you're going to see that I look back on this board and it's us smiling. There is one picture where my daughter is screaming, but that was the flu shot picture, and we did a hard thing. It was a beautiful day to do a hard thing, and I put it on that board, man. Kimberley: Good for you. She deserved to cry. I think that you're making a good point here, and I've had this conversation with some of my clients, is exposure is even if you don't smile for the photos, still put it up because you did it, right? Lora: Right. You did it. And that's a thing. Along the way, those victories, I really don't believe that there's such thing as small victories. I know we say it a lot. A victory is a victory is a victory. Take it, hold onto it, and know that's the fuel that you're putting in this device right now that is getting you through this. Kimberley: Yeah. I love it. Are there any other exposures that you did that you want to share that people may find different or creative? I love the creative ones. Lora: Well, I just think that the exposures started to become organic. When I was first diagnosed with OCD, I did not know OCD's voice at all. I was like, "No, no, no, that's the voice that's kept me safe my whole life." And so, along the way, the more I started to do some of the work, I started to realize that that what-if voice, that's when I'm like, "Ah, if I'm going along and doing something, what-if pops up." That's my voice of OCD. I've learned that. And so, for me, a lot of my exposures, even to this day, have to do with when the what-if pops up. How can I look the what-if in the eye? I left out obviously in a place where my daughter couldn't get them, but I've left out kitchen utensils before. Just last night, I mean, I mentioned how I'm doing some OCD work again right now because it continues. The what-if popped up and my daughter hadn't drained the bathtub. I was going to drain it right away. Now it's not even like what-if. It's OCD being like, "Whew, way to think of that one." That was it really. And then I stopped myself from draining the bathtub and it's like, "No, no, no." And so then, I left the bathroom and I'm like, "We're just going to leave that tonight." Kimberley: That's so cool. Lora: Really anywhere that I can poke the bear, I guess me and my daughter doing things out in public, then that just confronting that fear of me that I'm going to lose control, not be able to help her if she needs it. All those things, wherever the what-if pops up, that's where I knew my work was. And it still is to this day. Kimberley: Yeah. I love that you share that too. So, it sounds like some people, when we're hearing this amazing story, they think it's just, you're done. Your exposure is done. Is that the case for you? Lora: Yeah. I was one of those people, I'm going to get through this summer of ERP, which is why I still call it summer of ERP. It was the one summer. I had these high hopes that then once I get into grad school and once I really start working with people with OCD and helping people that the OCD just fizzles. I have recently just come into this space of understanding and ultimately, some acceptance of like, this is kind of a way that I live right now. I don't know what five or 10 years down the road looks like. And I'm really, as far as OCD is concerned, not too focused on it. I'm focused right now on, how's it showing up and are the things that I'm doing helpful? Are they getting me to where I want to be or am I staying in the same spot? That's my litmus test, is am I living the life according to my values that I want to live? So, recovery for me right now looks like I do exposures still, and I have even after the 20 months of COVID. I thought, man, I bet it could be really helpful to speak with an OCD Specialist again to get a little bit of guidance, get some creativity because that can help sometimes. So, I'm doing that right now even, and it's been amazing. I think it's just a process of building the muscle, of keeping the muscle and I think I'm gaining more acceptance by the year. Kimberley: Yeah. I mean, that's a piece of it. You had said before, as we talked like mindfulness and self-compassion and act was such an important piece of your work and acceptance is such a core part of all of that, because there is so much grief. We don't talk about it enough, right? Lora: Yeah. There is though. Kimberley: What was it like for you-- let me rephrase that. Was mindfulness and self-compassion a part of this process for you? Lora: Yeah, absolutely. So, my amazing therapist knew about Mindfulness-Based Stress Reduction and she had mentioned it to me. There was a program that was going on. I lived in Dallas at the time, at the Dallas Yoga Center. It was an eight-week MBSR program and I signed up for it. We did a body scan, a 40-minute body scan, the first class, and everybody woke up and they were like, "That was so relaxing. That was so awesome." I raised my hand, I literally raised my hand and I was like, "I don't think I did that right. I just had a 40-minute panic attack." It was awful. But I should say too, that shortly after I got diagnosed with OCD, I realized I had become incredibly dependent on alcohol, especially being a new mom. So, I had completely quit drinking. I was like, "All right, if I'm going to do this, I'm going to do this. Let's go." I quit drinking. I didn't want to have that crutch. I was in the MBSR program. I talked to the teacher. She convinced me to come back the next week. And then the next week, we did another meditation. Towards the end of it, she read a Mary Oliver poem that ends with "Tell me what you plan to do with your one wild and precious life." It felt like a dam burst open in me at that moment. I was like, it is so precious and it is so amazing, and like, "Lora, you can do this. Let's give this everything we've got, the exposures." Learning to sit with myself through mindfulness was huge because OCD and anxiety do not like that. We need to be moving. So, mindfulness was so huge for me to be able to just breathe and be in a moment and watch my thoughts instead of engage with them. Mindfulness then I say was the gateway to self-compassion because I'm not sure-- maybe I would've gotten there, but it wouldn't be as soon to be able to be with myself and to hold myself and that loving-kindness. When you don't even want to sit with yourself, it's really hard to be able to look at yourself and be like, "I'm here." You want to be like, "Let's go." So, yeah, self-compassion then was huge, because that voice of OCD is so nasty. I worked on a self-compassion journal for about six months straight, every day, really journaling. Kimberley: What would you write? What would that look like? Lora: Yeah. So, I read and worked through with my therapist the Kristin Neff's first book. And so, each day I would pick something that had happened, that was a little difficult and I would break it down into the three components of self-compassion. I would be mindful about what happened. Didn't need any of my judgment in there. Let's just lay it out there, what happened. Then the common humanity of it. Who else do you think in the world might have experienced this, or that feeling of not being alone. Man, probably a lot of people ran into something like this today. And then self-kindness. A lot of times, my self-kindness sounded like, "I'm really proud of you. That was really hard." I don't know how many entries I had over those months of being in a grocery store. Like a toddler going nuts in a grocery store and then just the flare-up of like, "Ah!" At the end of the day, that's what I choose. I remember a couple of months, maybe three or four months in, where I was sitting down to write and I couldn't think of something really hard that had happened that day. And I was like, "What?" It was such a weird feeling. After months and months and months of really intense therapy and some difficult things I was working with, I was like, "Today, I'm just going to be compassionate then about how much work I've been doing." Kimberley: Wow. I love that you're sharing that because I've found even since-- I mean, I wrote a book on self-compassion, but since I wrote the book, I'm even pushing my clients to do it even more. The journaling and the writing to themselves seem to be the most powerful part of the work, the writing to themselves. Lora: Yes. And I think that the writing to myself and the speaking to myself was the most powerful part of it. In the beginning, it was absolutely the hardest, especially with the voice of OCD. When I would look in the mirror and I would say, "You're doing the best you can, Lora. You're really doing this," OCD would be right there to be like, "Are you?" It's so egotistical. It just wants all the attention. "Maybe you're not." I sat down with my therapist a couple months into really keeping that journaling and I was just exhausted, just so tired from some of the work. I don't know if you can see it. Can you see on my back wall "As long as it takes"? Kimberley: Yeah. Lora: I sat down and I just started crying one day and telling her this has just been so hard that sometimes I feel like I haven't made any progress. I feel like I take two steps forward and five steps back, and was just really down about stuff. She sat there, just really holding some amazing space for me, but I said, "How long is this going to take?" She just looked at me and she just put her head to the side. Really, she's such a sweet person, and she said, "As long as it takes." She said it just like that, "As long as it takes." And I was like, "Okay. As long as it takes. Throw out the timeline then. Let's just keep going." Kimberley: Yeah. I love that I got goosebumps hearing you say it. All the hairs in my arms are standing up. And I love that you have it on the wall, because I read it as we were starting. I was like, "You know what? We're good." It shakes off all the rules and stories we tell ourselves. Lora: Yes. My mom actually, she made that for me, for my graduation from grad school. She made that and framed it for me. Kimberley: I love it. Yeah. You are so inspiring really. Lora: Thank you so much. Kimberley: Yeah. Number one, I'm so grateful that you're here and you're sharing this, and number two, I'm so excited that you're going to change lives for people, being a therapist and so forth. I'm just so grateful that I got to see some of it. Lora: Yes. Because before we even started recording, we were talking about how on the Mondays-- what were they? Magic Mondays? Kimberley: Magic Mondays. Lora: Magic Monday. I'd be like, "All right, it's magic Monday." I'd log on and I'd ask questions and I was really inquisitive and you were so sweet. You answered all the questions and you were just so-- it was like this feeling of it's going to be alright. It is. I think when we can cultivate that and know the sky sometimes can feel like it's falling, we do really have the power to look around and say like, "Here I am." Here I am, put our hand on our heart and say, "This is what I can do in this moment. I can at least show up for me at the very least." And that's not the least thing at all. Kimberley: No, no. Like I said, you're so inspiring. I've written so many notes, which is so fun. I don't usually get that many notes down. So, I'm just so grateful for you for coming on and sharing your story. I loved presenting with you. That's where I felt like I got to know you, so I'm so grateful. Where can people find you? Lora: I am on Instagram and the account that I share a lot of my OCD journey with and things that I have learned along the way is Judgment-Free Anxiety, but it's judgment_free_anxiety. Kimberley: I love that. What's for you in the future? Tell us about what's popping out for you. Lora: Oh man. Well, right now, I hope to be employed somewhat soon. It's a new life now after grad school and after becoming licensed, and just hopefully a lot more adventures with my daughter, going to do that. And man, that's it. I did actually recently become certified to teach mindfulness, so I'm also looking at doing something with that as well, but I'm not sure exactly what. Kimberley: Yeah. Such good skills to have in your toolbelt. Lora: Yes, absolutely. Kimberley: Well, thank you so much. You filled my heart up today. Thank you. Lora: Thank you so much, Kim. Thank you. ----- Thank you so much for coming and listening to our podcast. Before we finish up, let's do the review of the week. This is from nmduncan827, and they said: "Compassion, comfort, and wisdom. I've been following Kimberley Quinlan for years now and I can't say enough wonderful things about her and her work. As someone who has had OCD their entire life, I feel like finally at the age of 33 I'm beginning to find helpful resources to really push me along in my road to recovery. Between Kim's Instagram page and her podcast and her new book— there's little nuggets of compassion, comfort, and wisdom. I found this no matter where I am on my journey. I couldn't recommend this more for my fellow OCD and anxiety-disorder community! So grateful for Kim." Thank you, nmduncan827. Thank you so, so, so much. I am so honored. And of course, you can find me at Your Anxiety Toolkit on Instagram. You can get my book anywhere where you buy books, specifically on Amazon and barnesandnoble.com called The Self-Compassion Workbook for OCD. And of course, the podcast is here. Any time you like, go back, listen to old episodes. Sometimes they're the best ones. I will see you guys next week.

Feb 11, 2022

SUMMARY: Today, we are going to talk with you about the 7 common struggle you have with time management. Do you find yourself constantly looking at the clock? Or, wishing time would go faster? Do you feel like your to-do list is so long that you will never get them done? Or, do you feel like you never have time to prioritize yourself? In today's, podcast, we talk all about your relationship with time and why it is a HUGE part of managing anxiety, depression, and stress. In This Episode, we address the 7 common struggles you have with time management. "I don't have enough time" "I have so much to do" "I have so much I want to do" "I struggle to start and stop activities" "I don't a good understanding of how long things take" "I don't like structure" "I hate being told what to do with my time" Links To Things I Talk About: ONLINE COURSE Time Management for Optimum Mental Health https://www.cbtschool.com/timemanagement Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit , I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 221. Welcome back, everybody. I am so thrilled to have you here with me today for Episode 221. Oh my, how is that possible? We are getting so much feedback, such amazing feedback from last week's episode. I wanted to additionally offer you one more bonus piece of content from our new course, which is called Time Management for Optimum Mental Health. You can check it out at CBTSchool.com/TimeManagement. It is a course. We have it for $27. It's a mini-course, so it shouldn't take up a ton of your time, and it's me showing you exactly how I manage time. Now, the reason I created that course was because so many people were reporting to me – clients, followers, listeners – that COVID has destroyed the rhythm and the routines that they had, and that they really want to find a way to implement during their day time to do their therapy homework, do get exercise, maybe have more pleasure in your life, maybe reduce overwhelm, a lot of overwhelm because the to-do list is always so long. Am I right? The to-do lists are always so long. There seems to be a never-ending list of things to do. So, I added all that in, showed you exactly how I did that. Again, you can go and check that, or you can click the link below in the show notes. But as a bonus to that course, I did a Q and A where people submitted their questions. I have addressed that in that bonus, and I'm today giving it to you free in today's podcast episode. If you want to get a feel for what we're covering, you will have some reference to the course throughout, but you don't need to purchase the course to get benefit out of this episode today. However, together they would be really beneficial, I'm sure. Today, we're going to cover a couple of main topics. Here I'm going to give you some overview. Some of the questions people or the concerns or roadblocks they had around time management were things like, "I don't have enough time. I have so much to do on my to-do list." Another question we will cover in today's episode is, "I have so much I want to do. I just can't, again, find time." Someone brought up-- multiple people, forgive me, brought up that they struggle to start and stop activities. They struggle to get the motivation to get going. And then once they're going, they have a hard time transitioning into other activities. We address that as well. Someone posted in that they struggle with having a good understanding of how long things take. This is one of the reasons I have myself had to use a lot of time management, is I was underestimating how long things were taking and I was leading to a lot of anxiety and overwhelm. We also address people who don't like a lot of structure in their life and we also address people who don't like scheduling and don't like time management because they don't like being told what to do with their time. We're going to address all of that today, but we also go much deeper into that in the time management course. You can run over there if you want to take a look at that. Before we get into the show, let's do today's review of the week. This one is from Sheffie, and they said: "Wonderful resource! You can't help but love Kimberley ." Oh, that's so kind. Thank you, Sheffie. "She has such warmth and sincerity, is positive and funny, and spreads so much good into the world. On top of all that, she's a gifted clinician who does a great job sharing her knowledge with others. And she does all this with a lovely Australian accent." Oh my goodness, this is so kind. "All of her content is fantastic, but I especially love the podcast because each episode is packed with so many nuggets of wisdom that are applicable to so many situations. They're thought provoking and I find myself pondering them for a long while after. They're also a good length - great content without going on for hours, very digestible." Thank you so much, Sheffie. That is so kind. Actually, one thing, as I'm really listening and reading that off, sometimes I know I've mentioned this before, but creating a podcast can feel really lonely because I'm talking into a microphone. Sometimes I don't know if things land for everybody. I'm talking about what resonates for me and what I know has resonated from my clients, but it's never really sure, like how is anyone feeling about this? So, just getting your reviews actually is very heartwarming to me. So, thank you. It actually helps me to feel like I'm on the right track and I'm helping and I'm bringing value to your life. Thank you so much, Sheffie. Please do go and leave a review. It does help me so much in my heart, but so helps me just to get more followers and listeners. All right, let's get over to it. Let's talk today about your relationship with time. Let's address some of these common roadblocks to time management, and I hope you find it incredibly helpful. Have a wonderful day, everybody. Welcome, everybody. I am so excited to be here with you to talk about your relationship with time. Now, this is an interesting topic, I think, and one that very much relates to our mental health. I personally find a lot of my thoughts are around time and about my belief that I don't have enough of it. This has probably been a very big part of my own experience of suffering because I keep telling myself, "I don't have enough of it." I really want to see whether this is true for you. Now, I did a poll on Instagram and asked my friends there to give me their biggest struggles with time management. As you may know, I have a full course on time management specifically related to managing mental health, how you can make time for your recovery, how you can make time for things that really benefit your mental health. A lot of the times we end up getting our to-do list done instead of scheduling in pleasure and downtime and rest, and we don't rest and have pleasure until we've got our list of to-dos done. But the problem is, the to-do list is always longer than the day. Am I right? We cut all of these submissions of things that people struggle with, a lot of the topics we discuss directly in the course, but a lot of them I wanted to discuss today specifically related to these struggles and the relationship people have with time. The first one here is, "I don't have enough time." Now I have two answers to this concern. number one, chances are, you are right. You don't have enough time to do the things that you are pressuring yourself to do. Now, I understand that many of you have jobs and you're going to school and you have children or you have loved ones and you have your own chronic illnesses or mental illness. So I agree. The list of things to do is very, very long. But I've wanted to first just ask you, is all the things on your to-do list being demanded of you, or are you demanding them of you? It could be one or the other. I just wanted to ask you, because I know for me, there are lots of things that I get demanded to do. I have to work. I have to make money. I have to be a mom. These are things that I really value and I want to take care of. But in addition to that, there's a lot of things on my to-do list that I actually don't have to do. I place those stresses on myself right. Now we're not here to blame. I never want this to be about blaming ourselves, but it's helpful to inquire. What things on your list do you have that actually create more stress? Is it helpful to add those things on your list? Is there a way you could maybe give yourself a break from the long things of all the things you have to do? Assess for yourself what's important. Is it important to me to get this done? But here is the thing. As we talk about in time management, the online course, is I have so many things that I value. I have so many things I want to do. I have so many ways I want to show up for people and friends and family. At the end of the day, it's unrealistic. Even though I want to do it, I don't have the time. To reflect, I don't have the time. Yeah, that's true. Sometimes the most compassionate thing I can do is to acknowledge that and be more realistic with the projects I put on my to-do list. Often I'll speak with clients about, are you taking too many courses? And they'll say, "No, I have to. Everybody is taking this many." And I'll go, "But is it working for you?" If you're really honest with yourself, does taking that many courses benefit you and give you time to recover from your mental illness? Does saying yes to volunteer, while volunteering is an incredibly valuable and helpful thing, are you in a place in your life right now or a season in your life where you can do that in a healthy way that still prioritizes your mental health? Just questions to think about. You may have some strong reactions to these, and I would inquire if you do. I'm not suggesting anything here, except I want you to inquire what is best for you. Now on the flip side of this, I can also say, even on the days when I've managed my time and my to-do list, I still just have the thought. "I don't have enough time. I don't have enough time. I don't have enough time." And that's my relationship with time. It's not great. My personal relationship with time, I have a long way to go. My relationship with time, as if it's a thing, is when I look at it, I say to it, "There's not enough of you." But I only have 24 hours. You only have 24 hours and we have to negotiate with what we want to cram into that 24 hours. It can be whatever you like really. You can sleep for as long as you think you need to sleep. You can work, you can go to school, you can take up whatever hobbies. Your job is to decide what's best for you based on your values and your family and your needs. The next one is, "I have so much to do." Again, we have a relationship with time. When it's not about time, it's about our to-do list. I really want this time management course that I've created. You can go to https://www.cbtschool.com/timemanagement . If you haven't already, if you're listening to the course right now, I want you to really, really think about the to-do list and reassess the to-do list. If it doesn't need to be done, I would encourage you to consider taking it off. Now, I understand, a lot of things on the list have to be done and I want them to be done, which is why you should, if you need, take a look at the procrastination episode and module, and you can maybe look at that as well. But like I said always, a lot of the thoughts we have about time are either facts or the mindsets that we have. So, we may need to think about how much pressure we're putting on ourselves. Another very small shift to that thought is, "There's so much I want to do." Now, here is another, this is very important. I personally, as a human being, there is so much I want to do. I have such passion to do this project and write that book and to create that podcast. I have all these things and hobbies I want to do. It's a wonderful thing. Some of you may not have that experience right now and that's okay. Sometimes depression and anxiety can take the passion out of things. But a lot of you, I hear because you want to get things done and you can't find a way to put it into your schedule. I really want to encourage you to start to do these things you want to do, but you have to be realistic about time. A part of the reason I made this course and not other courses is that this course could be a very quick make. Meaning it didn't take me six months to make some of my courses. The Time Management course is-- what is it? Almost 100 minutes or 120 minutes. It's easier for me to do this than to create a six-month-long course. I did it in small 20-minute increments. I want to encourage you that if your relationship with time is saying, "I have so much I want to do, I don't have enough time," find in your schedule 10 minutes to start, because 10 minutes today and 10 minutes next week and 10 minutes the week after that, before you know it, you will start to have some momentum, even if it's 10 minutes a week. A lot of times we don't do things because we tell ourselves that there's not enough time and there's too much to do. Instead of just giving yourself permission to just do little baby steps, create what you can in small amounts of time. Somebody had written, "I struggle to start and stop activities." This is very, very important. A lot of people struggle with time because getting going needs a lot of created momentum. The thing to remember is that motivation, and I will create a full mini-course on this very soon as well, is motivation is not something you just get. It's not inherent. You don't wake up with it. Motivation is something that you have to really create of your own. You have to cultivate motivation. You have to harvest motivation. It's something that you generate on your own. So to start an activity, usually, you will need to look at first what's getting in the way. We talked about procrastination in last week's episode and in other modules of this course. That's a big one. Starting usually means you have to generate motivation based on willingness to be uncomfortable, cleaning up any negative thoughts you have or critical thoughts you have about doing the activity. Setting time and reminders to remind you, because sometimes really honestly, you're busy. You're a busy person or you're an overwhelmed person. So, you will need timers and reminders and calendars, but it's really generating that activity. One of the best things to do is to keep in mind or to draw on a piece of paper or write it down, how you will feel when it's done, what it will look like when it's done, like a vision board almost, but it's okay. Put some time into it, like what emotions will I feel when I've completed this email? Or what will be the result if I create this course 20 minutes at a time? Little baby steps. When it comes to stopping, it's probably going to be much of the same tools. Schedule your time to do things, set an alarm or a reminder if you're someone who gets stuck in it. So set a time or a reminder, put up sticky notes, and then also be willing to be uncomfortable. When I let my kids have tech time, we schedule tech time every day. When I say, "Turn it off," they don't like it. They're in this mode of playing their game. They're watching the thing they want to watch. Moving out of that can feel very jarring and uncomfortable. And so, we have planned ahead for that. We know that when tech time is over, my husband and I, we may want to implement some family time or snack time, something that can help move us onto the next activity. Something motivating and pleasurable is often very helpful when moving from some kind of either uncomfortable experience to a different experience or you're in a pleasurable experience. You've got to move into something uncomfortable. There are some tips that may help that you may want to experiment with. The next one is, "I don't have a good understanding of how long things take." Now, this is huge. Again, if you're listening to this on the podcast, this is another reason where I stress the importance of you. If you want to take the course, I stress how helpful it can be. I write down how long things take often. Probably once a month, I do an inventory of my day. How long does it take to get my emails done? How long does it take to get the kids to school? How long? While this may seem like a lot of work, it pays off because I will then realize I only scheduled 30 minutes for emails, but to be honest, emails are taking me 45 minutes. Helpful data. Important data to help me then renegotiate my schedule so that it is kind, or to really work at not spending as much time on emails, or to be less perfectionistic about emails, or to delegate emails or whatever project it is that you're doing to somebody else. It may be that there are multiple solutions to this problem of not understanding how long things take. But I think the first thing is, you've got to have data. You can't assume a solution if you don't know what the problem is. Please, I encourage you. It doesn't take long. Just have a little notepad, scratchpad, how long things take, particularly the things you're having trouble in the day. It doesn't have to be the whole day. The next one is, this was very cool, "I don't like structure." Now, if this is you, I am so with you. I was and have been in my life someone who doesn't like structure. It stresses me out, makes me anxious. The pressure is overwhelming. I don't like structure. However, as someone who was forced to practice these skills, because life was so chaotic and unmanageable, I have found now I have a much better life with structure. I have found I'm more creative and spontaneous now that I have structure in my life because I know the things I need to get done are done. So then I feel free to go and do spontaneous things, take a drive, go on a vacation, and so forth, because I know. Or in this case, during COVID, because everything is so uncertain, I know how long things take, the structure of days. If there were, let's say someone in my family gets COVID – my children, myself, my husband – I know how to renegotiate the day really quickly because I have a really good understanding of the structure. It helps me to recalibrate if there is a major change in the day, because I'm used to that structure. I know how long things take. I know the practice of things. It's been overwhelmingly beneficial in my life. If you don't like too much structure, it doesn't matter. You can actually just block schedule. I like to really be specific, but I know a lot of my colleagues and clients that I've taught this to, they just like blocks, like bigger blocks, like four-hour blocks. From 10:00 to 2:00 is work, from 2:00 to 5:00 is this. And those blocks can actually just create a little bit of structure for them. And then they can slice in new projects if they have them. Homework for therapy, if they need it. A lot of my patients, I see they're professional successful people who are now I'm giving them additional 45 to 90 minutes of homework a day, and they say, "How am I ever going to fit this in? I'm already overwhelmed." We go through this process and we look at where they could slide in, 10 minutes here and 15 minutes here. Can you do some of your homework on your way to work and so forth? That can be really beneficial. That way, even though they don't like structure, they've found a way to prioritize what they need to get done so that they can get the benefits that they wanted. Last one, this is a big one, "I hate being told what to do with my time." This is actually, I think, sponsored by my husband, but this was actually given to me from many social media people who have submitted their questions about time management. But I agree. I think my husband would very much agree with this – I hate being told what to do with my time. There is, when it comes to time management, a-- I wouldn't say it's a humbling, but it's a letting go, a letting go of control, because when you don't want to be told what to do with your time, it feels like you're being controlled. Again, I don't think you have to do any of this if you don't want to. I wouldn't encourage you to make any of these changes if you really, really disagree with them. However, I would encourage you to consider at least giving it 30 days, because what you will find is, when you schedule things, it might feel like you're being told to do something with your time. You're doing it. I don't want you to have anybody else telling you what to do, but if you're putting down on your schedule what you want to do, I want you to remind yourself why. Why are you doing this? Often it's because the chaotic and unplanned day only creates more suffering. Chances are, you already have a lot of suffering. I'm guessing because you know about me, you have some kind of anxiety or depression or medical or mental struggle. So, even though this scheduling and this time management practices can feel like you're using your freedom, I personally think it's gaining freedom. It's taking back control over the chaos in your mind – the running list, the mental rumination, the anxiety of all the things, and having it to be where it's all there and it's done. Now, it doesn't have to be for you. I want you to find specifically, and you will see, remember we talk about in the course, we have a whole module on considering your specific set of circumstances. I want you to consider what's good for you and make plans and adjustments, but keep my voice in your mind. Sometimes the more you plan it, the more freedom and free space you have in your mind to do the things you want, because you're not constantly carrying around the to-do list. It's there anyway, you might as well handle it efficiently. So, that's my real encouragement. Again, I'm really for it. You may not be for it. I'm not going to harass you and make you agree with my view on it. But I know the science here and I have seen it benefit so many people, and I really hope that you can give it a go and let your guard down and let go of your need to have that control and honor what's important to you and follow through with what's important to you so that you get the things that you want and you get the mastery of the things in your life that are important to you. I hope that's helpful. I'm so grateful to have you here with me today to talk about your relationship with time. There may be many other things I haven't addressed. If I haven't addressed your specific struggle with relationship with time, I encourage you to journal down and explore how you might manage that because we do only have 24 hours and I want you to really find some peace in some of those parts of your day instead of carrying around the to-do list. Have a wonderful day and I will talk to you very, very soon.

Feb 4, 2022

SUMMARY: In this episode, we review how important it is to address procrastination, as it impacts so many people in so many ways. We also will review how procrastination is the same thing as avoidance and how people can work towards implementing time management skills to help them build a routine that helps them get the things they want to get done. In This Episode: We outline procrastination definition and procrastination pros and cons. How procrastination is simply an avoidance safety behavior. How to manage procrastination in , Anxiety, OCD and OCD recovery Our new course called Time Management for Optimum Mental Health Links To Things I Talk About: ONLINE COURSE Time Management for Optimum Mental Health https://www.cbtschool.com/timemanagement Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 220. Welcome back, everybody. How are you? Really, really, how are you? How is your heart? How is your mind? What's showing up for you? How are you? I really want you to check in, in case you haven't checked in for a while. How are you doing? It's important. Let's make sure we check in. Today, we're talking about procrastination. It's one of the most common questions I get when I'm doing live calls on Instagram and Facebook, like how do I manage procrastination? A lot of you are also managing perfectionism and it's getting in the way of you doing the things you want to do or doing the things you have to do. Because I get asked this so much, I actually wanted to show people how I do it. So what I did is I created a whole mini-course, it's called Time Management For Optimum Mental Health. You can get it if you go to CBTSchool.com/TimeManagement , or you can click the link in the show notes below. It's a full course of showing you how I manage time and why I manage my time to help manage my mental health and my medical health. A lot of you know I have struggled with a chronic illness. Time management has been huge in me staying functioning and managing mental overwhelm and a lot of procrastination. In the course, it's only $27, it's a mini-course and it shows you exactly-- I have recorded the screen as I'm showing you exactly how I do it. If you're interested, go over and check it out. I'd love to have you take the course and put it into practice. Now, one of the things about this episode is this is actually me giving you a sneak peek into the course because it's one of the bonuses of the course to talk about procrastination. So I wanted to share it with you here on the podcast as well. You will hear me refer to the other parts of the course as you listen. That doesn't matter. You'll still get everything you need to know about procrastination and how to manage it today. But yes, if you've already taken the course, you probably have already listened to this bonus. But for today, let's talk about procrastination. Before we head over into the episode, I wanted to do the review of the week. This is a review from Sadbing, and they've said: "Desperately needed. I am an LICSW that has searched high & low for a podcast that delivers quality content. I felt relieved to finally find one! This podcast provides an honest depiction of how anxiety shows up in people's lives & gives you effective feedback on how to live with it. Thank you!" Thank you, Sadbing. Thank you so much for that amazing review. I do ask that anyone who's listening, please, the one thing you can do, this is what I offer freely to you all. If you get a second, just click below, in whatever app you're listening to, and leave a review. It helps me so much reach all the people. The more reviews we have, the more people will trust the podcast and continue listening to this free resource. So, yay. All right. Let's get over to this episode about managing procrastination. I hope you find it helpful. If you want to learn more about time management, head on over to CBTSchool.com/TimeManagement, and you can get a mini-course for 27 bucks. It's amazing value for a short period of time and a short amount of money. So, yeah. All right. So happy to have you here with me today. Thank you for giving your time to me and trusting me with your precious time. I will see you after the show. Welcome. You wouldn't have a time management course without really addressing procrastination. Procrastination is, number one, the biggest question I get, which is another reason why I wanted to make this course, is because it's so common. It's such an easy trap to fall into. It's such a human trap to fall into to procrastinate. But I wanted to take a deep dive into procrastination today and talk about some skills that you can practice to manage procrastination. Let me really just dive into, first, what is procrastination? Now simply put, procrastination is an avoidant safety behavior. What does that mean? When human beings assume or see or assign things as a threat, our mind does that. So our mind will assign something as threatening, whether it be, "I have to write this email." It could be as simple as writing an email. It could be, "I have to present something. I have to get a project done. I have to go and exercise." Our brain will present that as some kind of danger or challenge or threat. Now you might be thinking to yourself, there's nothing dangerous about exercise or writing an email, but there may be for you because doing that means you have to have some uncomfortable feelings. Maybe shame, maybe anxiety, maybe irritability. Anger might show up. Guilt might show up. Because those emotions are uncomfortable and maybe if we haven't developed skills on mastering those emotions, events like writing an email or exercising or doing a project may be experienced as dangerous or a threat. When our brain interprets things as a threat, naturally, it is going to set off the alarm and try to either get you to run away from it, to fight it, or to freeze. That's how fight, flight, and freeze response. And the most common as humans is avoidance. We avoid the thing that will create discomfort for us, and simply put, that is what procrastination is. Now, why do we call it a safety behavior? We could call it a compulsion. But we call it a safety behavior because not everybody does it compulsively, but they may do it to create a false sense of security, a false sense of safety. As human beings, we want safety. It feels good to feel safe. It feels good to feel like, "Oh, I don't have to face that hard thing." So, yes, we consider it a safety behavior. Now, does that mean that you're bad and lazy or not good? Absolutely not. Everybody engages in safety behaviors. It's a human part of life. But what we want to look at here is, is it creating trends in your life? Is it creating impact or consequences to your life that create more discomfort and more distress later? Most of the time people say, "Yeah, I avoid," and it's getting to be a problem. If that's for you and that's happening to you, you're definitely not alone. Now, how do we manage procrastination? The first thing is identify what it is you are avoiding specifically. Don't just say, "I'm avoiding the email." Don't just say, "I'm avoiding exercise," or "I procrastinate." Don't say those things. I mean, you can, but ideally, you will stop and go, "Okay, what is it about the email that I don't want to tolerate? Ah, writing an email brings up social anxiety for me," or "Ah, writing the email reminds me that I'm really behind on that project. Writing that email brings up shame because last time I spoke to them, I said something silly or something like that," or "I don't want to exercise because, ah, every time I exercise, it creates discomfort in my chest and it makes me feel like I'm panicking." So you'll identify the specific thing that is causing you to avoid specific. You might even get a specific like I did. It's the physical sensations I don't want to feel. Or it's the thought that this was my fault that I don't want to think. You may get to the bottom of that. Now, of course, if you guys know anything about me, I'm always going to say, it's a beautiful day to do hard things. The only way we can overcome these strong emotions, particularly fear and guilt and shame, is to stare them in the face. Our job, and this is what I'm going to encourage you to think about, is to really look at, yes, avoiding. What is the pros of avoiding this? And then on the right-hand side, you could write this on a piece of paper, what are the cons? What are the consequences of me continuing to avoid this thing? Now often when you write that down, that in and of itself is a motivator because you're going, "Oh my goodness, writing the email is uncomfortable for the duration that I write the email, not writing it is uncomfortable, even when I'm not working on it, because I'm constantly nagged by the fact that I have to write it, or it's constantly sitting on my list or I constantly see it in the schedule." A lot of you in, and we're in the Time Management course – a lot of you have avoided managing time because putting this in the calendar makes you face the fact that you've got something scary to do. Now, you will see me, I'm holding my hand on my chest right now and I'm sending you much compassion because these are really difficult things. These may seem easy for other people, but they're hard for you and me. And so we must be compassionate with the fact that they're hard. Here is what I'm going to say: Being compassionate can actually take some of that pain away. It won't take it all. You still have to do it. You have to ride the wave of discomfort. It will rise in full as you go. But you can also be gentle with yourself and reduce your suffering instead of criticizing yourself or how hard it is for you. Don't compare how it is for you compared to your friend or your seatmate or your neighbor. This is what you do. You practice compassion before you do the activity first. I'm sorry. You commit to doing the activity. You put it in your schedule. You write down when you're going to do it and how long you think it's going to take. And then you practice compassion. "Wow, I'm going to be really gentle with myself as I ride out the emotions and the experience of doing that thing." You may want to get a partner, an accountability partner, who can help remind you and support you as you do the thing. A lot of my patients have an accountability partner. They're like, "It's three o'clock." They're texting, "It's three o'clock. I know you're about to do a scary thing. Good job. Keep going. Don't stop. Don't back out. I'll be right here. You text me as soon as you're done." See if you can do that. If you don't have someone to do that, be that for yourself. So it's in your calendar. You're going, you're gentle. You're going to do the thing. What I personally like to do is keep a notepad down next to me as I'm writing an email or recording a podcast or doing something that creates anxiety for me. I jot down the thoughts and feelings I'm having. Not a lot, bullet points. Like, "Oh, I'm having the thought that this is not helpful. I'm having the thought that this is not good enough. I'm having the thought that this should be better. I'm having the thought that I made a mistake. I'm having the thought that this should be going fast or better." Like I said, and you may start to notice – and this is true, I've seen a lot of patients say – as you write it down, it's the same five thoughts over and over and over. When you're not aware of that, it feels like 55 thoughts or 55,000 thoughts. But once you have it on paper, you will see, often our brain is just repeating the same thing. When you can see that, you can go, "Oh, brain, I'm sorry that you're sending those messages. Thank you for showing up. Thank you for trying to alert me to the possible dangers, but I have avoided this for so long, and it avoiding it and it procrastinating only delays and continues my suffering." And you feel your emotions. You ride them out. You tender with yourself as you do the thing. And that's how you get through it. Once you're done, you must celebrate and say kind things and congratulate yourself. Don't forget that stage because that's so, so important. But the main point to remember here is that avoidance keeps you stuck. Avoiding the thing you're afraid of is actually what then creates some depressive thinking, some hopeless thinking, or helpless thinking. "I'll never be able to... I won't be able to... I can't..." We really want to be careful of that type of thinking, because that is the thinking where depression lives. Again, the more you face the things that are uncomfortable, you will build a sense of mastery of that. It won't go well the first time, I promise you. Most of life is trial and error. I have found the only way to move forward is to practice failing. Here is what I'm going to ask of you. As you practice this activity or practice of not procrastinating, of facing the thing you're afraid of, of doing the thing you've been avoiding, I want you to practice or remind yourself that you are really not growing if you're not failing. I'm going to say that again. You're really not growing if you're not failing, because if you're only doing things that go well, chances are, you're avoiding a lot of things. If you're only doing things that are going well, the chances are, you're not building mastery with the hard things in life, and life is 50/50. We know this, that life comes with 50% good and 50% hard. We have to practice failing so we can learn how to be better. This whole course is about that. You're going to practice not procrastinating. You may or may not succeed. That's not really the important part. The important part is that you look at the data, the data being, how did it go, like that reassess stage, which we have as one of the steps in the course. Look at the data, what worked, what didn't and what do I need to change? This is not a perfect practice. It's going to be changing as you change. And so having the ability to adapt and having the humility to say, "All right, it's not working. What do I need to do?" This has been probably my biggest struggle in my entire life, is I avoid looking at the data of what's not going well. If someone tells me what's not going well, I get offended instead of going, "Okay, this is not personal. It's just data. How can I use this data to help me not make the same mistake over and over again?" Often what I'm doing, I'm churning out a lot of content and I'm not looking at the data when the data could help me to say, what is the most effective? What is the most helpful to other people? How can this be as jam-packed helpful as possible? I have to look at the data, and in order to do that, I have to be willing to fail. It's okay to fail. This is a practice. It's not perfection. But when it comes to procrastination, you have to be willing to be uncomfortable. You have to be willing to do hard things. This is why we keep saying, it's a beautiful day to do hard things. Now, of course, go back, follow the steps of the whole course. You've gotta get it in the schedule before you can really do that. But then I want you to even get very microscopic and look at when you're scheduling. Let's say there's something you're avoiding and procrastinating on. Schedule small activities so that you don't procrastinate. One of the best lessons I've learned when it came to me, recovering from my medical struggles, is I have to get a lot of exercise. Not running exercise, a lot of personal training, physical therapy type of exercises, and I hate them. They're the most boring, annoying, monotonous things on the planet. However, I have found that if I schedule, "Kimberley, at this time, you're going to put your shoes on. Kimberley, at this time, you're going to fill up your drink bottle," I am more likely to do it. I get very microscopic in my planning. Now, again, you won't want to do this with all the things in your life. Pick one thing if that's what you want to work on, and work at creating a system that gets you to do the thing that you continue to procrastinate on. I would not probably do my physical therapy and my training, these annoying, repetitive activities, if I hadn't created a system that makes it doable. I have a Bluetooth speaker, I put very loud music on. It's usually reggae or something very hippy, so I feel like at least I'm chilling out as I do it. I marry the thing that's uncomfortable with something that's tolerable. Now, you won't always be able to do this, and that is fine. Sometimes you just got to ride the wave and face your fear. That's okay. But that is an idea if it's for things like daily activities and routines in your life. If it's facing fears and exposure work, well, no, we don't want to marry it with these things because that can work as a neutralizing compulsion. If you're someone who is in treatment for an anxiety disorder and you've been given an exposure, well, no, you're just going to have to practice riding the wave of discomfort, but do not forget that self-compassion piece. It is crucial. Do not forget using your mindfulness skills where you allow your discomfort. You're non-judgmental about your discomfort. You're willing to allow it to be there. These are all crucial practices. I would even consider writing down all the things where you struggle with procrastination and work through them, practice them, just like you would be lifting a weight, just like you would practice if you were learning French or piano. Pick up the basic things and practice the basics first and go through all of them. Try to get yourself through as many as you can so that you build a sense of mastery like, "I can do that. Even if I don't want to, I can. I could if I had to," which I think is a really great way of thinking about things that are uncomfortable in your life. "I don't want to do them, but I could if I had to." It's better than "I can't" and "I don't want to." All right. That is procrastination. I hope that has been helpful. I really want to stress to you that procrastination is a thing that everybody does. Again, it's not personal, but I really, really encourage you to master doing the things that you avoid. Avoidance keeps anxiety strong. Avoidance keeps you in the cycle of anxiety, and we want to break that cycle. I hope that is helpful. I am really excited to see you go out and do those things. If you want to, you can share them with me on social media or things that you're doing. It's a beautiful day to do hard things. I love when people tag me with that. Have a wonderful day, everybody, and I will see you in the next module.

Jan 28, 2022

SUMMARY: Today we have Amanda White, an amazing therapist who treats anxiety, eating disorders and substance use. Amanda is coming onto the podcast today to talk about her book, Not Drinking Tonight and how we can all have a healthy relationship with alcohol. Amanda White talks about ways you can address your relationship with alcohol, in addition to drugs, social media and other vices. Amanda White also shares her own experience with alcohol use and abuse and her lived-experience with sobriety. In This Episode: Do you have a healthy relationship with alcohol Why we use alcohol and substances to manage anxiety and other strong emotions How to build a healthy relationship with alcohol. How to manage substance abuse, anxiety and substance use in recovery. Tools and tips to manage alcohol use and abuse Links To Things I Talk About: Easiest place to get Amanda's book with all links amandaewhite.com/book Instagram @therapyforwomen My therapy practice therapyforwomencenter.com ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). Episode Transcription This is Your Anxiety Toolkit - Episode 219. Welcome back, everybody. I am thrilled to have you here with me today. You may notice that the podcast looks a little different. That is on purpose. We have decided to update the cover of the podcast. It now has my face on it. There were a lot of people who had reached out and said that the old podcast cover art looked like a gardening podcast. And I thought it was probably time I updated it. So, that was something that I had created years and years and years ago. And I'm so thrilled to have now a very beautiful new cover art. Okay. This episode is so, so important. I cannot stress to you how overjoyed I was to have the amazing Amanda White on the podcast. She's a psychotherapist. She's on Instagram, under the handle Therapy For Women. She's so empowering. And she talks a lot about your relationship with substance use, particularly alcohol. But in this episode, we talk about many substances. And this is a conversation I feel we need to have more of because there are a lot of people who are trying to manage their anxiety and they end up using alcohol to cope. Now, this is a complete shame-free episode. In fact, one of the things I love about Amanda is she really does not subscribe to having to do a 100% sobriety method. She really talks about how you can create a relationship with alcohol based on whatever you think is right. And she has a new book out, which I am so excited that she's going to share with you all about. Before we get into the episode, I'd first like to do the review of the week. Here we go. We have this one from Epic 5000 Cloud 9, and they said: "This podcast has absolutely changed my life and made my recovery journey feel possible. After completing ERP, I felt lost and confused as to why I did not feel 'better'. Kimberley has given me so many tools to build my self-compassion, grow my mindfulness skills, manage OCD, and do all the hard things." So amazing. I'm so grateful to have you in our community. Epic 5000 Cloud 9. So happy to have you be a part of our little wonderful group of badass human beings. I love it. Let's go right over to the show and so you can learn all about Amanda and this beautiful, beautiful conversation. Have a wonderful day, everybody. Kimberley: Okay. Well, thank you, Amanda, for being here. I'm actually so grateful for you because you've actually brought to my attention a topic I've never talked about. And so, I'm so happy to have you here. Welcome. Amanda: Thank you so much for having me, Kimberley. I'm excited to chat with you. Kimberley: Okay. So, tell me a little bit about you first. Like, who are you? What do you do? What's your mission? Amanda: Yeah. So, my name is Amanda White. I am a licensed therapist. You might know me on Instagram from Therapy For Women as my handle. I'm also sober and I'm really on a mission to destigmatize sobriety and destigmatize the idea that you can question your relationship with alcohol. And it's really why my Instagram page and everything I do isn't sober only focused because I want it to be something where people who maybe aren't necessarily sober or haven't thought about it can, in a safe unstigmatized, unpressured way, also explore their relationship with alcohol. And that is what led me to write a book. And my book is called Not Drink Tonight. Kimberley: So good. So, I already have so many questions. Why wouldn't one question their relationship with alcohol? Because what I will bring here is a little culture. I'm Australian. Amanda: Yeah. I was going to say. Kimberley: I live in America. The culture around drinking is much different. I have some great friends in England, the culture there is much different. So, do you want to share a little bit about why one wouldn't maybe question their relationship with drinking? Amanda: Absolutely. I think I can only speak for America specifically, but I know enough people in England and Australia, too, that there is a culture of drinking is good, drinking is normal. We watch our parents or adults drink when we're young. We think that's what makes us an adult. If you look at the media, you look at movies, TV shows, it's what everyone does when they're stressed. Women pour themselves a glass of wine. Men pour themselves a bourbon. So, I think that we're just raised in the society that doesn't ever question their drinking, because alcohol use is so black and white, where you either are normal and you should drink alcohol and it's what's expected, or you're an alcoholic and you should never drink alcohol. And there isn't a lot of space in between. So, if someone questions their alcohol use, people assume that they're an alcoholic. Kimberley: And so, now let me ask, why would we question our relationship? What was that process like for you? Why would we want to do that? Some people haven't, I think, even considered it. So, can you share a little bit about why we might want to? Amanda: Absolutely. I think it isn't talked about enough of how much alcohol really negatively impacts your mental health. For a while, I know doctors used to talk about there are some heart-healthy benefits of alcohol, which new studies say is not true. There really aren't any benefits to drinking alcohol in terms of our health. But really, I think especially anxiety and alcohol are so intertwined and people don't talk about it and don't think about it. And what I want people to know is when you drink alcohol, it's a depressant and your brain produces chemicals because your brain always wants to be in homeostasis. So, your brain produces anxiety chemicals, like cortisol and stuff like that, to try to rebalance into homeostasis. And after alcohol leaves your body, those anxiety hormones are still in there and it creates the phenomenon where you end up being more anxious after you drink. There's other mental health effects too. But I feel like, especially on this podcast, it's so important that people realize how intertwined alcohol and anxiety is. Kimberley: Right. You know what's interesting is I do a pretty good amount of assessment with my patients. But really often, I will have seen them for many months before-- and even though I thought I've assessed them for substance use and not even abuse, they will then say and realize like, "I think I'm actually using alcohol more than I thought to manage my anxiety." And I'm always really shocked because I'm like, "I swore I assessed you for this." But I think it takes some people time during recovery to start to say like, "Wow, I think there is an unhealthy relationship going here." Is that the case from what you see or is that more my population? Amanda: No. Absolutely. Because I think it's easy to lie to yourself. Maybe not even lie, just like not look at it because again, it's so normalized because we have an idea in our head of what someone with a problem with alcohol looks like. We don't consider ourselves to have that problem. But just because we aren't drinking every day or we're not blacking out or something like that doesn't mean that we might not be using it to numb, to cope with anxiety, to deal with stress. Kimberley: Right. You know what's funny is I-- this could be my personal or maybe it is a cultural thing because I always want to catch whether it's an Australian thing or a Kimberley thing, is I remember-- I think hearing, but maybe I misinterpreted as a young child that you're only an alcoholic if you get aggressive when you drink, and that if you're a happy drunk, you're not a drunk. You know what I mean? And that it's not a bad thing. If it makes you happy and it takes the stress away, that's actually a good coping. So, I remember learning as a teen of like, oh, you get to question what is an alcoholic and what's substance abuse and what's not. So, how would you define substance use versus substance abuse? Or do you even use that language? Amanda: I mean, yes and no. I use it in terms of it exists, and it is part of the DSM. So, it is in terms of, I do diagnose when needed and things like that. A lot of times though, I think the current narrative and I think people spend so much time trying to figure out if it's use or misuse, that they miss out on the most important question, which to me is, is alcohol making my life better. Kimberley: Yeah. Amanda: And if it's not, if it's right-- I have exercises in my book and I talk a lot about like, what are the costs of your drinking, and what are the payoffs? And if it's costing you a lot or it's costing you more than it's bringing to your life, I think that is where you should question it. And I think your life can change. You can go through different things in your life and maybe that's when you can ebb and flow with your questioning of it, especially people get so obsessed with the idea of whether they're an alcoholic or not. And the term 'alcoholic' is completely outdated. It's not even a diagnosis anymore. It's now a spectrum. So, to me, that word is just so outdated and unhelpful to think about really. Kimberley: Right. And even the word 'abuse' has a stigma to it too, doesn't it? Amanda: Right. In the DSM, it's alcohol use disorder and it's mild, moderate and severe. But it's wild thinking back. I mean, I was in grad school. Oh my gosh, I'm going to date. I don't even know how long ago, 10 years ago. Kimberley: Don't tell them. Amanda: A certain amount of time ago, I just remember being in 'addictions class' as it was called and we were talking about what is the difference between use and abuse and what makes someone an alcoholic. And I think people also get very attached to being dependent. It means it's abuse. And it takes a lot to become dependent on alcohol physically. So, we're just missing out on so many people. I say often, we can question so many things in our life. I'm sure you do too with your clients. I question how their sleep habits interact with their mental health. We talk about how getting outside impacts their mental health, all these different factors. But for some reason with alcohol, which is a drug, we don't question it or we are not allowed to. Kimberley: Right. Yes. I will address this for the listeners, is I think with my clients, one of the most profound road, like if we come to the edge of the road and we have to decide which direction, the thing that really gets in the way is if I put a name to it, then I have to stop. And that can be, a lot of times, they won't even want to bring it up – be in fear of saying, well, like you were saying before, is that meaning now-- as soon as I admit to having a problem, does that mean I'm in AA? Is it black and white? I think that there's so much fear around what it means once we really define whether it's helpful or problematic. That can be a scary step. What are your thoughts? Amanda: Yeah, I completely agree. And that's why I really believe in looking at it as a spectrum, especially I think about disordered eating, right? It's like, we know that based on studies, if someone engages in disordered eating, they're more likely to develop an eating disorder. So, in my book, I coined this term 'disorder drinking' and how I really think we need that term where people can-- it makes the barrier to question your relationship with alcohol much lower, where I find in my practice because I work with a lot of people with eating disorders. People are very open about saying, "Yeah, I'm maybe engaging in some unhealthy, disordered eating. I don't know." But there's a whole step there before maybe you recognize that you have an eating disorder, where I really think that that is what we need with alcohol. We need to be able to talk about how, like, yeah, most of us in college engage in disordered drinking. It's not super healthy, the way that we drink. Or we may go through a period of time in our life because we're super stressed or something's going on, where we engage in that. And that doesn't mean that you have, for sure, a substance use disorder or you're addicted or you have to never drink again. But I think it's important to recognize when we start to fall into that so we can change that pattern. Kimberley: Right. Particularly with COVID. I mean, alcohol consumption is, I think, doubled or something like that in some country. And I think too, I mean, when we're struggling with COVID that we have less access to good tools and less access to social. So, people are relying on substances and so forth. Yeah. So, what is this solution? There you go. Tell me all your answers. What is their options? How might somebody move into this conversation with themselves or with their partner or with their therapist? What are the steps from here, do you think? Amanda: Yeah. So, I think that the first step is to try to take a break. I think 30 days is a good starting point. A lot of times, if people just start off by cutting back, they don't really get any of the positive feel-good benefits of taking a break, which is why I recommend starting with taking a break first. Obviously, I believe in harm reduction. And if you are in a place where you can't take a break, moderation is definitely a good tool and better than nothing. Kimberley: Can you tell what harm reduction, for those who don't know what that means? Amanda: Yeah. So, harm reduction is the idea that rather than focusing on completely eliminating a behavior or especially completely eliminating a substance is we think about cutting back on that. And I think about specifically, if someone is in an abusive situation, if someone has a lot of trauma going on and alcohol is the one thing that's keeping them afloat, that to me is like, of course, I'm not going to say you must quit cold turkey or something like that. And even if you're talking about, alcohol is very dangerous to physically detox from if you are drinking every day, which a lot of people don't know. In those cases, yeah, it's really important to get support and detox in a safe environment. Kimberley: Right. Okay. So, sorry I cut you off. Take a break-- Amanda: No, it's okay. Yeah. So, that's what harm reduction is. But yeah, in general, I recommend starting with taking a 30-day break, seeing how that goes, see how your health improves, see how your anxiety might be reduced and improved. And really to me, the goal is to learn how to live your life without being dependent on alcohol. Because if we can't process our emotions, set boundaries, socialize, go on dates, whatever, without the help of alcohol, we never really have freedom of choice over drinking or not drinking because we need it on some level. So, my whole goal is for people to learn how to do some of those skills so that they don't have to rely on alcohol, and then they can use alcohol in a healthier way for celebrating or in a way that positively impacts their life and they don't use it as a crutch. Kimberley: So, that's so helpful. I'm pretty well-versed in this, but I wouldn't say I'm a specialist. So, I'm really curious. So, if somebody is using alcohol or any other substance to manage their anxiety, would you teach them skills before they take the break so that they have the skills for the break or would you just start to take the break and then pick up what gets lost there? What might be some steps and what skills may you teach them? Amanda: I think it's a bit of both. I think if you only teach skills before, someone might never take the break, which is fine. But I think if you are only teaching the skills, a lot of times, the skills, I think that's really good to start before you take the breaks. You can learn how to start dealing with your emotions maybe without drinking, for example. But some of the other stuff like going to a party, without drinking is something where if you don't actually take that step, it's probably unlikely that you're ever going to do it until you've pushed yourself to take that break. But in general, yeah. I mean, I think one of the most important ones is learning how to cope with your emotions. People use alcohol all the time, especially alcohol becomes a way to deal with loneliness, to deal with stress, to deal with sadness. And I think-- Kimberley: Social anxiety is a big one. Amanda: Social anxiety. Absolutely. And I think a lot of us literally don't know how to process an emotion, say no, set that boundary, take care of themselves on a basic level without drinking. So, those are some of the skills I think are really important to learn. Kimberley: I mean, yeah. And for a lot of the folks that I see because their anxiety is so high, would you say they're using it to top off that anxiety to try and reduce it? In the case where if you're not drinking, you're having high states of anxiety. Is there any shifts that you would have them go through besides general anxiety management? Amanda: I think the example I'm thinking of is maybe social anxiety. If there's a specific instance, right? I know you talk about this a lot on Instagram, like exposures can really, really help with reducing anxiety. And I think there are steps that you can take that are small if you have a lot of social anxiety about going to a party and not drinking, for example, and you're relying on alcohol to deal with going to a party. I mean, some of the things off the top of my head I can think about are like driving to the place where the party is before it happens, talking to someone who is going to be at the party – taking these small steps to desensitize yourself to it so you can build up your tolerance before you go. Or maybe you go, if this is the first year and you only stay for a short period of time, rather than going from nothing to expecting yourself to go and have fun and stay at the whole party the whole time. Kimberley: Right. What was your experience, if you don't mind sharing? What were those 30 days like, or can you share it, put us in your shoes for a little bit? Amanda: Yeah, absolutely. So, I struggled a lot with an eating disorder and I kept relapsing in my eating disorder when I would drink. And I had said to my therapist at the time, "I think that I might have a problem with alcohol. I don't know." And she recommended me do those 30 days. And it was really hard for me. I didn't actually make it to the first 30 days when I originally tried because I was so afraid of the pushback of friends, of people asking me why, of not being able to be fun. A huge part of my identity at that time was all wrapped up in what people thought of me and going out and being the fun, crazy one. Kimberley: Yeah. And it's interesting how the different experience, because I too had an eating disorder. But my eating disorder wouldn't let me drink. Amanda: Yeah. Kimberley: That would be letting go of control, and what if I binge, and what if I ingest too many calories? So, it's funny how different disorders play out in different ways. It was actually an exposure for me to drink. What we quote, I think I'd heard so many times "empty calories" or something. So, that was a different exposure for me of that. But I can totally see how other people, of course again, it does-- I mean, I think that this is interesting in your book, you talk about the pros and the cons. It does make it easier to be in public. It does "work" in some settings until it doesn't. Amanda: Exactly. And I think that's so important to normalize and it's part of why I wrote my book because there aren't many books that are, you'll get this as a therapist. I can think of many different situations where, like you said, I wouldn't tell a client, "You should absolutely stop drinking," because everything is unique. So, I really wanted to write a book that took into account different things and really led the reader through their own journey where they get to discover it for themselves because while there's amazing books out that I love, there aren't a ton that talk about this gray area, drinking, this middle lane, this truth that a lot of times you can feel lonely when you don't drink because you're left out of certain things. And that can cause more anxiety. So, we have to navigate all of that. Kimberley: Yeah. It's interesting too, and I don't know if I'm getting this research correct. And maybe I'm not, but I'll just talk from an experiential point. It's similar with cigarettes, I think. There is something calming about holding the wine glass. Even if it's got lemonade in it, for me, there's something celebratory about that. And so, the reason I bring that up is, is that a part of the options for people? Is to explore the areas? It's funny, I remember my husband many years ago that we talk about cigarettes, because he works in the film industry, and he would say, "The people who smoke cigarettes are the ones who actually get a break because they have to leave set and they get to go outside and sit on something and breathe and have a moment to themselves. If you don't smoke, you're lazy if you take a break." And so, is that a part of it for you in terms of identifying the benefits and bringing that into your life? Like, I still now drink sparkling cider or something, an alcoholic in old champagne glass. My kids are always joking about it. Is that a part of the process? Amanda: Absolutely. And that's something that I completely agree with you. I think sometimes we don't even want an alcoholic beverage. We want a moment. We want a break. We want a feeling different or celebratory, which is why we take out the wine glass that isn't a regular glass, something like that. And that is why I really believe, I mean, it depends on the person. And sometimes if someone has more severe drinking a non-alcoholic beverage initially could be something that's triggering for them. But I am a big believer too. And yeah, put it in a fancy glass. If you enjoy a mocktail, drink something different than water, you can explore different options. And I think some people are really surprised at how much it's not actually about the drink sometimes, it's the ritual of making a drink or the ritual of using that special glass, or the ritual of drinking something that isn't water. Kimberley: Right. Yes. Or even just the ritual of the day ending. I always remember, my parents would be five o'clock, right? And at five o'clock they would have the-- this is a big family tradition, is at five o'clock, you'd bring out the cheese and the crackers and the grapes and the wine. And it was the end of the day. And so, I could imagine, if someone said, "We're going to take that away," you'd be like, "No, that's how I know the day is over. That's how I move from one thing to the other." And sometimes we do think black and white. It means you have to take the whole cheese platter away as well, right? Amanda: Absolutely. We can get almost in our heads of maybe we think we're more dependent on that cheese platter or the wine or whatever, without realizing that what we really like about it is the ritual. Kimberley: Yeah. So, you can share it or not, how does your life look now? And for your clients, give me maybe some context of what do people arrive at once they've been through this process and how might it be different for different people. Amanda: Totally. So, I'm completely sober. I don't drink alcohol. I've been sober for seven years. And in terms of how the process looks for me, I drink mocktails. I drink out of wine glasses sometimes. I love going to a bar and seeing sometimes if there's an alcohol-free option on a menu, I think that's really fun. And for me initially, when I was thinking about this and working on it, like I said, it was very tied to my eating disorder. But the biggest thing for me is I used to think, well, I can't totally stop drinking because that's black and white, and that's not freedom. Freedom is being able to decide. And I think what is different and unique compared to an eating disorder, for example, is that alcohol is addictive, right? Unlike food, it is an addictive substance that we can live without. And for me, I used to, or for me, I don't have to think about it if I don't drink. When I was trying to moderate, it was a lot of decision fatigue. It's like, "What am I going to drink? How much am I going to drink? When will I stop? Am I going to drink too much?" It was all of these decisions. And freedom for me now actually is just not drinking and not thinking about if I'm going to drink or not. So what my life looks like now is I'm sober, I've been sober for seven years. I enjoy going out to restaurants and getting alcohol-free drinks and things like that. And I used to be really worried that that was too reductive, that I was too black and white if I just said I wanted to be sober. But the truth is unlike food, alcohol is an addictive substance. When you have one alcoholic beverage, it does create a thirst for itself for most of us. So, for me, the freedom is actually not worrying about whether I'm going to drink or not. It's so exhausting for some people, myself included, to be constantly thinking about how much you're going to drink, if you're going to drink, when you're going to drink, what you're going to drink. And now, the real freedom for me is I don't drink. I don't think about it. And that's the freedom because-- sorry, I just got caught up in what I was saying. Kimberley: No, I think that that is so beautiful. As you were saying it, I was thinking about me in a Fitbit. I will never be able to wear a Fitbit. Because as soon as I know, I could wear it for day-ish. And day two, I'm all obsessive and compulsive. I just know that about myself. And some people can wear it and be fine, and I can never wear a Fitbit. I just can't. My brain goes very, like you said, on how many? More or less, what's happening? And so, I love that you're saying that, is really knowing your limits and whether it's-- the Fitbit, it's not actually the problem, but the Fitbit is what starts a lot of problematic behaviors that I know is just not helpful for me. Amanda: Yes. And I think it's important to recognize there are factors that make us more likely to be able to moderate successfully or not, right? The amount of alcohol you've drank throughout your life, your past drinking habits, whether you have a history of addiction in your family or substance use, whether you have trauma, whether you have anxiety, all of these things might make it more difficult for you to moderate compared to someone else. Kimberley: Right. I don't know if this is helpful for our listeners, but I went sober. My husband and I did for the first year of COVID. What was interesting is then I got put on a medicine where I wasn't allowed to drink and I felt offended by this medicine because I was like, "But you're taking my choices away." And so, I had to go back. Even though I'd made the choice already, I'd had to go back and really address this conversation of like, "Okay, why does that feel threatening to you" and to look at it because a part of me wanted to be like, "No, I'm going to start drinking now just because they told me I'm not allowed." So, it's so funny how our brain gets caught up on things around drinking and the rules and so forth. So, I didn't think of it that way until you'd mentioned it. Amanda: Yeah, absolutely. And I think that that can be why people rebel against "I'm not an alcoholic" mindset instead of it being a choice, instead of it being "My life is better without drinking." I often say, my drinking was like Russian roulette. A lot of times it was fine when I drank, but the times where it wasn't fine, I was not willing to put up with it anymore. And I don't know whether I could drink successfully or not, but it's not a risk that I'm willing to take. And it's not worth it compared to all the benefits that I have from sobriety. And because of that, it really feels like an empowering choice. Kimberley: Yeah. My last question to you before we hear more about you is, what would you say to the people who are listening, who aren't ready to have the conversation with themselves about whether it's helpful or not? I think I learn in a master's grade the stages of change. You're in a pre-contemplation stage where you're like, "I'm not even ready to contemplate this yet." Do you have any thoughts for people who are so scared to even look at this? Amanda: Yeah. For people who maybe are in that pre-contemplation, not sure if they want to do the deeper work to question their relationship with alcohol, what I would recommend to them is start by just trying to reduce some of their alcohol intake. They don't have to stop drinking. They don't have to even think about whether it's serving them or not, but there are so many amazing alcohol-free beverages that exist now. I mean there's alcohol-free beers and wines and all kinds of things. And you could just try swapping one of your alcoholic beverages with that when you go out or at home and just see how that makes you feel. Kimberley: Yeah. It's a great response in terms of like, it is. It could be. Would you say that's more of the harm reduction model? Amanda: Yeah, absolutely. Or someone who's not ready or really interested in the big conversation. That's one of the reasons I really support and like the alcohol-free beverages and stuff like that because it gives people, I think, an easier way to step into it. And sometimes even realizing too, like alcohol-free beverages can taste really good compared to the beverage that has alcohol in it. So, you're not drinking this for the taste. Kimberley: Exactly. Sometimes when I have drunk alcohol, I'm like, why am I even drinking this? It's not delicious. Amanda: It's true. Kimberley: It's not delicious. I love that you say that about-- I think one of the wins of the world is they are creating more, even just the bottles and the look of them are much nicer than the general or dual looking kind of bottles, which I think is really cool. I love this conversation, and thank you so much for bringing it to me because I do really believe, particularly in the anxiety field, we are not talking about it enough. So, I'm so grateful for you. Amanda: Absolutely. I'm so glad that I got to chat about it because, yeah, the anxiety connection is huge. Kimberley: Yeah. Tell me about your book and all about you. Where can people find you? Amanda: Yeah. So, my book comes out on January 4th. It's called Not Drinking Tonight. And 2022, because this is out. Kimberley: Yeah. Amanda: Sorry if I messed up. Kimberley: No, no it's good. So, for people who are listening on replay, it will be out as of 2022. Amanda: Yeah. It's called Not Drinking Tonight: A Guide to Creating a Sober Life You Love. It is broken up into three different sections so that you can learn in the first section why you drink, and I go into evolutionary psychology and trauma and shame. In the second part, it's about reparenting yourself or the tools that you need to stay stopped. So, I talk about boundaries and self-care and all of the things, emotional health, how we take care of our emotions. And then in the last section, I talk about moderation, relapsing, the overlap of alcohol use and other substances or ways we numb. So, really though my book is structured around alcohol. I talk a lot about eating disorders, perfectionism, workaholism, other drugs, because I think a lot of it is the same in that sense. Kimberley: 100%. Amanda: So yeah. And you can find me on Instagram at Therapy For Women, or my website is amandaewhite.com. Kimberley: Amazing. Thank you so much. It's so great to actually have a conversation with you face to face. Well, as face to face as we can be. So, thank you so much. Amanda: Thank you. This was so great. ----- Okay. And before we get going, I'm sure you got so much out of that episode. Before we get going onto your week, I wanted to share the "I did a hard thing." This one is for on Paula, and she said: "I started ERP School earlier this year. While looking into my OC cycle, I was surprised to find out that I had some overt compulsions. I thought they were mostly mental. And that's when I figured out I had a BFRB. My loved ones had commented on my hair pulling in the past, but I didn't realize how compulsive it could be. I watched Kimberley's webinar on BFRBs, and I got inspiration to be creative. I tried to use hand lotion, so it would make my hands sticky and demotivate hair pulling. I also got a fidget toy to keep my hands occupied whenever I felt like pulling. But what worked best was you using a transparent elastic band to tie up the two strands I used to pull. It's perfect because it creates a physical barrier to pulling, but also a sensory reminder. If my fingers feel the band, I can say to myself, "Oh, the band, that feels different." And because I'm trying to make a change, way to go me. Thank you, Kimberley, for all the amazing work you do." So guys, this is amazing. If you didn't know, if you go to CBT School, we have a free training for people with BFRBs. If you have OCD, we have a free training for people with OCD. So, head on over to CBT School, and you can get all of the cool resources there. Have a wonderful day, everybody. And thank you so much for the "I did a hard thing." That was so cool. I was not expecting that, Paula. Congratulations! You are doing definite hard things. Have a wonderful day, everybody.

Jan 21, 2022

In today's episode, Kimberley Quinlan talks about the importance of identifying catastrophic thinking. The reason this is so important is that this type of cognitive distortion or cognitive error can increase one's experience of anxiety and panic, making it harder to manage it at the moment. Kimberley talks about the importance of mindfulness and self-compassion when responding to catastrophization also. In This Episode: What is Catastrophization? Why is it important that we catch how we catastrophize? How to manage Catastrophization? How correcting our thoughts can help, sometimes..but not always. Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 218. Welcome back, everybody. How are you doing? How are you really? Just wanted to check in with you first, see how you're doing. We're friends, so it's my job to check in on you and see how you are. Thank you for being here with me again. I do know how important your time is, and I am so grateful that you spend it with me. Thank you. That is such a joy and it's such a wonderful experience to know that I am spending time with you each week. This week, we are talking about the danger of catastrophization. Now, I'll talk with you a little bit more about what that means here in a second, but basically what I want to do in this episode is really to take off from the very first episode of this year, which was the things I'd learned in 2021. One of the points that I made there was to really take responsibility for your thought errors, right? And I wanted to pick one of the thought errors that I see the most in my clients. In fact, in the last couple of weeks, it's been an ongoing piece of the work we do. It's not all of the work, but it's a piece of the work, is for me just to be, I'm still doing teletherapy. So, we're sitting across from the screen and just reflecting and modeling back to them some of the ways in which they speak to themselves and really looking at how helpful that is and how that impacts them. So, before we get into that episode, I want to offer to you guys to submit your "I did a hard thing." Today, as I went to prepare for this episode, I checked the link and we'd actually used up all of the ones that were submitted probably in August of 2021. And so I'm going to encourage you guys to submit your "I did a hard thing" so I can feature you on the podcast. When we first submitted, we had like 70 submissions, and I've used all of them up. And I would love to get new ones to share with you and have you be featured on the show. So, if you want to go over, you can click on the show notes for the link, or if you want, you can go to kimberleyquinlan-lmft.com. So, that's Kimberley Quinlan - L for License, M for Marriage, F for Family, T for Therapy.com. Click on the podcast link, which is where we hold all of our podcasts, and you could submit your "I did a hard thing." And I'd love to have you on the show. It actually is probably my favorite part. I could easily just have a whole show called "I did a hard thing" and it could be just that. All right. So, let's get into the episode. Today, I want to talk with you about the danger of catastrophization, and let me share with you how this shows up. So, I want to be clear that you cannot control your thoughts, your intrusive thoughts that repetitively show up, and you can't show your fear up. You cannot change your feelings. So, you can't tell yourself not to be sad if you're sad and you can't tell yourself not to be anxious if you're anxious and you can't not panic if you're panicking. But you can change how you react and how you behave. That is a common CBT rule. Now often, when you have an intrusive thought, a lot of my patients or clients will report having anxiety or having a thought or having a feeling or having an urge or having an image that shows up in your head – because that's what I do, right? People come to me with a problem. The problem is usually a thought, feeling, sensation, urge, or image. That's what I do. And what I try to do is change the way they respond. That is my job, right? Now, what often happens is, there is a thought or a feeling or a sensation or urge, impulse, whatever it may be that shows up, and they often will respond to that by framing it in a way that is catastrophic. I'll give you some examples. So, when they have the presence of anxiety in their body, they may frame it as: "I'm freaking out." That's a catastrophic thought. When they had a lot of anxiety or maybe they had a panic attack, they frame it or they assess it by saying, "Kimberley, I almost died. I had the biggest panic attack of my life. I almost died." Or "It nearly killed me. The anxiety nearly killed me," or "The pain nearly killed me." They may have tried to do an exposure or they may have tried to reach a goal that they had set, and they'll say, "I failed miserably. It was a total disaster." They are trying to recover from a mental illness or a medical illness, and they'll say, "I'll never amount to anything. I'll never get better." Or they're suffering. We have different seasons in our lives. We have seasons where things go really, really well and we're like winning at life. And then we have seasons where things are hard and we just have hurdle after hurdle, after hurdle, and they'll say, "There's no point, my life is not worth living," or "I'm never going to be able to solve this." Now, first of all, if you've thought any of these things, I am sending you so much love. Your thinking is not your fault. I'm not here to place blame on you like, "Oh, you're bad at this," because our brains naturally catastrophize, because our brain wants to make sense of things and put them in little categories because that is the easiest, quickest way to understand our world. So naturally, we do this to make sense of the world. If I said to my daughter, "How are you doing with math?" She'd go, "Oh, it totally sucks," because it's easier to say, "It totally sucks," than to say, "There are some things that I'm doing well with and some things that I am not. I am struggling with this thing, but I'm finding this part really enjoyable." That takes a lot of energy to say that, and it takes a lot of energy to hold opposing truths. We've talked about this in the past. It's not the fastest, efficient way to live when you're living in those types of ways. So, what we often will do, particularly if we are having a lot of strong emotions, is we catastrophize. Now often a client will say some of these or many others. There's many ways we can catastrophize, which is to make a catastrophe out of something. When they say it, I don't say, "That's wrong. You're bad for thinking that." I'll just say, "I'm wondering what percent of that is correct. Like I almost died. Okay, I'm interested to know a little bit about that. Did you almost die?" And they'll be like, "No." I'm like, "Okay." And I'm not there to, "I really want to model to you." I'm never across the screen or across the office with my patient, trying to tell them how wrong they are. Never. That's never my goal. But I want them to start to acknowledge that the way in which they think and they frame an experience can create more problems. Now if they said to me, "Kimberley, I want to think this way. I like it. It makes me happy. It brings me joy. I'm fulfilled this way," I have nothing to fix. But often, once we reflect, and I often will then ask my patients, "So when you say 'I totally freaked out.' You had anxiety and you said, 'I totally freaked out,' how does that feel?" And often they'll say, "Not good." They'll say, "It actually makes me feel more anxious." Or if they had an intrusive thought, let's say they had OCD and they had an intrusive thought and we can't control intrusive thoughts, and then their response was, "I'm a horrible human being who doesn't deserve to be a mom for having that thought," I'll say, "How does it feel to respond to your intrusive thought that way? How does that have you act?" And they're like, "Well, it makes me feel terrible and not worthy. And then I don't want to do anything, or then I just want to hide, or then I have so many emotions. I start freaking out even more. And now it's a big snowball effect." So then we start to gently and curiosity-- sorry guys. Then we begin to gently and curiously take a look at what are the facts or what actually lands to be true and helpful. I want to be clear. We do not replace catastrophization with positive thinking. I would never encourage a client to replace "I am freaking out" with "I am feeling wonderful" because that's not true. They're actually experiencing discomfort. They are experiencing panic. They had an intrusive thought. They're having an urge to pick or pull. They're having an urge to binge. They're having depression. They're having self-harm thoughts. So I'm not here to, again, change those particularly. But I really encourage them to look at how you frame that experience, how you respond to that experience. What would bring you closer to the goal that you have for yourself? Because usually, when people come to me, they'll say, "I want to feel less anxious," or "I want to do less compulsions," or "I want to pick my skin less," or "I want to binge less," or "I want to love my life. I want to feel some self-esteem and worth. I want to take my depression away." So, we want to really look at catastrophization and look at the danger of continuing to use that pattern. Now, let me get you in on a little trick here. I titled this podcast "The Danger of Catastrophization" because the title in and of itself is a catastrophization. Did you pick that up? That's a lot of what happens in social media, is they use catastrophic words to peak your interest. It sells a lot of things. In fact, some businesses sell on the principle of catastrophization. They tell you what catastrophe will happen if you don't buy their product. They might say, "You'll have wrinkles. Terrible, old wrinkles if you don't buy our product." And that may feel like a catastrophe because they're trying to sell you their product. They may say, "If you don't buy this special extra filter for your car, it could explode on the highway." That's a catastrophe. "Okay, I'll buy it." So, even my naming of it, I want you to be aware of how it piques your interest, the catastrophes, and how it draws you in because nobody wants a catastrophe. But for some reason, we think in this way. So I made a little trick there. I tricked you into listening. I try not to use it as a tool, but I thought today it would be really relevant to bring it up and see whether you caught that catastrophization that I did to get you onto this episode. I'm a naughty girl, I know. There it is. I want you to catch how you frame things and how you tell stories about things that you've been through or about the future and catch the catastrophization that you do. If you have a supportive partner or friend or somebody in your life, a loved one, and you trust them, you may even ask them to just give you a little wink every time they catch you using a catastrophization. Sometimes you don't catch it until someone brings it to your attention. Because again, our brain works on habit. Our brain works on what it knows, and it doesn't really like to change because that means you have to use more energy. But I promise you. I promise, promise, promise you, this is the energy you want to use. This little extra piece of energy is totally worth it, because think about it. If I said to you, "I had a panic attack, it was really uncomfortable. I rode it out. There were some moments where I felt really confident and some moments where I was struggling, but it did go away eventually," ask yourself how that feels. And then I'm going to tell you a different version: "I was totally freaking out. I totally thought I was going to die. It was so bad. I really think it was the most painful thing I've ever been through in my whole entire life." How does that feel? It feels terrible. A lot of panic comes from people catastrophizing, using language that feels really dangerous. The danger of catastrophization – remember, it feels dangerous when we use catastrophization. So, just be aware of it. Catch it if you can. Okay? All right. Before we finish up, I want to do the review of the week. This is by Dr. Peggy DeLong and she said, "Wonderful practices!" She gave it a five-star review and said, "I appreciate that you highlight these skills as practices. Coping with anxiety is not a one-and-done deal. Practicing these skills, even on good days, especially on good days, helps to promote long-term well-being. Thanks for providing this service!" Thank you so much, Dr. Peggy DeLong. I am so grateful for your reviews. Please, go and leave a review if you have some time. I would be so grateful. It really helps me reach people who, let's say, look at the podcast and think to themselves, would this be helpful to me? And if there's lots of reviews, it helps build trust for them that they would then click, and then hopefully I can help them. Okay? All right. Sending you all my love. One quick thing to remember is if you go over to cbtschool.com, we actually have a full training on this, on correcting the way that you think. Again, the goal is not to change your intrusive thoughts, but the goal is to work on how you reframe things. So you can go there for that training. All right. All my love to you guys. Have a wonderful day. It is a beautiful day to do hard things.

Jan 14, 2022

SUMMARY: Today we have Windsor Flynn talking about how she realized the benefits of meditation for anxiety and OCD in her recovery. Winsdor brought her lived experience and training to the conversation and addressed how meditation has helped her in many ways, not just with her OCD and mental health. In This Episode: The benefits of meditation for general anxiety The benefits of meditation for OCD The roadblocks to practicing meditation How Mindfulness and mediation help with daily stress (especially through COVID-19) Links To Things I Talk About: Instagram: @windsormeditates Instagram: @Windsor.Flynn Website: www.windsorflynn.com (Windsor is certified to teach the 1 Giant Mind 3 Day Learn Meditation course). ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 217. You guys, 217. That's a lot of episodes. I'm very excited about that. Today, we have with us the amazing Windsor Flynn. I cannot tell you how incredibly by inspired I am with Windsor. She is very cool and has so much wisdom and so much kindness to share. Today, we have her on to talk about having anxiety and learning the importance of meditation. Now, Windsor speaks specifically about having OCD and how much it has helped her to take up a meditation practice. She goes over the couple of main key points, which is number one, anyone can meditate. And that meditation can be user-friendly for people, even with OCD. And she said, "Especially for people with OCD." And she actually gives us the amazing gift of a guided meditation at the end, that just helps you bring your attention to the present and learn to drop down into your compassion and your body. And then the third point she makes is that meditation can be integrated into your life, even if you feel like you don't have time, or even if it's really uncomfortable. And she shares some amazing experiences and examples of where she really struggled and how she got through those difficulties. So, I'm going to quickly first do the "I did a hard thing" and then I'm going to let you guys get right into the amazing conversation with Windsor Flynn. So, today's "I did a hard thing" is from Anonymous, and they said: "I wear a dress that has been sitting in my closet for months. I was always scared to show my skin since breaking out in hives over my social anxiety. I felt proud for the first time in a long time." This is so cool. You guys, I love this so much. They're really talking about showing up imperfect and all, or letting people judge them and going and doing what you want to do anyway. And that is what this podcast is about. It's about living the life that you want, not the life that anxiety wants you to have. And often, anxiety will keep your life very small if you only listen to it and only follow its rules. And so, anonymous is doing this work, walking the walk, not just talking the talk. So, yes, I'm so, so in love with this. Now you guys, you can go over to my private practice website, which is where the podcast lives. It's Kimberley Quinlan - L for License, M for Marriage, F for Family, and T for Therapist – I had to think there – .com. So, KimberleyQuinlan-lmft.com. And then you can click on the podcast and right there is a link for you to submit your "I did a hard thing" and you can be featured on the show. So, go do that, but not right away. First, I want you to listen to this amazing, amazing episode. Kimberley: Welcome. I am so excited for this episode. I have a reason for being so excited, which I'll share with you in a second, but first, I want to introduce to you Windsor Flynn. She is incredible. I have watched you grow over the last what? A year or two years since I've known you. It is so wonderful to have you on, so thank you for coming. Windsor: Yeah. Thank you for inviting me. This is so cool because I've spent a lot of time listening to your podcast and, I don't know, just hoping to be on Monday, but I didn't know for what. So, this is really cool for me. Kimberley: Yeah, this is so cool. So, you're coming on to talk about meditation. And the reason that this is so exciting for me is that is actually what this podcast was originally for – was to bring mindfulness and meditation practice to people who have anxiety. And I did a lot of meditations at the beginning and then I lost my way. So, I feel like you coming here is full circle. We're going back to the roots of the show to talk about mindfulness and meditation. Do you want to share a little bit about your story with mental health and why you landed on this as being your passion project? Windsor: Yeah, sure. So, I started-- I guess my mental health story goes way back, but I'll just start at the beginning when I first came to my OCD diagnosis. I had been experiencing anxiety. Looking back, I will say it was pretty debilitating, but I was sort of just powering through it. I was a new mom. I didn't have a lot of mom friends, the first in my group to have kids. My parents are across the ocean in Hawaii. I'm in California, in San Francisco with my boyfriend who is shocked at being a dad. So, I'm very anxious, but I'm doing all the things. And I had started experiencing intrusive thoughts, which I didn't know were intrusive thoughts. I was just really worried that I was going to become a headline for like moms that murder. I hate moms that kill because I had heard of this story. I'm sure so many people who grew up at the same time as me were really familiar with the Andrea Yates story. I don't need to go full into detail, but she had some mental health issues and she ended up killing her kids. It's a very, very sad story, but I had attached to that because I was just so, so scared that that would happen to me. And I don't know why I was nervous that this would happen to me. But ever since I was little, I just always thought that anything drastic, it would happen to me. I would be there for the end of the world. I would be there to witness a mass murder, or I would be a victim of a serial killer. All these things, I just thought it had to be me. I don't know why. So, of course when I have a baby, I'm thinking, "Oh no, this horrible thing, it's bound to happen to me. I need to pay attention." So, that's when the hypervigilance started, all of these things that I now have language for, but I wasn't quite sure how to explain, and I also didn't want to explain it to anyone because it sounds unhinged. So, I was doing this alone. I was trying to keep myself very busy. I was doing all the classic compulsory activities that happen when you're trying to avoid intrusive thoughts and avoid this massive discomfort in fear. And eventually, we moved out of the city. So, not only was I mothering by myself-- not really by myself. I had a partner, but he was working a lot just with his schedule. So, he was sleeping most of the day and gone all night. So then we moved across the bay to Alameda and then I just didn't even have friends anymore. So, I was all alone. So, I was thinking, "Wow, if there's ever going to be a time that I'm going to just completely go off, it'll be now." And then it just snowballed. It spiraled into this thing where I couldn't not be scared and I didn't know what was going to happen. I was convinced that I was going to kill my son for no other reason. Then I just had a feeling that something bad was going to happen. So, I looked up postpartum mood disorders because somehow, I knew those existed. And I was hoping that this had something to do with it. I still had hope that there was an explanation. And I found something that said Postpartum OCD, and anxiety. And of course, I hit every single track mark. It wasn't mild symptoms. I was just, yup. Check, check, check, check, check. And so, I felt a little okay. Not really, right? And I finally saw someone who ended up being-- she said she was a postpartum specialist, which was great. I signed up with her. We talked. She told me I had OCD. It was cool. But she didn't give me any tools. She was doing the root cause stuff, which is probably really helpful in other circumstances, not necessarily for OCD. But she reassured me enough that I was cool with my OCD. I was like, "Well, I'm not going to kill anyone. That's fine. I can go home. I can continue being a mom as long as you're telling me I'm not a murderer." Just like, "No, you're not a murderer." I was like, "Great, well, we're done here, I guess." And I got pregnant again. And of course, I was so scared. I was like, "That's going to happen again. I'm going to have postpartum OCD." So, I couldn't pause my whole pregnancy, but it was in the name of preparedness. So, I didn't know that I was making my symptoms worse and worse and worse until I had the baby. This time I'm not scared I'm going to kill anyone. I'm just scared that now I think she's the devil, which I did not know how to recognize it. So, finally, I'm experiencing a whole different subset of OCD symptoms. I didn't know, but I just thought, well, it was OCD the first time. I'm just going to check. And luckily, I landed on my therapist. I still see-- even though this was four years ago, I still see her every two weeks. I love her. She's the best. She's given me all the tools I needed to manage my mental health, got me to a place where not only was I totally understanding the disorder, but I felt really comfortable sharing and sharing in a way that I thought would be helpful to other people. So, that's when I started advocating for maternal mental health and OCD, and that's how we know each other, through the internet, social media space. And I guess that was a mouthful, but that was how I landed onto the advocacy part. And eventually, I switched to meditation because I felt like this was a tangible way that I could offer a service that I know to be helpful for the management of mental health. And I know how much resistance there is towards starting this meditation practice because I too went through a number of years where I absolutely said no to this idea of meditation. But once I started, I realized, wow, I don't know why I didn't do this sooner. There's really something to it. And it's very teachable. And I know from firsthand experience how beneficial it is. Kimberley: I love that. I actually don't think I've heard your entire story. So, thank you for sharing that with me and everybody. I didn't realize there were two waves of OCD for you and two different subtypes, which I think is common, for a lot of people. Windsor: Yeah. Kimberley: I love that. So, I think what you're saying, and can you correct me if I'm wrong? So, the first wave was reassurance, what you used to get you through. And then the second you used ERP? Windsor: Yes. Kimberley: Okay, great. And then from there, the third layer of recovery or however you want to say it, was it meditation, or were there other things you did to get to the meditation place? Windsor: Well, I was doing ERP and that really helped with my OCD management. I was able to recognize whenever I had a new obsession, and I feel like I could recognize anyone's new obsession. At this point, I was like, 'Oh, that's this, that's this. It's tied into this." So, I had a really great understanding, and that was cool. But I still have two kids, we're still in a pandemic, I still have communication issues with my partner – all these normal things that ERP doesn't necessarily help with. So, it was really just about finding that balance between working on myself and stress management and really getting to be that calm, chill person that I've always wanted to be. Even when I was doing the best with my OCD, I was still not so relaxed because I had a lot of attachments to how I wanted people to perceive me, how my children were behaving, not necessarily in a controlling way, but just really feeling a lot of responsibility over everything. And so, the meditation was just this next step that I was hoping would get me there, because I was feeling a lot of stress, not even related to my OCD, just in general. And I wanted to be able to find something that would help me get through that stress so that I could start really figuring out what it is I wanted to do, just even for fun again, instead of just only feeling this overwhelmed. Kimberley: Yeah. No, I really resonate with that. All I can say for me is, while I had a different story, I had an eating disorder, I was trying to do meditation during that, but the thoughts and everything was just too big for it. And it was hard for me to access actual meditation without it just being an opportunity to ruminate, sitting there, just cycling. So, the main thing I really want to ask you, if you're willing to share, is let's say specifically someone with OCD, what were some of the struggles that you had with meditation? Because I know so many people with OCD are really resistant to it because the thoughts get louder when you sit still and so forth. So, what were some of the things that you had to work through to be able to sit on a cushion? Windsor: Yeah. That's such a great question because I feel like, had I not figured out that I had OCD and then done all this work with ERP to really learn how to acclimate myself to the presence of intrusive thoughts, I don't know that I would've been successful in meditation. Actually, I know that I wasn't because I had tried it before, and it was too hard. So, I really-- even with ERP, once I started the meditation journey, the first few weeks were pretty challenging for me because as someone with OCD, every time I close my eyes and I'm not occupied, or my brain is not occupied, it's like prime time. This is OCD's favorite. It's like the time to shine. It's like, "Okay, here I am. What can we throw out to you today?" And so, knowing that this was a possibility, even when I signed up to learn meditation, I was like, "Okay, I'm going to do this. I'm going to try, I'm going to give college a try." Then my OCD was like, "No." You close your eyes, something could happen, like you could have a breakdown or you could make all these realizations that you are a psycho killer. And then you'll just definitely kill everyone. Thank God you tried meditation. Now your true self can come out. And I was like, "Okay, I'm going to just do it anyways. I'm just going to meditate because I have to see, not even in a compulsory way, I have to see if this is true. But I can't-- knowing now what OCD does, I couldn't-- it was almost I took it as a personal challenge. Kimberley: Like an exposure, right? It was like an exposure, like, "Okay, fine. I'm going to-- let's see." Windsor: I signed up to learn meditation as a true exposure because now I had this fear that if I come to all these realizations, it won't be cool. It will be devastating for everyone around me. So, I was like, "Well, I'm going to try. I'm going to try to meditate." And do you know what? I cried and panicked the first time. I had to turn off my camera because I did not want the teacher to see. Kimberley: So you did it live. Windsor: I did it live. It was so hard. It was like a total exposure because this was in front of-- I think there were 25 people in the course and everyone was closing their eyes, I'm assuming. But 20 minutes is a long time to meditate. So, I know people were going to be opening their eyes. So, I was live having this fear that I was going to turn into a psycho killer on the camera. So, I was crying because it was hard. But you know what? I'm so glad I did because also ERP showed me that crying is fine. We can cry when we do hard things. I was doing the hard thing and I was proud of myself. I even shared afterwards. We were like, "Who wants to share?" And I was like, "Me." I cried and I had a panic attack. Kimberley: See. That is so badass in my mind. That is so cool that you did that. You rode that wave. Windsor: Yeah. And it was great because if I didn't do that or purposely put myself into the situation to cry and do this hard thing, I wouldn't have been able to get to the good part of meditation, which I love. I like to talk about the good part of meditation. But having OCD makes starting the hardest part. Kimberley: Yeah. What is the good part of meditation for you? Because I think that no one wants to do hard things unless they know there's some kind of reward at the end. Everyone's going to be different, but for you, what is the why? Why would you do such a thing? Windsor: Well, because I learned this thing, right? That was so valuable. Someone told me, we don't gauge the benefits of meditation for how we feel when our eyes are closed. We're more interested in what happens while our eyes are open. How is it impacting? And I noticed almost right away that when tensions were high, when I usually would be the first to participate-- because I'm really affected by the way other people's moods are. I feel responsible or I have to change it. I became dysregulated really easily. I noticed almost right away that when other people were feeling their feelings around me, I was able to observe them instead of participate in that, which was really cool. And it was just so much nicer to be able to be supportive instead of become one of those people who also needed support in that moment. And I also noticed right away that I had a higher tolerance for loud noises and just disruptions, because I'm pretty sensitive to lots of different noises at once. It gets me pretty anxious and agitated. So, having kids at home all day isn't ideal for that. And so, the meditation really helped me a lot with that. I was able to recover more quickly from periods of dysregulation. Maybe I would become dysregulated, but I could calm down quicker. And so, I really loved that. And I noticed that as before where I would be like, I need wine at 4:30 or whatever time it was. Once I started meditating for a few weeks, then wine just became something that tasted good that I liked in the afternoons. I didn't need it. Sometimes I would be like, "Wow, we're having dinner. Oh my God, kids, I didn't even have wine." And they were like, "Wow, you're right." And so, I would pour myself a glass just because I like it. Kimberley: Right. Not because you needed it to get through the afternoon. Windsor: Yeah. And so, I really liked all those changes. And it just is really restful, which I wasn't expecting. The practice itself, the one that I practice, it's twice a day. And I find that doing those two meditations really gives me more energy because I'm not a coffee person. So, yeah, I just feel like what started as a thing that I wanted to feel more rested and less stress, it has actually become a tool that I can use to help maintain a busier lifestyle, which as much as I don't love for everyone, I can't avoid it. Anyway. Kimberley: That is so cool. I mean, how amazing that this practice came to you. So, you are talking about this specific meditation practice that you use and the benefits. Do you want to share a little about what specifically you use? I'm sure some people here have heard from me of self-compassion meditations and mindfulness meditations, but do you want to share specifically what practices you are interested in practicing? Windsor: Yeah. So, the practice that I find the most success and enjoyment out of is a silent meditation, which actually was the most intimidating for me, but I love it. It's the one giant mind being technique. It's called a being technique because, I guess the focus of the meditation is to connect with your being, which I guess if you say it without sounding too woo-hoo or anything like that, we're just connecting to your true self apart from all the thoughts and the ideas and all the conditioning we have. Just getting back to you, which is something that I really wanted, especially after having two kids and being confused in the state of life that's not really developed yet. So, I love that part. And since I didn't have to focus on anything like someone else's voice, or trying to follow a guided meditation, sometimes I feel that takes more energy because I still have to pay attention to something. A silent meditation allowed me to really find that rest and allowed my brain to just slow down. Kimberley: Yeah. I too. I mean, I love guided meditations for people who are starting off and need some instructions. But I find the silent meditation once I got the hang of it, I could practice it in a minute between clients. I could just sit for-- I could quickly go into that and then come out. Or if I'm presenting and I'm listening to someone, I could just drop down into that. So, I really love the idea of this as well because it's something you can practice in small pieces. Not so formally, but drop into just connecting down out of your head into your body kind of thing. Okay, so the biggest question I'm guessing people have is, are you "successful" with your meditations daily? What does it look like day-to-day? Are there ups and downs? How is it for you? Windsor: Yeah. This is something that comes up a lot when people ask, because we know that, yes, all meditation is helpful. But we also know that to get the most benefit out of meditation, it's best to have a regular practice. And this could mean meditating once a day, or with this particular technique, meditating twice a day. And it sounds a lot. And I would love to say I meditate twice a day every day, no matter what. But I have OCD, so I allow myself to be a little bit more flexible. I don't really love rigidity when it comes to things like that because I have a tendency to really grab onto them. So, I do allow myself to skip it sometimes, either for reasons like I forget, or the day just gets ahead of me. As important as meditation is, there's a lot of things that trumpet, like do my kids need something? Do I have to pick someone up? Is everyone being fed? There's all these things that are also really important. So, I do try to meditate twice a day. Most days I do. Sometimes I don't. But that's okay because I did what I had to do to keep everything going. Kimberley: What about during your meditation? Windsor: What, excuse me? Kimberley: What about during your meditation? Is that an up and a down process? Do you have "good days" and "bad days" with it or is it pretty consistent for you now? Windsor: Well, I don't like to talk about the meditations as being good or bad. Some are really gratifying and some are less gratifying, because even the less gratifying meditations are really good for you. You're still going to benefit from them, even though it wasn't necessarily easy or didn't feel good. But that's just like a lot of things. Meditation can be categorized as something like that, like maybe brushing your teeth or exercising. Maybe you don't love it all the time, but you do it because it's good for your body and it helps you reach certain goals. And sometimes it's really hard for me to get to a good juicy place, and that's okay. I've just started to not expect a certain experience when I go into the meditation. And that makes everything a lot easier because then I'm not letting myself down or I'm not feeling disappointed or I'm not crushing a goal. I don't go into the meditation feeling like I'm going to feel so relaxed and cool. I just say, "Oh, I'm going to close my eyes and we'll just see what happens during this session." Kimberley: And that's why I love what you're saying because it's so in line with recovery, like dropping the expectations, dropping just the good feelings, dropping goals, having these big goals all the time. I think that's-- sometimes I have found, what happens in your meditation is like a metaphor for life, right? Like, okay, today is a busy brain day. There's going to be days like that. And I think that it's a great way to just practice the tools in a small setting that you would be practicing in the day anyway. Windsor: Exactly. That's why I love it for people with OCD too because let's say you commit to doing it 20 minutes a day or 20 minutes twice a day. During that 20 minutes, you know that any thoughts can come up, any feelings can come up, and you're just going to let them be there. And this is excellent practice for when you're going about your daily life and you have no control ever over what comes into your mind or what happens. But since you've been practicing this in your meditations, those responses to accept and let go become more automatic. So, not only are you having great meditation experiences or anything, but in your life, you can use those same tools. It's not just adding another thing. It all works together. The meditation is so helpful in every aspect. Kimberley: Right. It's like we go to the gym to strengthen our muscles and we meditate to strengthen our brain muscles, right? Windsor: Yeah. Kimberley: Yeah. I love that. So, one thing I didn't ask you ahead of time, but I'm wondering, would you be interested in leading us through a couple of minute meditation to get us experiencing that? Windsor: Yeah. And you know what? I was thinking of like, maybe I should think of something to say in case she asks it, but I don't think she will. So, yeah, we can just do a short-- what I do sometimes when I don't do the whole 20 minutes is I just do a short mini one, like a minute or two. Kimberley: Would you lead us? Windsor: Yeah. Okay. So, for everyone listening and for Kimberley, I just want to show you a little bit about what it looks like to connect to your being and to practice a silent meditation, just for a short little grounding experience in the middle of a busy day or before a meeting, anytime you need to. So, what I like to do before I meditate is to just get into a comfortable spot. You don't necessarily have to be on a fancy cushion. You just have to have your lower back supported. And go ahead and close your eyes. And what I like to do before I start any meditation is take a few deep belly breaths. So, we'll just breathe into our noses right now. Feel your belly. Feel your chest... And release through the mouth. One more deep breath into the nose... into your belly... and release. And one more deep breath into the nose. Feel your belly... and release. So, now you just want to let your breath settle into its own natural rhythm. This isn't a breathing meditation. We're not going to focus on our breath. And you can scan your body for any tension that you might be holding. A commonplace is in your neck and your shoulders. Make sure you drop your shoulders, can wiggle your jaw a little bit, and just let all of that tension go. So, when we're meditating, we don't want to put a focus on any thoughts that might come into our mind. But when they do come in, we just want to acknowledge them and recognize that this is a normal part of meditation. We never want to resist any thoughts or feelings that we might have. These are all important. And just continue following your natural breath. And has any thoughts come into your mind, just remember that we don't have to engage with them. It's okay to just witness them and let them pass through you. Maybe you might notice a sound outside or a body sensation. That's okay. Just be a witness to that too. Now you can take another deep breath into the nose... Into your belly... and breathe out. And you can start to bring your awareness back to your body and see how it feels to be where you are. You can start to bring your awareness back into the space. And slowly, when you're ready, you can open your eyes. Kimberley: Oh, what a treat. Windsor: And that's a little meditation, but I was really feeling it for a second. Kimberley: Yeah. I just kept smiling because it was such a treat. What a treat that I get to have my own little meditation instructor in the middle of a podcast. It's my favorite. What a gift. Thank you so much. Windsor: You're welcome. Kimberley: Yeah. Thank you. I think I love-- I just want to highlight a couple of things you said, which is, for those who have anxiety, meditation is not the absence of thoughts and feelings, right? You highlighted that and that was so helpful, just to acknowledge that thoughts and feelings will happen, sensations will happen, but we just become an observer to them, which I think again, not only helps us with meditation, but it helps us with response prevention, during our exposures. It helps us during panic. Such a great tool. So, I'm so grateful for you sharing that. Windsor: Cool. Well, thanks for letting me. I love to talk about it when I have the chance. Kimberley: Yeah. Okay. So, I want to ask one final question, which is, what do you really want people to know? If there's something we've missed today or if you want to drive home the main point, what is your main message that you're wanting people to take away from today's podcast? Windsor: I guess what I really want people to know about meditation is that you don't have to be a certain type of person to do this. You don't need to be a specific personality type or have certain interests to make meditation work for you. You can just be yourself and come as you are and treat this practice as a gift that you're giving yourself, that you deserve to take part in because it offers such deep rest and relaxation. That meditation can be a part of a modern, busy lifestyle. You don't have to be common Zen all the time to do it. I think that meditation is for everybody. Kimberley: I love that. I always remember, I think I could be killing this here, but the Dalai Lama says, and this always gets me laughing because he always says, if you don't have time for meditation, you are the one who needs to meditate the most. Windsor: Yeah. I love that one. Kimberley: I killed the way that he said it, but for me, so often I'm like, "Oh, I don't have time. Oh, I didn't get time today." And he really keeps nagging me in my mind in terms of knowing the more busy you are, the more you may want to prioritize this. Of course, like you said, that happens and priorities happen. But for me, that was the main message I had to keep reminding myself when it came to meditation. So, I loved that. Windsor: Yeah. Kimberley: Well, thank you so much. This is just delightful. Really it is. It has brought such joy to me today because like I said, it feels full circle to be coming back and talking more about meditation and doing more of that here. Where can people get a hold of you and hear about your work? Windsor: So, I have my Instagram, @windsor.flynn, and that's my OCD one. I talk a little bit about meditation on there, but I know that not everyone is necessarily ready for that. So, I do have my other Instagram, @windsormeditates. And that's when I focus a little bit more on the meditation. And if you're interested in taking any of my group courses or private meditation sessions, you can just go to my website, windsorflynn.com. All very easy, just search my name on the internet, and then you'll find some links for those. Kimberley: And we'll have all the links in the show notes as well. So, if people are listening on, they should be able to connect to that. So, amazing. I'm so-- pardon? Windsor: I was just going to say thank you so much for having me. I'm a big fan of yours and I love the work that you're doing and I feel so honored that I get to be on your podcast. Kimberley: No, I feel likewise. I love what you're doing. There's so many things I wish I could focus on. And I love when somebody like you will come along and they focus on that one thing. It just makes me really happy because I just love when people are finding little areas, particularly in the OCD and mental health space where it's like, we need these sources. So, I'm so happy that you're doing that work. Thank you. Windsor: Cool. Thank you so much. Kimberley: My pleasure. And like I said, go follow Windsor. She's amazing, and I'm just honored to have you here. Windsor: Thank you. ----- Okay. So, before we finish up, thank you so much for being here and staying till the end. Before we finish, I want to share a review of the week. This one is from Cynthia Saffel and she said: "I'm so excited to share these podcasts with my clients." She gave it a five-star review and said, "I first was introduced to Kimberley's clear and compassionate teaching style when I took the ERP school course for therapists." For those of you who don't know, we have a CEU approved course called ERP School, where you can learn how to treat OCD using ERP. And she went on to say, "In the past 3 weeks since taking the course I recommended both the course and podcasts to my clients." Thank you so much, Cynthia, for your review. And for everyone who leaves a review, it is the best gift you can give me in return for these free resources. So, if you have the time, please do go over and leave a review and have a wonderful day. It is a beautiful day to do hard things. Have a wonderful day, everybody.

Jan 7, 2022

SUMMARY: Today, I wanted to dedicate an entire episode to the five things that I learned in 2021. I have found 2021 to be one of the harder years, but probably the most transformational for me, and that is one of the things I'll talk about here very, very soon. The 5 Things I learned this Year: Recovery goes smoother when you slow down and act intentionally Life is not supposed to be easy It is my responsibility to manage my mind Catch your thought errors I am not for everyone Links To Things I Talk About: Changed our name on Instagram Lots of exciting information on cbtschool.com ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 216. Hello, my friends. Happy 2022! Oh my goodness, it is crazy to say that. I'm excited for 2022, to be honest. I've had enough with 2021, I'm not going to lie. And I'm guessing that you are in the same boat. I'm grateful for 2021. Absolutely, I'm not going to lie, but I'm really happy to be here in 2022. Today, I wanted to dedicate an entire episode to the things that I learned in 2021. I have found 2021 to be one of the harder years, but probably the most transformational for me, and that is one of the things I'll talk about here very, very soon. Before we do that, you may notice that the show looks a little different. We have new podcast cover art. If you follow me on Instagram, there's a ton of different visual and aesthetic changes there as well, as well as that we have changed the name to Your Anxiety Toolkit instead of being Kimberley Quinlan. I will explain a little bit about why I've made these changes here in a very little moment. Before we get into the good stuff of the show, the bulk of the show, I want to give you the very best stuff, which is the "I did a hard thing" segment. So here we go. For those of you who are new, every week, people submit their "I did a hard thing" and we talk about it, and we share it and we celebrate the big and the small and the medium wins. This one is from Kboil, and it says: "I went to work for the first time in five weeks after a horrendous meltdown where I wanted to take my own life. I am still struggling daily with my anxiety and panic attacks, but I am doing it. XO." This is the work, you guys, that may be triggering for some people. But the truth is we have to talk about how impactful our mental illnesses can be and how important mental health is, because if we don't take out care of our mental health, it can get to the place where people are feeling suicidal. Let me also reframe that. Sometimes we get to those really difficult places and dark places. Not because you're not taking care of yourself, but for multiple reasons, daily stresses, genetics, medical struggles, grief, trauma, high levels of anxiety. Kboil is really bringing the most important piece of mental health discussions, which is, when we're really, really struggling, number one, it's important to celebrate your wins, and number two, nothing is off-limits. We must be willing to talk about these really difficult topics. Thank you, Kboil. I am just so honored that you shared this and so excited that you're taking baby steps, and I really wish you well. I know it says you're still struggling, so I'm sending you every single ounce of my compassion and love to you. Ugh, it's so good. My heart just swells for you all when you write in those "I did a hard thing's." Okay. Let's go over to the five things I learned in 2021. The first one is probably the most important, and it does explain why I've made certain changes in the way that I run my business, the way that I show up on social media and here on the podcast, and why I really want to make some changes in 2022. Be very intentional. First of all, this is proof that people can change their mind. It's okay to change your mind. Actually, that's probably the sixth thing I learned. Number one is, it's okay to change your mind. But really the number one was, it's important to act intentional. I did a whole episode on whacking things together, how it's okay to whack things together. I did that because I found myself becoming very perfectionistic. I am still a massive fan of the whack-it-together model, which is ultimately to practice not being perfect and just getting things done. But what I think I did is I went a little too far in the whack-it-together model and I wasn't being as intentional. I was doing too much and not doing a great job of the things I was doing. I mean, it was still great and I was still helping people and I was still showing up and I'm so proud of what I did in 2021. But what I really learned is sometimes when you get into moving too fast and pushing too fast and too hard that you lose the intentionality. And when you lose the intentionality, you often lose the real lesson and the growth. If you're in recovery for anxiety or an OCD-related disorder or an eating disorder, or a body- focused repetitive behavior, if you're rushing through and pushing through and wrestling with things instead of slowing down and being really intentional in your practices, chances are, you're going to miss a lot of opportunity for real growth and real recovery. So slow down and be very intentional. Some question you may ask is: What is it that I'm trying to achieve here? For me, often I'm like, because I'm trying to reach a certain goal or so forth, it's like, well, is this rushing? Is this behavior actually moving the needle forward? If it comes to recovery, particularly if you're having anxiety, I'm going to encourage you to ask: What am I trying to achieve here? Am I trying to get away from anxiety? Or am I trying to be with my anxiety? Because if you're intentional and you're trying to be with your anxiety, your recovery will benefit. Now, how does this apply to me and you guys and us together is, I really don't want to be as much on social media anymore. One of the things I really learned this year is that it's not good for my mental health when I push it like I was, and I found that I was showing up on social media. Even here on the podcast, I'm not afraid to admit, I would sometimes sit down and just throw myself into it instead of actually stopping and doing what I originally did, which is I used to, and I used to do this all the time, but I think I fell out of the practice, which was to stop, and before I did anything, get really clear on like, who am I speaking to? What do they need to hear? How can I show up and serve them in a way that also serves me? Am I just showing up here to say that I showed up and recorded an episode so I can say that I did a weekly episode? That's not how I want to be anymore. I really want to move towards being intentional and engaging in behaviors that actually push the needle forward and that are healthy for me. I've moved Instagram from Kimberley Quinlan to Your Anxiety Toolkit because for some reason, every time I got onto Instagram, I felt like it was about me, even though I know it's not. And I don't want it to be about me. I want it to be about mental health and anxiety and tools to help you. So, that's how it's going to shift. We've got a ton of amazing guests happening, which I've already pre-recorded. And then after that, I think I may even take a little break from having guests and just practice sitting down with you and really talking about the important stuff I want you to know. Like this stuff that sits on my heart, that I really want you guys to know. So, that's number one, is become a little more intentional if you can. Don't become perfectionistic, but move towards being intentional. Life is not supposed to be easy. This is a huge one that I learned early in 2021. I was learning from a public speaker, and she constantly says, "Life is 50/50." And that used to bug me so bad. It used to really make me angry because I'd be like, "No, life is not 50/50. It's like 80/20. It's like 80% good and 20% bad." Until I was like, "Wait, if I'm really honest with myself, it is 50/50." I think a lot of the suffering that I was experiencing, and I'm guessing a lot of the suffering that you were experiencing is trying to get it to be 80/20 or 90/10, because life is not supposed to be easy. Life happens. Life is hard. Bad things happen to good people, and that was a big lesson to me. A friend of mine was going through a really hard time. I kept thinking, this is crazy. Why is this bad stuff happening to good people? Until I was like, that's an era in my thinking. When did I learn that bad things shouldn't happen to good people? Because bad things do happen to good people, and it's not their fault. Sometimes when we can give ourselves permission to drop the expectation of the 80/20 or the 100% or the 90/10 and just let everything be 50/50, it's so much easier. Even as I parent my children, I think I was parenting them with this expectation that I'm supposed to be really, really good at it. But when I accepted that things will be 50/50, they're not going to like when I ask them to pick up their room. They're not going to like when I serve them vegetables that they don't like to eat, and I can't be disappointed when they're disappointed about the vegetables I've served them because life is 50/50. One of the best lessons I can give them is for them not to expect too much either. I'm not saying drop your standards and accept terribleness at all. What I'm saying is, do the best you can. Go for your dreams. Love your life. But still come back to the fact that you still have to brush your teeth and we break things and we spill things and we have to pay taxes and we are exhausted at the end of the day after having a great day at work. You might have some negative parts of it too. There's pros and cons to everything. So, that was really powerful for me, is life is not supposed to be easy. I've talked about this before. I think it was in the summer of 2019, where I would catch myself throwing mental tantrums in my head like, "It's not fair. It shouldn't be this hard." And I'm like, "That is exactly the problem. Those mental tantrums that I have in my brain." The other one, let me add, is I actually had a whole therapy session about this, which was about this entitlement that I caught in myself of like, "This isn't fair. Things should be easier. Things should be going easier or they shouldn't be so hard." And this real entitlement that came with that, and even though we use the word "entitlement," I'm not using that as a criticism towards myself. It's just naming it what it was. I felt this entitlement inside me of like, "No, things should be good. I should succeed at everything I try." And that's totally not true. It is my responsibility to manage my mind. This one really hit me in September. I actually think I read something online that really hit me with this. I'm writing this down as I talk to you just so I make sure I get it in for you in the show notes. Often, I talk to my patients and clients that you can't control your thoughts and you can't control your feelings, but you can control your reaction to those thoughts and feelings. And when you do that, you may find that your thoughts and feelings start to change. It's a very basic concept of cognitive-behavioral therapy. Cognitive-behavioral therapy is a helpful modality of therapy for many, many, many different mental illnesses. But when I talk about managing my mind is being, again, very intentional about the way I respond to problems and stresses in my mind. I'm not saying that you can control your intrusive thoughts, but I'm going to say it is my job to manage when anxiety shows up. It is my job to manage when thoughts and strong emotions hit me and make me want to lash out or project. A lot of my patients have reported this. They'll come to session and they'll say, "You will not believe my husband. He just won't do A, B, and C, and he knows it makes me crazy. He knows it makes me anxious. So why is he doing it? If he loved me, he wouldn't do this." And I have to keep gently reminding them, "It's your responsibility to manage your emotions. It's not their job." We talked about this in one of the last episodes of the year in 2021, which is setting boundaries, you are responsible. You're in your lane to manage your mind and your emotions. It's not anybody else's. I think what was really hard about this is when I heard this, I used to take offense and I'd be like, "Oh my God, that's just so mean. What about the people who are really, really, really suffering?" or "Wow, that's so abrupt and dismissive." Until I really sat with it. I actually journaled a lot on this of like, what shows up for me when someone talks about the word "responsibility"? I wrote about this a lot in the self-compassion workbook for OCD – compassionate responsibility. And I think the word "responsibility" really triggers us into thinking that if we're taking responsibility for ourselves, we don't deserve other people's support. And that's not true. But when I really sat on "It's my job to manage my mind," everything changed. I think that's why I came to the place where I was like, "Okay, I'm going to be way more intentional because it is my job. It's my job to really slowly and in baby steps, work at changing how I react and having really hard conversations with myself on like, 'Wow, you fully reacted in a little bit of a crazy way there.'" What was going on for you? What do you need to change? How do you need to show up for yourself different? How can you be intentional around this? Because it's your job. I'm saying that to myself, "Kimberley, it's your job. It's your responsibility." It's the most compassionate act you can do, is to practice managing your mind. Catch your thought errors. Again, these all tie beautifully in together because once I took responsibility for really managing my mind and really owning what was showing up for me, it was then my job to catch the thought errors. Again, I want to be really clear here. I'm not saying that you can control your intrusive thoughts. Absolutely not. But what I'm speaking about more, and I'm actually going to do a whole episode on this in just a couple of weeks, is catching thoughts like, "I'm going to screw this up. That was the worst. I am a failure. I am freaking out." These are all often not accurate statements, So I'm talking about the way in which we frame and perceive things, not your intrusive thoughts. I want to be really, really certain. We're not in the business of correcting intrusive thoughts of anxiety. When it comes to depressive thoughts or very negative thoughts or catastrophic thoughts, or very black and white thoughts, we can be very intentional and be like, "Wait a second, I catch myself on this all the time. I'll be like, my husband often comes home in the end of the day and says, 'How was your day?' And I'll often make these sweeping statements like, 'Oh, it was a really hard day.' Even if that's true, how does it benefit me? Was it 100% true? Because what's probably 100% true is, oh, there are a couple of really, really difficult times that took me some time to come down from. But there were also some really beautiful moments." That's the truth. It takes more effort to say that and you have to be more intentional to say that. But if we say, "It was a really hard day," our brain is going to pick up on that and it's going to start to feel overwhelmed and heavy. I am not for everybody (and that's okay). I'm going to leave you with this one because this one was the best. That is the lesson I took away – I'm not for everybody. I guess what we could say in parentheses is, "and that's okay." I actually was on a podcast this week with Bryan Piatt, an amazing OCD advocate. He had asked me this question and I was reflecting on it the other day, which is, I think that in my many years of being on the planet earth and being in my human body, I thought that if I was just kind, there's really no reason anyone could not like me. If I was just kind to everybody and I did my best and I kept out of drama, everybody should like me. There can't be much to hate. I think I banked on this as a way of avoiding conflict and as a way of getting people to approve of me. I learned last year that even when I'm kind, even when I show up in the best version of myself and I do nothing, but show up with loving kindness in my heart, I'm still not going to be for everybody. Do you want to know how crazy that made me when I realized that? In 2021, a lot of you may know, but I was very seriously online bullied and shamed and trolled. There is this one particular person who really trolls a lot of mental health accounts, and I seem to be one that they loved to really bully and shame. I kept crying and going home to my husband and saying, "But why am I so kind?" I had to realize it's that same kind of concept of like, good things should happen to good people and bad things should happen to bad people, until I was like, "Oh, that's not true." Life is 50/50, and you're never going to be for everybody. So, I'm going to offer to you the same thing. I'm not for everyone. You're not for everyone. Try to get a good 10 people in your life on your side and the other billion gazillion people, you don't need to please them. Just be a little intentional there. And I'm too, I'm doubling down now in really just being intentional on who matters and whose opinion does matter and everyone else can take me or leave me. I hope that those five things were helpful to you. Maybe they sparked some curiosity for you and you may or may not agree with some of those. The good thing to remember here is, these are the things I learned, but they might not be exactly what you needed to hear today. And that's totally okay. Sometimes we need to hear things at a certain time. At other times, they're not for you at that particular time in your life. And that is okay. So, there are the things I learned this year, in 2021. I'm so excited about this year because I have those amazing lessons that I learned. I'm going to be much more intentional about the podcast and I'm going to try to use the podcast to be a little more personal, where people in my podcast are more my insider group compared to social media because again, I want to be really intentional and healthy around social media. Before we finish, I want to do the review of the week. Please, please, please, please. If you can do me one gift, it would be to leave a review for the podcast. This one is from Kanji96 and they said: "Thank you, Kimberley. This podcast is very helpful for me, especially when I'm going through hard times. Right now happens to be one of those hard times. Here I am back listening to Kimberley. Thank you." I'm so grateful, Kanji, for that you support me. Thank you so, so much. I'm going to leave you all with a quote that Kanji almost used and that I always use, which is, it is a beautiful day to do hard things. Let's do 2022 together. I'm so incredibly thrilled to be walking on this path with you. I know that your time is valuable. I appreciate you coming and spending your time with me, and I'll see you next week.

Dec 17, 2021

In This Episode: How to identify what your role is in a relationship How to manage a mental illness and set boundaries How boundaries are needed when you are in recovery How to set boundaries with a loved one during the holiday season. Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 215. Welcome back, everybody. It is the final episode of Your Anxiety Toolkit for the year 2021. I will not be putting out a podcast next week because it falls right on the holidays, and I really wanted to make sure I give you all time to be with your family instead of listening to my voice. If you are in the holiday season and you want to listen to my voice, there are so many, in fact, there are 214 episodes. You can go back and listen to. I just want to be with my family, and I want you to be with the people you love. Speaking of people you love, today we're talking about setting boundaries with loved ones or managing our relationship during the holidays. However, I did a whole episode about this last week. You can go back. It's episode 214, where we talk about holiday anxiety. We did discuss some of this there as well. So, you can go back and listen there. But for right now, I want us to talk about managing relationships, specifically during the holidays, but this episode can be applied to any old day of the week. Now, before we get started, we always do the "I did a hard thing." This one is from Rachel. We do an "I did a hard thing" to motivate you, to remind you that there are more people out there going through what you're going through. You're not alone. Rachel shared with us today: "I have somatic OCD." For those of you who don't know what that means, it means that you have OCD about specific sensations that show up in your body. You sometimes feel like you can't stop noticing them or you're afraid you will never stop noticing them. Sometimes you're afraid that the feeling will never go away and it can feel really disorienting. So, Rachel says: "I have somatic OCD, and I always need to distract myself not to notice them. I've been able to drive without the radio or calling anyone and it feels so good." Rachel, this is so good. You're doing what we talk about in ERP School. ERP School is our online course that teaches how to expose ourselves to fears, specifically obsessions for people with OCD, health anxiety, and these types of OCD, like somatic OCD, on how to practice facing our fear. In this case, it was her driving, that without using safety behavior or compulsions. So, in this case, the compulsion would be to have the radio on or calling someone to distract her on her somatic obsession or her sensation. So, Rachel, amazing job, you're doing the work. You're doing the exposure and the response prevention. One thing I want to mention to everybody, if you have OCD or an anxiety disorder, is we must do both. We must face our fears and not do the safety behaviors to reduce or remove that discomfort that we feel when we face our fear. So, you've explained this perfectly. Congratulations. I am so proud of you. Love getting the "I did a hard thing's" from you guys. And so, just so thrilled to get that message from you. All right, let's go over to the episode. It's the holidays. You're anticipating the gifts and the food and the time and the travel and all the things, but what's worse than that is anticipation of the interactions that you're going to have with certain family members. Now, if you're listening to this and it's not the holidays, it's the same. You're anticipating going to work, but you're dreading the interactions. You're dreading how messy things get. You're going to school, and you're dreading how messy things get with the people you have in your life – your students, your classmates, your teacher, your friends, whoever it may be. I want you to think about your responsibilities. And I talk a lot with my patients and clients about responsibility because it's a really important part of recovery. When we think about the holidays, we think about a certain event that's coming up. I'll often explain to my patients that really all you need to do is you need to focus on your lane. So, I've talked about this before on the podcast, but I want you to imagine you're driving on the highway, you're in your car, and the only thing you're responsible for is to not run into other people in their lane and to stay in your lane and to go at a pace that's right for you and a speed that's right for you and in a car that's right for you. Now, that metaphor is exactly how you're going to get through the holidays or get through this event that you've got coming up. Your job is to take responsibility for you and your lane. Now, sometimes people in the lane next to us come on over into our lane and they want to tell us how to act, and they want to tell us what to do, and they want to impose on you their beliefs. Now, our job is to remind them and set boundaries that that's not your lane, that's their lane. And their job is to stay in their lane. And our job is to stay in our lane. Now, in addition, we have to be careful that we are not popping on over into their lane and telling them how they should be, and telling them how they should act, and trying to take responsibility for their feelings, and trying to prevent them from judging you because that's their lane. We talked about this in the last episode. Go back and listen to that. But that's not your job either. It's not your job to get their approval because that's their responsibility. How they feel is their responsibility. We can't control that. And so, first, before we even talk about setting boundaries, we have to be really clear on what's in your lane. So, an example for me is, as I go into the holidays, I am going to be really aware of what is my responsibility, how do I want to show up? And then it's my responsibility to show up in my lane doing so. But it's also important to catch when I'm-- often we do this. It's like, "Well, I'm going to do X, Y, and Z because I really want A, B and C to like me." But that's your lane. It's not your responsibility. It's not your job to get them to approve of you because we don't have any control of that. And as we talked about last week, their judgment of us is their responsibility. It's a reflection of them. It's not a reflection of us. So, we have to be really careful of really getting clear on how we want to show up and only trying to control us, because we can't control our family members. They're going to do what they do. They're going to act out. They're going to be up in your lane. From there, we can set a boundary to protect ourselves from them coming into your lane. So, when we set boundaries, we usually set boundaries when somebody is imposing their stuff onto us. Imagine if someone came into your house and walked in with their shoes on and put dirt all over the carpet, you might say, "Excuse me, please would you take your shoes off?" There's like a boundary violation. If they come into my house and they start smoking cigarettes, no disrespect or judgment on people who do smoke cigarettes, but I'm going to say, "I'm really sorry, we actually don't smoke in this house. Can you please put your cigarette out and go out to the back?" And so, that would be me setting a boundary. Now, a lot of you brought in and you asked questions about this. Last week we addressed a lot of the questions. So, an example, somebody said, "How can I communicate with my family about my OCD and keep my boundaries?" So, what you might do is first ask yourself. If I was going to communicate about my OCD or my anxiety or my depression or my eating disorder or whatever you may have, panic, is ask yourself, are you communicating with it so that they change the way they act because that's their lane? The only reason we would need to communicate about our stuff is so that we can set a boundary. Let's say a really big one that I have had to practice is when family members comment about weight. I had a couple of family members in my childhood who every Christmas would, "Have Merry Christmas, Kimberley, your weight is blank. You're up a bit. You're down a bit. You're bigger, you're smaller, whatever." And it was so incredibly painful and so incredibly unhealthy for me. And so, the boundary here would be to say, "I would really prefer that you don't comment on my way. And if you do, I'm going to remove myself from this interaction." So, that's a boundary and it's respectful and it's compassionate, and I'm not doing it to harm them or discipline them or pay them back. I'm doing it because it's a boundary violation, and it's in my lane. When I'm in my lane, I want to have a really positive idea about my food and my body. If a family member is telling you how you should act, you might say to them, "Thank you so much for your thoughts. I am going to choose to do it this way. And I would really appreciate if you didn't comment. if you're unable to hold that boundary, I'm going to have to leave," or you can say whatever you want. You can just set the limit. Sometimes you don't even need to tell them your boundary. You might just keep it to yourself. Like, "Oh, if they're going--" if a family member says, "I'm so OCD about stuffing," or whatever they say, "I'm so OCD about my cooking," you might just not even need to express the boundary with them. You might gently just get yourself up and walk away. That's a boundary. Sometimes we don't have to verbally express boundaries because we can just remove ourselves from the situation and stay in our lane. Somebody said, "How to say no to things?" So, you've decided you don't want to do something. We talked about this last week in Episode 214. You've decided you don't want to do something. And so, you say to them, "I'm going to bring baked goods. I'm not going to bake them myself. I will buy them at the bakery. No, I'm not going to hand bake them." Or you might say, "No, I'm not going to go to that Christmas party," or "No, I am not going to buy gifts this year." Okay? Now, that's you holding your own boundary. Then your job, and again, this is why I shared about the lanes, is your job is to let them have their feelings about it. They're allowed to have their feelings. They're even allowed to act out. If they act out and they say something unkind, you may set a boundary with them. But we can't hold everybody to our standards. Some people are going to act out. They may not have the skills you have. They may be triggered. They may have expectations of you. And that's okay. They're allowed to have expectations, but it doesn't mean you have to do it. You may choose to follow their expectations. We talked about that again last week. But that's your decision. You have to be responsible for you and saying yes to what matters to you and saying no to what doesn't matter to you. Any time you notice resent, show up, that's usually because you violated your own boundary. You did something you didn't want to do and you should have said no to. It's okay. I'm going to keep saying this to you guys. It's okay to disappoint people. We will disappoint them. It's either they get disappointed, or you do the thing they want you to do, and then you're disappointed. And you have to choose. It's your responsibility to choose. And we do this responsibility work compassionately. I speak a lot in my book, The Self-Compassion Workbook for OCD, about compassionate responsibility. That's saying: "I am responsible for me," but not in a disciplinarian, like you're responsible for yourself, you're alone, you're on your own kind of way. It's a compassionate act of, "Yes, I get to take responsibility for myself. I get to take care of myself. I get to say no, I get to say yes. I get to make those choices and I'll do them kindly." Somebody asked a question about managing irritability. This is a great one, because our family members and our friends and our loved ones and the people at our Christmas party or our Hanukkah party, our Kwanzaa, they may irritate us. Yeah, it's okay to feel irritated by our family members. My husband and I always-- we learned this maybe five years ago. We get caught up in it. I'll be like, "Why are you acting that way?" And he'll say gently to me, "Kimberley, I'm allowed to feel this way." And I'm like, "Oh crap, you're right. I keep forgetting that you're allowed to feel what you want to feel." Or he'll be upset and he'll be like, "What's wrong? Why are you being this way?" And I'll be like, "I'm allowed to feel this way." And he's like, "Oh crap, you're right." You're allowed to be irritable. You're not allowed to be unkind. I mean, you are, but you have responsibility, There's consequences. But ideally, let yourself be irritable. Be compassionate with your irritability. Like say, "Yeah, it makes complete sense that I'm irritable. This is hard. It makes complete sense that I'm annoyed. They've said something that annoyed me." Again, they're allowed to say annoying things. We get to remove ourselves if it doesn't feel right or we get to express ourselves." That really hurt my feelings. That made me upset." This is why you're allowed to share. Let's see. Someone said dealing with a toxic parent. Well, it depends. My answer to that is it depends on whether you're a minor or an adult. If you're a minor, it's hard to remove yourself from a toxic parent. They are your guardian. You're legally under their care. But you can remove yourself from them physically in terms of going to another room. You can try and share with them. "That was really painful for me to hear that. If you do that again, I'm going to leave the room." Or you get to make your own boundaries. They may be physical boundaries where you leave. They may be emotional boundaries where you don't go to them and you don't share with them if they can't hold space for you compassionately and respectfully. If you're an adult, you can choose to set as many boundaries as hard or as strong, as light as you need. Some people set boundaries with their family members. Like, "You can't come here without announcing yourself. You must let us know first. You can't say those things about me or I'm going to leave." Or you may, again, you don't even have to say them out loud. If they're really toxic, you may say to them, "I'm not going to see you anymore if you keep acting like this towards me and my family. I can no longer put myself through that." You get permission. We don't get to choose our family, but you don't have to see them either if they're really unhealthy for you. You may want to get some therapy around it and have the help of a clinician to help you navigate what's a right boundary for you. Everybody's different. Someone said, "I get really bad depression during the holidays and people have expectations for me to be happy." Well, that's their lane. You don't have to act or be any way. Be kind, be compassionate, but do the best you can. It's your lane. You got to just do the best you can with what you have. So, again, I think that's a really big part of this, is really take care of you because that's your job. One thing actually, before we finish up, let me mention, it's no one else's job to make us feel better either. I know a lot of this today is going to feel like a lot of hard truths, but I promise you, there is so much liberation that comes from this. It's a hard pill to swallow, but it's still a really, really good pill. It's a good pill. It's a helpful pill. And so, it's not other people's job to make us joyful on Christmas either. That's our job. I'll tell you a story, when I was really a young adult, I think it was quite shocking to me that when you're a kid, everyone throws you a big party. And when you're an adult, it's not as big of a deal. And I used to get really offended that people didn't throw me a massive party until I was like, "Wait, it's really not their job." And so, I started doing it for myself, and I have no shame about it. If I know I want to feel special on my birthday, I always organize something really special for myself. For the last three years, except for the year of COVID, I always rent-- you guys, probably know this. I rent an RV and I invite my three best girlfriends and I have a party for myself, and I'm not ashamed about it. I'm happy to celebrate myself. A If you are feeling like other people's job is to bring you joy on Christmas, I would say, no, bring yourself joy. Buy yourself a gift. Make your special meal you want to have. Treat yourself and shower yourself with the joy that you want to feel. That's a huge liberation, a huge freedom. Such a gift. Okay. So, that's it. That's how you set boundaries. You get to set them. It's your lane. You get to decide. But other people are allowed to have their feelings about it. And that's okay. That doesn't mean you're bad. They can even tell you you're bad, and that doesn't mean you're bad. They can say, "I don't like you," and you don't think you're doing the right thing and they get to have their opinion, it doesn't make it a fact. This is hard work. I am not going to lie, I am still working on this. I'm still learning from this. I still have to practice it every single day. So, be gentle and remind yourself, this is a journey. This is not a destination that you're like, "Yay, I'm great with boundaries." It will be something you'll have to keep practicing. But the holidays are the perfect time to practice them. It's so important. My loves, you probably have lots of questions about this. Do go over to social media. I'll leave links in the bio. If you want to send me questions, I do a live Q and A every second and fourth Monday of the month at 12 o'clock Pacific Standard Time. So, I'm happy to answer your questions there. Have a beautiful day. Happy 2021. I will be seeing you in 2022, holy macaroni, but I can't wait. I'm actually really pumped about Your Anxiety Toolkit next year. I'm going to put a ton more effort into it. That's where I want my attention to be next year. So, sending you love. Have a wonderful day, and I'll talk to you soon. Oh no, wait. Before we finish up, what was I thinking? It is time for the review of the week. This is from IsaacRThorne, and they said: "Love this show and I look forward to it every Friday." Sorry, Isaac, I nearly missed you here. "No matter what you struggle with, there's more than one episode where your mouth will drop open, your eyes will grow wide, and you'll shout: "That's totally me!" Isaac, this is the best review ever. It just brings me so much joy. "Your mouth will drop open, your eyes will grow wide, and you'll shout, "That's totally me!" So, I hope this episode was that for you. Thank you so much for your wonderful review. Please, if you don't want to give me any gift of the world, it would be to leave me a review on the iTunes app. Thank you so much for your reviews. They bring me joy, but they also help us reach more people. So, thank you, thank you, thank you so much. We are going to give a free pair of Beats headphones to one lucky reviewer when we hit a thousand reviews. We're on our way. Please go and leave a review. It would be the best, best, best gift you could give me. Have a wonderful day, everybody. And now I officially say, have a wonderful day and I will see you in the New Year.

Dec 10, 2021

SUMMARY: I had so many people asking questions about how to manage holiday anxiety and stress that I decided to do an entire podcast on this. This is part 1 of a 2-part podcast Q&A. In This Episode: Q&A from this episode include How do I enjoy the holidays? How do I let go of the last Christmas? How do I survive the Holiday blues? How do I survive the holidays? How do I manage social anxiety over the holidays? How do I manage holiday travel anxiety? How to manage the financial stress of the holidays? Mental Health Holiday gift guide? How do I let go of my holiday expectations? Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 214. Welcome back, everybody. We are approaching the holiday season. In fact, some of you may already be in the holiday season. And if that is so, I wish you nothing but joy and peace and fulfillment. I really do. I hope you have moments of elated joy. Now, while that is my wish and my intention for you, I also know that the holidays can be pretty dang hard. It is anxiety-provoking for the best of people, let alone if you're already struggling with a mental illness or an anxiety disorder, or you're struggling with anything really. It can be so incredibly difficult. So, what I wanted to do is answer some of your questions. So, what I did is I went on to Instagram and I asked my community: What are your questions? What do you need help with over the holidays? And they've given me a bunch of things to talk about, and I'm going to go through each and every one of them. Now, this is actually a two-part podcast. This week I'm answering general questions about managing anxiety throughout the holiday season, or just general stresses. And next week, we're talking about setting boundaries during the holidays with family and loved ones. Setting boundaries. However, the truth is we don't even need to make this specific to the holidays. This is for everybody at any time. So, if you're listening to this and it's not the holidays, it'd be probably helpful to listen to it at any point in time. Before we do that, I wanted to share with you the "I did a hard thing." The "I did a hard thing" segment is where people write in and they share what hard things that they have been doing. This is a really important part of the podcast. If you're new, or if you're being with us for a while, I really want to stress the purpose of this podcast is to inspire you, is to help you feel like you're on the right track, that you're not alarmed, that people are doing the hard thing and I want you to know how they're doing the hard thing. So, I'm going to share, this one is from Marilee and she says: "I'm facing the fear right now. We moved two weeks ago. Today when I was getting dressed and picked up my socks that were laying on the floor in the living room, a silverfish crawled out from where it was laying. I hate them. It's probably a phobia. I compulsively checked and cleaned in the previous place to get rid of them. I feel them all over my body." As you're listening folks, you're probably feeling a little itchy and scratchy, I'm sure. "I imagine them everywhere and anywhere. My hard thing is to feel these feelings. I'm going to give myself permission to feel anxious and freak out about it, to do the reasonable thing and buy lavender scented sachets and place around the house, to not compulsively clean and check to find them. I'm doing it right now. It is hard, but I'm not going to let this fear dictate how I live in my home." Marilee, you're literally walking the walk. This is so good. I love what you said. "I'm going to allow myself to feel the feelings. I'm going to give myself permission to feel anxious." You're doing the hard work, and that is the hard work. Even when I'm meeting with face-to-face clients, they often will say like, "But what do I do?" And this is exactly what you do. Somebody who's doing it in real-time. So, yay. Congratulations, Marilee. You are doing the hard thing. Let's get over to the questions. We've got a ton of them. So, let's go through one by one. I'm going to do my best to address each and every one, but I'm guessing each of these could probably have an episode of their own. So, I'll do my best to manage time here. 1. How do I enjoy the moment? Some of my thoughts may get somewhat repetitive, but that's on purpose. So, here is what I'm going to encourage you to do: Going into the holidays, we want to enjoy it. Even the Christmas paper and the stockings, depending on what holiday you celebrate, and we want to be inclusive and uncover all of them, all of them are centered around community and joy and celebration. I want to give you permission to not have that expectation, to not try to make this holiday Instagramable. I know that's not a word, but you know what I mean. So, when you drop the expectation that you're going to enjoy it, then you can start to be curious about what's actually happening and be present about what's actually happening. And I want you to notice little things. This isn't a real example. Every year, I make the same mistake and I'm promising myself I'm not going to do this this time – I know that putting up all the Christmas stuff is so fun. We turn the music on, the kids get all of the decorations out. In my mind, it's such a special moment, but I'm rushing the whole time. I remember last year at the end of the holiday, I actually caught myself rushing and reminded myself, just get in touch with your senses. Of all the decorations, which one do you enjoy the most? Simple. Which texture do you enjoy the most? Which color? Which shape? Do any of them bring back memories? And just get really basic and simple. Don't worry about the overwhelming joy and the satisfaction of it ending perfectly, but just get in touch with the small things. For me, it's like, I hate wrapping presents, but I love giving presents, and I'm going to try to slow down and just really focus on the giving. And if I happen to receive a present, I'm going to really focus on the receiving. The receiving of the present. Just get in touch with the simpler things and put aside this massive goal to make this overly joyous. So, that's that. 2. How do I let go of last Christmas? Last Christmas I had COVID, and that's when my anxiety started. So, I'm going to generalize that often when we go into the holidays, we may actually have memories of events that weren't so great in the past. Maybe you had a huge family fight last year, or in this case, you had COVID last year, or you were lonely and alone last year. A lot of us are probably grieving with what's going on, and I'm going to give you permission to just grieve. Your question said, how do I let go of it? And I'm going to basically say, I think it's important to check in on what letting go will look like. Letting go isn't going to mean you have any less grief. We're not going to get rid of the uncomfortable feelings. But what you might do is you might make space for that grief, and then you might put your attention on how you want this moment to be. Only this moment. Don't even worry about the future and the holiday, but just focus on right now. Where am I? How am I? Am I okay? What's going on? Again, go back to the sense and the smells and the shapes. And allow grief, validate your grief, pushing it away. It's only gonna make it worse. So, validate it. Yeah, last year was hard. Last year was really difficult. I'm going to be super gentle with myself about that. Now, if you find you're ruminating about it, you might want to catch yourself on that and bring yourself again, back to the present moment. That's all we can do. 3. Surviving. Well, it's funny because I actually like the word "surviving." What that means is getting through one minute at a time. Just that's sort of, you're going back to the bare bones. This is going to be hard. We know it's going to be hard. It's a beautiful day to do hard things. You know I was going to say that. And I don't mind the idea of surviving. But here is where you can make some choices. And this is important for the whole holiday, is we actually do have some choices on how we perceive the holidays. So, if we're saying, "Okay, let's just get through it minute by minute. But as I do it, I'm going to walk in with a real positive bias." So, the thing to remember here is this positive bias and negative bias. Negative bias is, I'm going to look at the negative. Positive bias is, I'm going to look at the positive. You could also have a neutral bias. And so, what I want you to do is, as you go minute to minute, it's important that you acknowledge that you have a choice on whether you say, "This sucks. This sucks. I hate it. It's not good. I wish it was better. Why isn't it better? This sucks. I wish it was better. It sucks. I don't wish it was this way." That's really negative bias, and that is a choice. Unfortunately, I'm giggling. That is a choice we make. Now, another choice would be to go, "This is wonderful. It's excellent. I love it." But that might not even land either. That's not super effective either. But what you can do is take the judgment out of it and just be aware of what is happening. Again, be aware and drop the expectations. Be gentle, and find joy in the little things. Last year, we didn't get to see my husband's family. We didn't get to see my family. It was just us at home, and I thought it was going to be really terrible. But what I loved was making a big deal out of the simplest things. Like, hot chocolate, get your favorite mug, get the chocolate that you like, put the toppings on it that you like, and really savor it and watch the heat come off of it, and find joy in teeny tiny little pots of the holidays. Again, it doesn't have to be Instagramable. It doesn't have to be Pinterestable. And yeah, go minute to minute. 4. Winter blues. Now, this is a big one because some people do have a clinical diagnosis of seasonal depression. Now, if that's the case, I encourage you to go and see your doctor. There are tests they can do. There are supplements you can take. There are UV lights that you can use that have some science-backed behind it that can help with the winter blues medication you can take. So, I don't want to gloss over that as like, "Oh, you just feel sad." No, that's actually a clinical diagnosis and you deserve to get treatment for it. And so, definitely go and see your doctor and talk to your doctor about that. 5. Social anxiety. "I panic due to social anxiety. So, how will I manage that?" Social anxiety is, again, its own diagnosis, and it's usually the fear of being judged. I will talk about this a little in next week's episode, but here is the thing to remember: The truth is, people are going to judge you. They are. But that is not a reflection of you. It is a reflection of them, and it's out of your control. If I wear fabulous purple boots to Christmas, which I am not going to, but I wish I was now that I think about it. If I wore purple boots to Christmas and a family member judged me, that's not evidence that my purple boots are ugly. It's evidence that they don't like purple, and they don't particularly like these purple boots. And that is a reflection of their views. It doesn't make them right, it doesn't make them valid and it doesn't make you wrong. The best thing we can do for ourselves is give ourselves permission to allow people to judge us. And then our job is just to feel our feelings about that and be super gentle. Ouch, it hurts when people judge us. Yeah. But that's very human. It's a part of the human condition to not be the same as everybody else. Thank goodness. We'd all be wearing purple boots to Christmas. That wouldn't be so fun after all. Now, when it comes to panic, we have tons of episodes on panic. I encourage you to go and listen to them and really double down on your practices there because the more you resist panic, the more panic will come. Your job is to allow it, to be kind, to send to yourself, to breathe through it. Don't catastrophize and wait for it to pass on its own, which it will. 6. "I do not want these holidays." It wasn't really a question. It was a statement. It says: "Everyone is happy and serene, except me." This is my favorite one, to be honest, this is the one that actually I think we get caught up in. Number one, there's a lot of black and white thinking here. "Everyone is happy." Well, that's not true because I have a whole bunch of questions here from people who are telling me that they are not happy. "Everyone is serene." Well, that's not true. Most people find their mental health goes down over the holidays. That's just the facts. So you're not alone. Sometimes I find it really helpful to share with your friends that I find the holidays really, really hard, and they're going to say, "Me too. This is what I find hard. What do you find hard?" And it might be different. They might find it difficult to get the shopping. You might find it difficult to manage the finances of gift-giving. They might find it difficult because they have food restrictions or an eating disorder. You might find it hard because you have anxiety and you might have anxiety about meeting people or OCD about contamination or whatever it may be, harm obsessions. It could be anything. And so, everybody's diagnosis and everybody's brain come with us through the holidays, which means not everybody is happy and serene. So, I want to just give you permission to not isolate yourself in your thinking and acknowledge that, no, not everybody is happy. And even if on Instagram, they have big, old happy faces. They may have just had a massive fight with their father-in-law or their sibling or somebody. You just don't know. 7. "I have travel anxiety. How can I manage that?" Well, again, travel anxiety is no different to social anxiety or any other anxiety. I think it's about your willingness to be uncomfortable, your ability to be compassionate and coach yourself through it. I would encourage everyone to start to do exposures to their fears ahead of time. That's really important. We use exposure and response prevention a lot with specific fears like travel and any other fear. I have a whole course called ERP School that teaches people how to expose themselves to their fear. And so, that's super important. That's super, super important. So, yeah, that's what I would encourage you to do. And give yourself tons of grace because not only are you traveling, but you're traveling during a difficult time. The holidays are hard to travel in, not including it's still COVID, not including we've had a lot of time where we haven't seen a lot of people. So, seeing for the first time is really, really hard. Really, really hard. You haven't had practice. You haven't been naturally exposing yourself to it, so the anxiety is going to be higher. 8. How to get through the holidays without my therapist? Here is what I'm going to encourage you all to do. I have a patient who always jokes with her family, and her family always jokes with her. When she's struggling, they sit down and they say, "WWKD." WWKD is "What would Kimberley do?" or "What would Kimberley say" is sometimes the acronym, WWKS. And so, what I'm going to encourage you to do if you have a therapist and you're unable to see that therapist is to ask yourself, what would my therapist say about this situation? What advice would they give me? What would they tell me to do? If you don't have a therapist, you might say, "What would Kimberley have me do?" Even though I'm not your therapist, which I want to be really clear that this is a podcast, it is not therapy, but you know what I'm going to encourage people to do. I'm using mostly science-based treatment goals and tools. So, you could say, "What would the science have me do?" or "What would the general treatment look like in this setting?" And try to do that and get through it as best as you can. Again, go back to just getting through moment to moment. 9. "How to manage the financial aspect of the holidays? I don't want to let people down." Well, here is the thing: Whether you have $10 to spend on a family member or $100 or $1,000, it's important to remember not to spend more than you have. The thing is, the people who love you don't want you to go broke because of the holidays. Most people don't want you to suffer and they definitely don't want you to be under distress financially or emotionally. And I think it's important that you acknowledge that. And it's okay to let people down. If you let people down, that's their business. It's not your business to try and control how people feel about you and what you give. The gift of giving is exactly that – it's about giving what you can, what's meaningful. If all you can afford is to write a letter to them, and if they're let down by that, again, go back to the social anxiety conversation. That is a reflection of them, it's not a reflection of you. And if you want, you can explain to them, "Money has been hard, difficult and it's tight time, and I really just want you to know that I put everything I have into this," if that helps you. But again, we are not responsible for other people's feelings. We're not responsible for their actions. That's their responsibility. All you can do is honor yourself and be true to what's right for you. We'll talk a lot about that in the next episode. 10. "I'm always so anxious that I'm not showing enough gratitude when I get a gift. I don't want to seem like a brat." Again, be yourself. If other people perceive you as a brat, that is a reflection of them. It's not a reflection of you. People's judgment of us is a reflection of them. It is not a reflection of us. If they think you're a brat, that's because they had expectations that you were going to act a certain way. That's their stuff. You've got to stay in your lane. Now, I think the thing to remember here is you're probably putting so much attention and energy and pressure on yourself that it's probably feeling really inauthentic. I want you to receive the gift. I want you to thank them for the gift and then allow yourself to have anxiety about whether or not it was too much or not. Again, that's their stuff. Try to be as true to you as you can. Ask yourself, what would I do if fear wasn't here and try to do that? Now, if receiving gifts is so anxiety-provoking and you totally freeze, you may want to practice saying whatever feels right to you. For me, I might say, "Wow, that is so thoughtful. Thank you so much." That's really all you need to say. You don't need to jump up and down and get all freaked out. Just be yourself. You may even be totally calm, and then write them a beautiful Thank You card a week later and share with them what you like about it. I try to teach my children when they write Thank You cards to just say, "Thank you so much for the t-shirt. I loved the color." "Thank you so much for my drink bottle. It will fit perfectly in my lunch box." "Thank you so much for this toy. I have loved playing with it." This is just basic stuff. That's all you need. It doesn't have to be a full-on production. We're getting closer here. We're getting close. 11. "The holidays make me feel alone and lonely." I am sure you know, I recently wrote a book called The Self-Compassion Workbook for OCD. The reason I bring that up is I'm going to emphasize, so much of the time when we're suffering, all we need is compassion. So, you don't need to read the workbook for this, but I'm emphasizing the reason I wrote that book is because when we are suffering, we need self-compassion. It has to be a part of the work. So, as loneliness and aloneness show up for you, really be tender to yourself. validate yourself. Acknowledge this is true for me. I feel lonely. Don't tell yourself a story about it, though. Don't go off into the narrative of, "This means I'm a loser and no one's ever going to love me." Don't do that because that's not a fact. There's no evidence of that. So, I don't want you to focus on that, but do give yourself permission to feel what you feel. How are we going? Are we doing good? We're almost there. A couple more to go. 12. Another year of suffering, expectations not met. So, back in the past, we did a podcast on this. It's called "It's time for a parade." It's really early. It's like number 14 or 15 or something like that. Go back and check on that, because so often we need to really lean into the present, really lean into dropping out expectations. And again, we want to be compassionate. Yes, it is another year of suffering. I cannot agree with you more. I have multiple times broken down over the last week into tears because yet again, I'm missing my family. Literally, every single member of my family I won't get to see. And I know a lot of you have been doing this and are going through even much harder things. This has been a really rough couple of years. So, please validate yourself, acknowledge your suffering, allow yourself to grieve. Really go back to some of the tools we've talked about. Being present, getting really clear on the few rituals you want to do, the hot chocolate, the songs. Maybe it's taking a walk, maybe it's journaling, whatever it may be. I just want to take a breath and just really honor you all right now because the holidays are so hard. They're so, so hard. 13. How to show up for myself during the craziness of the holidays? Here I'm going to give it to you. I ask you a question and I want you to answer it honestly to yourself. All of the things that you've planned, how many do you actually want to do? And of the things you don't want to do, how many of the things you actually have to do? And then whatever's left over, don't do them. So often we add all this extra crap and we actually don't need to do it. You're allowed to keep it simple. You're allowed to just make it really easy. You might say to your friends, "You know what, guys, I'm not doing presents this year. I'm only doing gift cards. Buy them online, be done." Or you might say, "I'm not cooking/baking this year. I'm going to order them from the bakery." Done. Make it easy. You deserve and it's okay to drop the craziness. We don't need the craziness. Say no to people. We'll talk about this in next week's episode. Say no to people. Don't do what you don't want to do if you don't want to do it and it's not highly valuable to you. Here's the thing, and I'll share a story. This Thanksgiving, while I'm recording just before Thanksgiving right now, there is a couple of things I don't want to do around Thanksgiving. Now, even though I don't want to do them, I'm choosing to do them because I think they're really important for my children, particularly given the fact that they haven't had a lot of social interaction over the last year and a half. So, I'm choosing to do it. Now, what I'm going to say to myself as I do it is I'm not going to go, "Oh, I don't want to do this. Oh, I don't want to do this." I'm going to say, "I'm choosing to do this because..." and I'm going to answer, "because my children deserve this holiday." And when you say, "I choose to do this, because..." it brings you into a place where you're owning what you want to do and why you're doing it, even if you don't want to do it. But if it makes you crazy, don't do it. There's no need. 14. Gift guide for people with mental illness. If you go to cbtschool.com, we have a mental health gift guide. Go over and check it out. https://www.cbtschool.com/mental-health-gift-guide 15. Changes in the schedule. Now, this is where we use the tool of flexibility, and you have to be flexible during the holidays. Flexibility is dropping your expectations, dropping all of the goals and going with the flow. When things change, stop and ask yourself, what about this change is creating anxiety for me? Can I lean into it? Can I allow it? And go with it. Practice. Use it as an opportunity to practice the skill of flexibility. I'm not sure if I've done a podcast on flexibility. So, come to think of it, I will do one in the New Year. All right. You guys are so cool. I hope you have a wonderful holiday period. Before we finish the show, I want to do the review of the week. If you want to leave a review on iTunes, I would be so grateful. It would be the best Christmas gift you can give me. It'll cost you nothing. And my wish is that if you do it, not for me, I don't need the ego stroke, but the more reviews we get, the more people will click on it and the more people I can help with this free resource. So, here it is. The review of the week is from WalkerMom77, and they said: "Kimberley is a warm hug. While the content of this podcast is excellent and has inspired me to do further research, read books, etc., it's Kimberley's compassion that keeps me coming back. She is so authentic and genuine and her voice just relaxes me." Thank you so much, WalkerMom 77. I love, love knowing that I inspire you and keep you moving forward and bring you some compassion. Well, that's it for now. I'm going to see you next week and we can talk about boundaries with family members. I hope you have a wonderful day. Sending you so much love. Please be kind to yourself. It is a beautiful day to do hard things.

Dec 3, 2021

SUMMARY: Today we have Natasha Daniels, an OCD specialist, talking all about how to help children and teens with OCD and phobias. In this conversation, we talk all about how to motivate our children and teens to manage their OCD, phobias, and anxiety using Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and other treatments such as self-compassion, mindfulness, and ACT. We also address what OCD treatment for children entails and what changes need to be made in OCD treatment for teens. In this episode, Natasha and Kimberley share their experiences of parenting children with phobias and OCD. In This Episode: The difference between the treatment of OCD and phobias for children What OCD therapy for kids looks like compared to OCD therapy for adults How to practice exposure and response prevention for kids and teens How to motivate teens and kids to face their fears (using Cognitive Behavioral Therapy Special tricks and tools to help parents support their children with OCD and phobias. Links To Things I Talk About: Natasha's Parenting Survival Online Program www.ATparentingsurvivalschool.com Natasha's instagram @atparentingsurvival ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 213. Welcome back everybody. Oh, so happy to be here. How are you? How are you doing? I've been thinking about you all so much lately, reflecting a lot after Thanksgiving, being so grateful for you and this community and for your support. So, thank you, thank you, thank you. I am super thrilled to have the amazing Natasha Daniels on. Natasha is an OCD specialist. She is an amazing therapist who is skilled at treating children with OCD and phobias. She does an incredible, incredible job. So please do check the show notes to learn more about Natasha. But today, she came on to talk about managing anxiety in the kiddos. We don't talk enough about managing anxiety with the kiddos. And the cool thing for me was, it was so synchronistic because the day that she recorded and came on, we were prepping in my family from my daughter to do a really, really, really hard thing. So, I needed to hear what she had to say. Even though I knew a lot and I'd been trained a lot on it, I just needed to hear it as a parent. And if you are a parent of someone who has anxiety, you will just love, love, love this episode. So many amazing tips and tools and skills and concepts. I just cannot tell you how grateful I am to have Natasha come on and talk about these things with us today. Before we go over to that episode, I first want to do the "I did a hard thing segment." The first one is from Becks, and Becks is saying: "I have been so anxious that I've been carrying COVID without knowing who I'm infecting." Now I think this is true for a lot of us, myself included. So I think we can all resonate with this story. Becks went on to say, "Recently, I have been doing five to ten lateral flow COVID tests every day to check before leaving the house. I had run out of tests and had planned to eat with a friend with her three-month-old baby. I was so anxious before leaving the house and considered canceling to avoid the doubt of passing COVID unknowingly. But I gave my fear of talking to." I just love that you did that. "I didn't want to get fear to win this time. I wanted to see my friend and her beautiful new baby. I shared my fear with my friend, and without asking for reassurance, I spent the loveliest day with them. I have been ruminating a little since, but I keep reminding myself to return to my values and not let fear win." Becks, amazing work. It sounds like you're waiting through some difficult fear and you totally let values win. So, that makes me so, so happy. Great job. I am so in love with you guys when you share your hard thing with us. ***** Okay, let's go over to the episode. Well, thank you again, Natasha, for being on. Before we finish this episode, I wanted to also make sure we highlighted the review of the week. I so appreciate your reviews. This one is from Paulie Bill and they said: "So helpful. I can't describe in words how much this podcast has helped me. Kimberley is so open and accepting even via headphones." I love that. "She has sent me on the path to recovery in my anxieties. I look forward to do the work." Thank you so much. I do love your reviews. We are on a mission to get a thousand reviews. If you would go over and leave a review on iTunes, that would be so wonderful, the biggest gift you could give me. It allows us to reach more people. When people open up the app and they see that it's highly reviewed, it means they're more likely to click on and listen. And that means I get to help more people for free with this free resource. So, thank you so much, Paulie Bill, for leaving a review. I love you all. Have a wonderful week and I'll see you here next week. Kimberley: There we go. Well, I am so excited to share the amazing Natasha Daniels. Natasha, I can't wait for you to tell us about you. I'm going to let you explain about your work. You're doing such amazing work. I'm actually so excited for this episode because we're talking about managing OCD and phobias in children. We talk a lot about this stuff, but not specifically around children. So, I'm so happy to have you here. Welcome. Natasha: Yeah. I appreciate you having me. It's always nice to talk to you. Kimberley: Yes. First, tell us about you and the work you're doing. Natasha: Well, I am a child and anxiety child therapist, and I have three kids with anxiety and OCD. So, I get it on both hats. And I provide online resources for parents who are raising kids with anxiety and OCD because we need a lot of support. Kimberley: Right. Your platform is so great. In fact, I've taken one of your training, the SPACE training, and it's so wonderful. So, I can't wait at the end for you to share about that for people and parents who are struggling, but also for clinicians. Really, really helpful. Natasha: Oh, thanks. Kimberley: Yeah. So, I want to talk with you about ERP but also just anxiety management for the kids who are struggling with OCD and phobias. In your experience, is there a difference between how treatment looks for folks who are adults and the children who have OCD and phobias? Natasha: I think on a fundamental level, it's very similar. The whole structure is identical, but then we have to take into consideration a couple of different things. One, I think you have to work on the motivation and incentivizing more than you do with someone who's coming willingly. So, a lot of times we might notice an issue going on with our child, but they're another person. And so, that approach will look different. And also, developmentally, how they can understand ERP. So, how you explain it, how you gamify it. That looks different. I think as well, we want to engage them. If you don't have an engaged child, you don't have ERP. So, that's another aspect. And then I'd say the third one, the last one is developmental aspects of it. So, we're very careful with ERP to not do a lot of education because we worry, maybe if I'm educating them, I'm actually assuring them. But with kids, I find at least with myself and my practice and with my own kids, I have to do a little bit of psychoeducation because they may not even know what's normal versus what's not normal. And so, I think that piece might be a little bit different than when you're working with adults. Kimberley: Right. Yeah. I think that's so true, particularly even, I remember when my son was really young and had a really severe dog phobia. He was around a lot of dogs, and when a dog ran at him, he actually thought they were going to kill him because they're the same size. So, it was really important that we educated him on, "This is a dog, but it's not a lion" kind of thing. So, it was really important for him. Natasha: Yeah, definitely. Kimberley: You mentioned gamifying, and I wanted to just-- can you explain what that means? Natasha: Well, I think we want to offer incentives. And so, because they don't have their-- most kids don't have that intrinsic motivation to realize the bigger picture of, "I don't want OCD. This is going to have huge ramifications in my life." They just see now. And so, asking them to go, metaphorically, swim with a bunch of sharks, it's just not going to happen, but if we can gamify it and make it fun-- and I use bravery points or the earning stuff, and they can buy things at my bravery store. I use apps, I take-- I actually like the Privilege app. They should pay me because I promote them so much. Because it's a chore app, but it's just really easy for kids to convert it. And then they can have it on their iPad. So, I'm giving my kids points and they can hear the little change going on their iPad, like they just got something. That aspect of it really helps motivate kids to work on and do hard things because they may not philosophically get the benefits. They will long term, and even short term. Once they start doing ERP, they say, "Oh my gosh, it feels so much better." But that's not enough. And so, gamifying, it actually makes a lot of kids come and ask me, "Can I do another exposure?" My kids always ask, "Can I do another exposure?" if they want something. "What exposures can I do for this?" And that creates a household where we're doing ERP for fun. Kimberley: I love that. You talk about that. I mean, we do live in such an electronic world, and it is an incentive, I know for me, my kids will do anything if there is some kind of electronic reward at the end there, and it's a huge piece. I have a daughter, I mentioned to you before the recording, who is doing her own set of exposures right now, and she doesn't want to do them. Then why would she? So, it's really helpful to gamify it as much as you can. I love that you mentioned that. Natasha: Yeah, it definitely helps. And I think even people who are raw screen fans and they follow the CPS model. I hear that a lot in the parenting world. He's not pro-incentive. And I interviewed him and even he was like, for anxiety and OCD, it can be a very important component, as long as you're constantly, I think, upping the game so you're doing an exposure that's harder and harder. So, they're not just getting A plus B equals C all the time. And then you're pulling back those incentives over time, spreading them out, using intermittently. So, there are ways to pull it back. Kimberley: So good. So, let's say a child at different ages, it could be-- you may even want to distinguish different age groups if that's appropriate, but let's say they have a fear of phobia or an obsession about something. Can you share what it would look to do ERP with a child? Natasha: I think the first part is really getting them to understand what it is, because I think sometimes I have parents that they are ready to go and they forget they have to really educate the child and get the child to meet them where they're at. So, understanding how OCD works, that the more you avoid, the bigger it grows, and then partnering with them, ideally, if your child is in that space. So, sometimes we have to actually work on communication and trust for a long period of time. And that might be your only step for a long time. And parents miss that. They think, "If my child's not willing to do ERP, then all bets are off." And I say, "No, you're at the beginning of the journey." So, to educate them and motivate them, work on communication. But then as we progress – I'll just use my kids as an example because it's easy – if they have a phobia or if they have an intrusive thought, we'll say, "Okay, what are some things--" they get the concept of, "I have to walk towards my fear or towards my discomfort." So, we want to partner with our kids and say, "What things can we do to upset your OCD, to sit in discomfort?" And so, we might just make a list, might brainstorm. My daughter had a two-day period where she had this extreme intrusive thought about blood and it wasn't one of her themes, but it was just-- I'm going to use this as an example. And so, it just went from zero to 60. She had one science experiment. They were online. They had to look at a body with the pathways of the veins and the arteries or whatever, and she couldn't touch anyone because she didn't want to stop their blood. And so, just whatever that is for your child, just sitting at them and saying, "What are some things that we can do?" And she was very resistant. "I don't want to do anything." And so, I was like, "Could you look at an emoji of a little thing of blood?" So, we started off making a list. And I would say, "You don't have to do all this, but let's just brainstorm some of the things that would upset your OCD right now." And then some people pick a menu like, "Just pick one today and let's just start with that." And that's how you begin. It's just baby steps towards learning how to sit in the discomfort. Kimberley: I love that. Now, during the exposure, what does that look like for a child? I'll give you a personal example. We were doing a video exposure with my daughter yesterday, and she was all tense up, leaning back, head in the pillow, grasping, gripping, resisting, all the things, and I educated her. So, what would it look like for a parent? How would they maybe, or in a clinician, how would they coach them through the actual exposure? Natasha: In a perfect really, we want them to take the lead, and it's so hard when they have that response. And I had done needle exposures too with my kids. And so, sometimes when I see that reaction, I'll stop, and I'll just say-- well, actually, my son had to take a COVID test. This is another example. And he wouldn't stick it up his nose. And so then, of course, I got frustrated. So, I was chasing him and I was like, "Give me your nose." It was not a fine mom moment. And then finally, I stopped and I was like, "How do you want to handle this? What do you want to do? We cannot do it." And then he's like, "I'll do it." And so, I just had to walk away. But I think sometimes with exposures, it's just taking that pause and saying, "Where do you want me to poke you?" if we're talking about a poking exposure or "Where's your level of comfort?" Ideally over time, we want them to start doing these things for themselves. And so, we want them to be on automatic pilot that they're doing an exposure and we're sitting back. So, all we're doing at some point is saying, "This is less for a phobia that's situational and obviously more for an ongoing thing." But with my daughter, with emetophobia, the fear of throwing up, I might say, "What exposure do you want to do? Let me know when you do it, and then I'll give you a brave point." And then I might hover in the kitchen and just watch her do it, but try to be less involved. Kimberley: Right. I love that. On our end, I had to keep explaining to her that the more you tense and the more you cringe, the more you're reinforcing the fear to try and sit still. She's trying to practice. Again, she doesn't have to act perfect. I always say, "You don't have to take the fear away, but you can't be cringing and hiding behind the pillows and so forth." That's a big piece of the work. Natasha: Yeah. And I think it's such an important piece that I think a lot of parents miss, is not surviving the exposure. For my son with this anxiety, I'd be like, "Go upstairs to do an exposure. Go get your shoes or whatever." And this was more anxiety-based, not OCD. And he'd run upstairs like he's avoiding a killer and then he'd run back downstairs. And I'm like, "All you did was teach your brain that you survived. It's going to work." Kimberley: Yeah. I love that. Okay. So, I love that you've already shared like you didn't have a perfect parent moment, right? Because I think parent is already-- it's hard to be a parent. We have so many expectations on ourselves. Can you give us some ideas of what to say and what not to say or how parents may support their child better in these examples? Natasha: It is really tricky. And I think start, and you're so good at this, the self-compassion piece. And I think parentally, we have to start with self-compassion and say, "You're not going to knock it out of the park all the time." You're going to say things that you're like, "Oh my gosh, that was the worst thing to say ever." You might trigger your child inadvertently. So, I think having that compassion first is really important. And that's why I always often share my mistakes because I'm human, we're all human. But I think in a perfect world, the ultimate goal is we're just trying to get our child to be able to sit in discomfort. So, we're not discounting their fears. And I think sometimes parents here, "I'm not supposed to accommodate," which they, in turn, view as "I'm not supposed to support them." And that concerns me because I think a little bit of information can be harmful. So, it's not that you can't support them, but you just want to sit and validate. I know this is hard for you. I'll take an example, just so I'm all concrete. Let's go back to emetophobia, the fear of throw up. Sometimes parents will say, "When I say you can't say--" I don't normally talk like that, like you can't say, but it's not helpful to say, "You're not going to throw up," because you really want them to accept that they may or may not throw up and that they're going to be okay either way. I'm sure they can handle the discomfort. And so, sometimes that confuses parents because then the child's stomach is hurting and they're saying, "I'm worried I'm going to throw up." And then they can't say anything. So, they're like, "Got to go to school, get your shoes on." It's like turning into robots, but it's just validating the feelings. "I know this is hard for you. I know that this is really rough and I'm so--" this is how I talk to my kids, "I'm so sorry that OCD is really bothering you right now. And I know that you can handle it, no matter what happens." And so, giving them that support and validation without the accommodation of "Nothing bad is going to happen to you." Kimberley: Yeah. It's hard. I mean, it's funny because it's hard to see your child in pain, right? It's hard to watch them struggle. You want to take their pain away. You want to come in. And in some cases, I will even disclose, there's times where-- or maybe I'm not feeling I'm being a good parent in general and I want to rescue them so my kid likes me again. You know what I mean? There's so many components that can suck us into "Let me just rescue this one time." Where I really am curious to hear, what I really have struggled with my patients, the thing that they're working through is when a compulsion or avoidance is done because they want their kid to go to school. Like, "Well, if I don't do this compulsion for them, they won't go to school, and I need them to go to school," or "I need them to get their homework done. So, I'm actually going to do this compulsion for them and accommodate them because school is the most important thing at that point." So, what, what is your advice to parents who get stuck in that accommodation cycle because they're trying to keep the kid functioning in other areas? Natasha: It's definitely a balancing act because we cannot accommodate everything at once. And so, if the ultimate goal is get them to school, and there might be some things that we have to do to get them to school, but then we have to pull back. And it can snowball. It snowballed with me. I'll just throw myself under the bus the entire interview. Why not? I mean, Natasha, it looked really good. But when my daughter was, I think, first grade, she had emetophobia, her throw up in sensorimotor OCD where she thought she was going to pee all the time. So, both of those together was a nightmare. And we just needed to get her to school. She didn't want to go to school. And so, initially, it was just, "I can't go into the cafeteria." And so, there were accommodations made, "Oh, if it's just lunch, then we'll have you go eat in another classroom." But OCD is never satisfied. And so, you have to have that awareness. And that was me as a parent. Intellectually, I knew, okay, you have to be careful with this because we're accommodating it. But then it was recess. Then it was PE. And then she was spending half the day in the nurse because we were over accommodating, and then we had to start to scale back and then get her back into the cafeteria. So, I think you just have to be aware that it is a balancing act that, yes, there are some things that you might have to accommodate, but then it's not a permanent thing. You have to start. You have to constantly reassess and pull back those accommodations. Kimberley: Right. And I love that you share it. It's funny because sometimes I shock myself as a clinician. I know exactly what to do and I completely forget to do it with my kids. It's so hard. And I say, I completely forget. I'm not in denial. I actually forget like, "No, no, she's my child. It's my job. I have to protect her or protect him." So, I think it's important that we talk about that because parents can be really, really hard on themselves and beat themselves up. I know we've talked about that in the past. So, thank you so much for sharing that. Okay. So, what about in the school setting? How do you encourage parents to communicate this with teachers, personnel, or principals, and so forth? How much do you encourage people to disclose? Natasha: I think it's really important to help the school understand your child. And I know that a lot of times parents are worried about stigma or their permanent record. And so, they avoid that. But really, we're setting our kids up for failure and we're setting the teacher up for failure. So, if they're young, especially when they're young, I think it is good to write a little summary of like, these are their issues. But be specific. These are the ways that it will show up in school and these are the ways that you can help. And giving that to the teacher, I always gave that to the teacher. Whenever you'd get that thing in the mail that said, or in their backpack, "Let me get to know your child," I'd be like, I would staple this whole clinical summary in the back or email them, or I would ask them, "Can I meet with you alone after the parent-teacher conference?" But I wanted them to-- so, sometimes parents will say, "Well, I want them to get to know my child first before they see them as having a disorder." And I have found over and over again that it only benefited my child when they knew they had anxiety and OCD, that they weren't being a problem child. They weren't trying to go to the bathroom to avoid. They had certain issues that were going to show up. So, I do think it's important. Now, my son and my daughter, my older daughter, both also have anxiety/OCD issues. My daughter's 18. Once she hit an age, I'd ask her, do you want me to notify your teachers? She hit a bump in high school and I offered, "I can go in and talk to the counselor." And I actually did this past year because we had another issue going on, but there was a respect issue. At that point, that was her life. And my son, who's 12, now I also ask. But when it became an issue, I said, "I need to tell your teachers. Yeah." And so, you have to decide. Kimberley: Yeah. And now there's no rule, right? And every kid is probably different too. I know for my kids, they're such different little human beings, so my approach is way different with them. Absolutely. Okay. A couple of questions. I know I'm just coming up because I wanted to ask. So, as a parent managing, it's hard to see your kids suffer and it's also hard to see them avoid. I know it's interesting. My first reaction surprisingly was anger, right? It made me angry that this was happening. What might parents do for themselves to manage their own emotional experience when they watch their child suffering? Natasha: It could be very triggering and it could impact your relationship with your partner because you're approaching it differently. It can tap you out because you're spending so much time helping your kids, that you are forgetting to focus on yourself. And so, that cliche statement of putting the oxygen mask on yourself first actually has a lot of validity because, how you view your child, how you take care of yourself, your health, your emotional and physical health, and also how you catastrophize your child's issues will impact your child's ability to have long term success. And so, sometimes I try to get parents to connect their child's success with their own issues because that's the only thing I'll motivate them to focus inward because they're selfless and they want to focus on their child. "Don't worry about me. That's not a front-burner issue. Let me focus on my child." And I try to get parents to see you're a pivotal point, because when you're catastrophizing and you're seeing a college student in front of you not functioning and they're in kindergarten, that's doing something to how you approach that child. That's creating a lot of anxiety with that. So, self-work is really important. Kimberley: Yeah. It's so important. It is so important. I did some reflecting this week in terms of, we have a dentist appointment that is going to be hard. It's funny, we're talking this week because this is the week that we have a huge procedure happening. And I'm doing my own work and sitting in like, it is what it is. I can support, I can encourage, I can do the exposures. But when I start getting grasping, I'm like, "No, it has to happen. She has to get it. It has to be done. And it has to be done that day." And that's when I don't show up as the parent I want to be. And it shows up in many areas. It's not just when I'm with them. It's like, I'm angry when I'm typing and I'm frustrated when I'm taking a walk. So, it shows up in so many areas. So, I feel such deep compassion for the parent who is anticipating these upcoming events like vaccinations and Halloween being a big one for some kids. Some parents are dreading these events. Natasha: Yeah, and knowing what your own triggers are. I know what my triggers are. I know I can't handle choking. I know I can't handle-- my husband used to take my kids to get blood work because I have a thing with shots and blood work. And so, if you can tap out and have someone else do it, if it's a trigger for you, that could be helpful. Or knowing how to center yourself, I had to really fake it this past year because there was no help. And they were just sitting on my lap and they can feel my energy. They can. So, I had to authentically do my own work, not fake it because they can feel it. They can feel in your body and just say, they don't get it done. like you said, if they don't get it done, they don't get it done. If they pass out or throw up – because I think that's my phobia, it's like, I don't want them to pass out in front of me because they always do – then it's going to be okay, no matter what. Kimberley: Did you, as a parent, if you don't mind me asking, have to do your own exposures to their exposures? Natasha: Taking them has been an exposure. It's actually not an exposure because it's just happening to me. But I didn't. I actually didn't. I just do my own internal work. I find just telling myself that it doesn't matter if they pass out and they do. And they still do. And it's all still okay. Kimberley: You're amazing. It's really inspiring actually to know you're walking the walk, not just talking the talk. It's really quite impressive. Natasha: Oh, thanks. Kimberley: Yeah. So, what do you do if your child adamantly does not want to engage in treatment? Natasha: It's really important that we get them to enter treatment approaches on their own, because I really feel like we can break their ability to embrace approaches lifelong if we strong-arm them and we force them and we do things. I've had parents say like, "I just take their hand and I make them touch stuff." And I think that child's never going to do that on their own then because we're always going to dig our heels back. So, I think it's meeting your child where your child is at. And there's always an entry point. It may not be the entry point you want, and I totally get that because my son, he did not want to do anything initially. And that's frustrating when your child's starving to death, but it's not going-- you can't force it. You can't grab the steering wheel and drive for them. And so, what do they need for me to get them to that point? Do they need-- do I just have to work on communication with them? Do I just have to work on them trusting? They say something and I just listen. Can I just get them to watch a bunch of YouTube videos or read a couple of books and give them bravery points for doing that? That's treatment. That's education. So, I think it's just finding out where does your child want to start. Kimberley: Right. I know I took one of your courses, the SPACE training, which was amazing. And I found that really helpful too, is to just catch-- if they don't want to do treatment to catch where the accommodation is happening on the parents end. Did you want to share a little about that? Natasha: Yeah. I think that SPACE Program, Eli Lebowitz's SPACE Program, is huge because it finally empowers parents to do something, even if their children don't want anything to do with it. So, you can work on your trust and communication, but then there are-- OCD is a family affair, we often say, and there's a lot that we can do that OCD wants us to do. And so, working on how we approach it, what kind of family environment do we create in our home? What things do we pull back, our accommodation? There's a lot of work that a parent can do on their own. And that's what the SPACE program does. And I have a study guide because I think some people just want a video of like, "Just break it down for me, Natasha." Kimberley: That was me. I want the bullet point version. Natasha: Yeah. Kimberley: That's what that does. And it was amazing. Okay. So, thank you so much. This has been so incredibly helpful. I'm wondering if you could give us some major points, things that you really feel that we need to know either as clinicians or parents or loved ones of a child who's struggling with OCD and anxiety. What are some main points or things that you want us to know of before we sign off for the day? Natasha: Well, I think you cover a lot in your podcast with such good information. So, I would just add to that and say, don't forget to make it fun, right? I mean, all this doom and gloom, the kids can feel that. And we can make OCD fun and we can gamify it. So, that's really important. And I think the other part is not forgetting to highlight the superpowers that kids with anxiety and OCD have, letting them know that there are amazing qualities that come with a person who has anxiety or OCD. And my kids get proud of that. They start to feel like, "I'm intuitive," or "I'm kind-hearted," or they'll even actually say, "My superpower is..." So, don't forget that part. That piece is important. Kimberley: So important, particularly because with OCD and anxiety comes so many qualities, right? They can have qualities. They're so brave. They're so courageous. They're so resilient. These are things that will serve them for why. Natasha: Totally. Kimberley: Yeah. Well, I thank you so much. Number one, as a human being, thank you, because I needed this this week without even realizing it. Natasha: I'm glad you need it timely. Kimberley: It was such great timing, but also thank you for all the amazing work that you do. I think this is an incredible resource. So, can you tell us where people go to hear more about you? Natasha: Yeah. And thank you for your work. I think that you're just putting such good stuff out there. People can find, if they want to look at my online courses, they can go to atparentingsurvivalschool.com. And I provide online resources for parents and courses to teach you how to help your kids crush anxiety and OCD. They can also listen to my podcast. Kimberley: Great. And I'll have links in the show notes for anyone who wants to access that. I am so grateful to you. Thank you so much for doing such great work. Natasha: Thanks for having me.

Nov 26, 2021

SUMMARY: In today's podcast, we take a deep dive into a common question I get from followers and CBTschool.com members. HOW MUCH ERP SHOULD I BE DOING DAILY? Because ERP is such an important part of OCD treatment and OCD therapy, I wanted to outline how you might set up an ERP plan for yourself and how that can help you with your OCD treatment. In This Episode: What is ERP (exposure and response prevention)? What an Exposure and Response Prevention plan looks like. How to determine how much ERP you should do each day Why it is important to practice ERP for OCD, health anxiety, and other anxiety disorders. How to taper off doing ERP once your obsessions and compulsions have reduced. How to practice self-compassion during ERP Links To Things I Talk About: ERP School: https://www.cbtschool.com/erp-school-lp Kimberley's ERP Book: The Self-Compassion Workbook for OCD CBTschool.com Episode Sponsor This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit – Episode 212. Welcome. I am so thrilled today to talk to you about a question I get asked all the time, which is, how long should I be doing exposure and response prevention per day? So we are going to go all the way through that here in just a sec. But before we do that, we always start the show with our "I did a hard thing." Now, each week people submit their "I did a hard thing" and we share it because we want to spread the word on all of the hard things that people are doing to inspire you, to help you realize you're not alone and to help give you that little bit of motivation to face your fears as well. Now, what we usually do after that is we do the review of the week as well, which is where people leave a review on iTunes for this podcast, Your Anxiety Toolkit. But today, somebody left a review that was also the "I did a hard thing." So I thought, no better opportunity than to do both at once. This is from Jayjenpeezy, and they said: "Right on time! I cannot even begin to say how helpful this podcast is and I have incorporated into parts of my daily meditations and/or listen to it on my walks. A few weeks ago I was admitted to the ER and kept overnight for an observation and what the doctors originally thought was tachycardia turned out to be a panic attack which I had never experienced to that degree before. I spent the next few weeks even more anxious at the thought that it would happen again and thought I'd lost my mind and began taking antidepressants as a quick solve which now I know is not the solution I truly needed. (Mind you, I am speaking only for myself and understand that not everyone is able to be off their prescription meds.)" I love that you included that. "After doing some research I learned about this podcast and ERP and am starting to feel much better about a lot of things. I've also changed my diet to be more alkaline, incorporated daily meditation, gratitude journaling and have been able to finally leave my house to take daily walks. The journey is different for everyone but as she continuously reminds me that "it's a beautiful day to do hard things" and that panic attacks are not actually attacking you it's your adrenaline rushing through you and in time comes to pass when you are able to meet it eye to eye. I also learned to look at it as willful tolerance," we have a whole episode on that "and it is not so scary anymore. I am taking it one day at a time and am mindful of being present as possible. Ending up in the emergency room while my children were left at home at night was enough for me to take any and all necessary steps to not allow my anxiety control me. Sending love to all and may the force be with you." I love that. Let's just say that is the perfect marry between "I did a hard thing" and a review. So thank you so much to our reviewer, Jayjenpeezy. I am in such admiration of you. So let's get over to the show. Today, we are talking specifically about how long or how frequent your ERP should be. Now, when I say "should," I'm going to disclose here, it's different for everybody, but I'm going to tell you just briefly what I would tell any of my clients. And then from there, you get to go and decide what is right for you. Okay? So, let's go over to that topic. When someone asks me how long or how frequent and what duration I should do for an exposure, I almost always tell them the same thing. In ERP School, the online course for OCD, and in my new book, The Self-Compassion Workbook For OCD, I say exactly the same thing in both, which is ideally, you should practice exposures for around 45 to 90 minutes per day. Now, I know that doesn't work for everybody. So you have to go and do and find a balance of what's right for you. But let me show you how you might incorporate that 45 minutes to 90 minutes per day. While it's totally fine if you do this, in fact, I applaud you if you do this, but I don't suggest that you do it just in one lump sum time. It's hard to schedule 45 to 90 minutes if you have a job, a family, or you go to school or you have another mental illness that you're working through. What I encourage people to do is to displace that time throughout the day. Again, you can follow my rule. I did a whole episode about scheduling and how it's important for your recovery. You can schedule it into your day in blocks, like for 15 minutes after breakfast, you do an imaginal, or for 15 minutes before lunch, you'd go and face something that you're afraid of. For 10 minutes before you go and make coffee, you may do some of your homework. You can schedule it in blocks. I like that. That's my preference if it were me. But a lot of people, what I encourage them to do is pair it with activities you're already doing, or you would already be doing had you not had OCD or this fear. So an example might be, as you're driving to work, you could be listening to your scripting in ERP School, our online for OCD, and in The Self-Compassion Workbook For OCD. We explain extensively how to do scripting and imaginals. You can do that while you drive to work. You can do that while you make your breakfast. You can do that while you wash the dishes. You can do that while you walk around the block. You can do it while you stretch. You can do it while you're in the shower. These are activities where you don't actually have to stop what you're doing to do exposures. You can do many exposures in your normal daily life. In addition, let's say you have the fear of contamination or doing some activity and fear of what thoughts you may have. I would encourage you to try to go about your day, having the thought on purpose. So you don't have to, again, stop your day and stop your schedule and your normal functioning. You could start to implement these things that you're afraid of throughout the day. Or if again, something you're avoiding, you may then want to practice implementing that back into your day, particularly if it brings you fulfillment and wellness and more functionality into your day. Instead of, let's say, you have a compulsion where you ask somebody to accommodate you, you might actually choose to do it yourself. You get points for that. That is an exposure. That should go towards your 45 to 90 minutes per day. Now that being said, that's just exposures. The response prevention is something that you do throughout the entire day. For those of you who don't really understand the difference, an exposure is where you face yourself to your fear or your obsession. You face that fear of obsession. Response prevention is then not engaging in a compulsive behavior to reduce, remove, or eliminate the discomfort, uncertainty, or feeling that you're experiencing. Some form of discomfort it usually is. The response prevention is something you will practice for the whole 24 hours as best as you can. Now, does that mean you need to do your exposure? Let's say your exposure is to touch a certain object or face a certain object or have a thought. Does that mean you need to go completely cold turkey from your compulsion? No. In a perfect world, yes, that would be the case, but we don't live in a perfect world. You don't have super powers. I wouldn't expect my clients, myself, or you to go from 0 to 100. What we can do there is we can practice it in small baby steps. You face your fear and you say, "Okay, I'm going to try and do response prevention for the next five minutes." Then you move it up to 10 minutes. Then you move it up to 15 minutes. Then you might move it up to an hour or whatever feels right to you. What we're talking about here is, do as much response prevention as you can, work your way up. As we say in ERP School, ERP is really like a ladder building hierarchy. You start small and you work your way up slowly. Preferably you have a plan. You know what the plan is, you know what the first step is, you know what the second step is. Life isn't perfect, like I said, so I don't expect it to be perfect. But I think with that model, where you first practice accumulating 40 to 90 minutes of exposures, and then you practice response prevention as much as you can, as you build up and build up and build up steps, you have a great ERP plan right there, an amazing ERP plan. One thing to consider. When my husband came on the podcast, it's episode 99. He talked about his panic attacks that he had an agoraphobia he had on airplanes. He brought up the concern of, it's not like he could get on a plane for 10 minutes and then get on a plane for 15 minutes and then get off. There are certain situations where you have to go from 0 to 100. So you have to get on the plane and stay on the plane. In his case, it was 17 hours to Australia. So there will be situations where you have to take that huge leap. That is okay. You can still tolerate that. I still want to reinforce and empower you to believe you can still tolerate those big, big exposure jumps from 0 to 100 or from maybe four or five to 100. You can still tolerate those. I don't want you to feel like it's not possible. Anyone can face their fear. It just depends on how willing they are to be uncomfortable. But what he did as he led up to that is find creative ways to practice the scenario and simulate the scenario as best as he could. He took the train. He took little buses. He took the trolley. There's a small trolley back and forth from the mall, so he practiced on that and practiced tolerating his panic. So you can find ways. Even if it's not the specific fear, you can find other ways to simulate that fear or that thought or that sensation so that you can practice building up to those bigger, longer exposures where you don't get to choose how long you do the exposure for. So there are some ideas on how you can practice ERP, what frequency, what duration. Now the other question I commonly get is, do I have to do it every day? No, you don't have to do it every day, but I always encourage my patients to do it as much as you can. This is like building a muscle. So the more mental push-ups you do, the better and stronger you get. Now we also know that you can do too many pushups and burn out. And so it's important to keep an eye on that. I always try to talk about balance. So try to find a plan or a system or a routine in your calendar that is sustainable, that you can continue to do over time. Some people have written in and said, "I went full gung-ho, went hard, burnt out. The idea of ERP was so overwhelming after that. So I stopped." So I really discourage you from going that kind of way. You don't have to be perfect. Please don't do this perfectionistically. Find little baby ways to implement it throughout your day so you don't burn out. That is how you do this work for a long period of time. That is how you get better. That's how you do it in a healthy, compassionate way. So that is how we do it. You don't have to do it every day. In fact, some of my patients schedule different obsessions on different days. Other patients take a six-day exposure and take Sunday off or one day off a week. You could do whatever feels right to you. Just be really honest with yourself. When you schedule your ERP, are you scheduling it because of your values and your self-compassion or are you scheduling it because you're secretly afraid? Even if it's that, even if it's the letter and your scheduling because you're secretly afraid, no problem. We are doing the best we can with what we have. Just be really honest with yourself, and look and work on that if that's the main issue. Thank you so much for being here today. I am honored to spend this time chatting with you. Hopefully, you got a ton from this episode. I love when I get questions from you guys. If you are, go over to Instagram and you can chat with me there. I'll leave the link in the show notes. You can always ask me questions there. I often do Q and A's and I'd be more than happy to answer your questions. All right, you guys know what I'm going to say. It's a beautiful day to do hard things. Go and do the hard thing. You will not be sorry. You will be so empowered. You will feel so much better. It is hard work, so be gentle with yourself. But I believe in you. Have a good day.

Nov 19, 2021

In this week's podcast episode, we have the amazing Shala Nicely, author of Is Fred in the refrigerator? and Everyday Mindfulness for OCD. In this episode, we talked about people-pleasing and how people-pleasing comes from a place of shame, anxiety, and fear of judgment from others. Kimberley and Shala share their own experiences with people-pleasing and how it created more shame, more anxiety, and more distress. In This Episode: The definition of people-pleasing How it is common for people who have OCD and Anxiety disorders. How people-pleasing impacts people's self-esteem and their wellbeing. How people-pleasing anxiety keeps us stuck. How to manage people-pleasing in daily life. How self-compassion can help to manage people-pleasing. Links To Things I Talk About: Shala's Website shalanicely.com Shala's Book "Is Fred In the Refrigerator?" ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). Episode Transcription This is Your Anxiety Toolkit - Episode 211. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, everybody. This is an episode I am so excited to share with you. Maybe actually "excited" isn't the word. I feel that this is such an important conversation. Today we have my amazing friend and someone I look up to and I consider a mentor, the amazing Shala Nicely. She's been on the podcast before. Everybody loves her, as do I. And interestingly that I say that because today we are talking about people-pleasing—the act of getting people to like you. Shala is very easy to love, but we are talking about how invasive people-pleasing can become, how problematic it can become, our own personal experience with people-pleasing, and what we have done and are continuing to do to manage people-pleasing behaviors. It is such a wonderful, deep, comprehensive conversation, so I cannot wait to share that with you in just a few minutes. Before we do that, I would like to first, of course, share with you the "I did a hard thing" for the week. This is from Jack, and I'm so excited because Jack said: "I haven't been able to drive on the highway since I had a severe panic attack a couple of months ago. I have felt trapped and it has put a strain on my life. I recently drove on the highway for an hour by myself. I felt anxious during it, but I was able to calm myself down. It was a huge step for me." Amazing work, Jack. This is such a hard thing and you totally did it. This is so inspiring. You got through it. You actually stand your fear right in the face. So cool. Just proof that it is always a beautiful day to do hard things. Let's move over to the review of the week. This is from YFWWFH, and this review said: "Life-changing in a meaningful way. I found Kimberley's podcast through another psychology podcast I've been listening to where she was a guest. I started listening to hers and was so happy. I found it. The insight this podcast offers and the expertise she shares are incredible and truly make a difference in the way you think about things and feel when struggling with some of the topics talked about. I truly love this podcast and the effect that it has." Yay, that brings me such joy. Thank you so much for sharing that review. You can leave your reviews on iTunes. Please go over to iTunes to leave a review. The more reviews you leave, the more people we can reach, which means the more people I can help with this free resource. That being said, let's move over to the show, such an important interview. I am so excited and I'm so curious to see what comes up for you as you listen. I hope it's helpful. I hope it gives you food for thought. I hope it gives you direction. And I just can't wait to share it with you. So let's go straight to the episode. I will see you guys next week. Have a wonderful day. It is a beautiful day to do hard things. Kimberley: Okay. So, you guys know that I love Shala Nicely, and today I have the one and only Shala Nicely talking with us about people-pleasing. And this whole conversation came organically out of conversations we've had recently. So, welcome, Shala. Shala: Thank you, Kimberley. And as you know, the love is mutual. So thank you for [ 04:42 inaudible ] me again. Kimberley: Okay. I have so many questions and this is probably the most relevant topic to me in my stage of my recovery. You can share as much as you want to share, but I'm so grateful that we're talking about people-pleasing, because I feel like it runs rampant for those who have anxiety. Would you agree? Shala: Absolutely. Kimberley: How would you define people-pleasing? Shala: People-pleasing to me is putting your own needs in the backseat so that you can do things that you think will make others happy or like you. You're not quite sure about that. You're mind-reading, you are estimating what other people might want or what society might want. I think people-pleasing is not just, "I'm pleasing the individual person." It could be, "I'm pleasing a culture, a society, a family." But I think it's all about putting your own needs in the backseat and doing what you think other people want in order to make them happy, but really it's in order to reduce your own anxiety. Kimberley: Right. So, there's so much there you said that I want to pull apart. So, you emphasized "You think," and I think there is a major concept there I want you to share. We want to please people. Of course, we want to please people. We like seeing smiley, happy faces. I don't like seeing sad faces and angry faces. But so much of people-pleasing is based on what in our minds we think they want. Can you share your thoughts on that? Shala: If you look at people-pleasing behavior–I'll take me as an example–obviously, it starts with an intrusive thought, "What if they don't like me? I've not done well enough. They're going to think less of me, drop me," et cetera, et etcetera. So, I think it starts with some sort of intrusive thought like that. And from there, it goes into how to answer that what-if. And the what-if is made up. We don't actually know it's a real problem. It's an intrusive thought that has come in. It may or may not be a problem. And so, if we engage in this, we're trying to figure out, "Well, how can I make sure that what-if doesn't happen?" And so, you're dealing with a really made up situation. And so, there's really no data there for you to know what to do. And so you're guessing. "Gosh, what if this person isn't getting back to me because I did something wrong and they don't like me? And I need to do something to show them how much I like them so that they'll change their mind about me." The whole thing is based on the premise that what if this person doesn't like me, which is probably 99% of the time not even a premise. So, we're guessing all over the place in both guessing there's a problem we have to solve. And then guessing how to solve that because we don't really know if there are problems. So we have to whack it together, you might say. Kimberley: Right. I remember early in my marriage, me getting my knickers in a knot over something, and my husband saying, "What's happening?" And I'm like, "Well, you want me to do such and such this way?" And he was like, "I've never said that. I've never even thought that. What made you think that I would want you to be that way?" And I had created this whole story in my head. For me, that's a lot of how people-pleasing plays out, is I come up with a story about what they must want me to be, and then I assume I have to follow that. How does it play out for you? Shala: I think "story" is the right word to use there. You create this whole story in a scenario. It's got main characters and a plot and the ending is always horrible, and it becomes very believable in your mind. The thing is it's in your mind. We've made it all up. But those stories convey very powerful emotions and then we're acting to somehow get rid of those emotions, which were created by the story that we made up in the first place. Kimberley: Right. And that was the second thing that you said that I think is so compelling, is for me in my life goal of reducing people-pleasing behaviors, I will be on this journey for the rest of my life. I'm pretty confident of it. It's a matter that I have to learn how to sit with the feeling instead of just going into people-pleasing to remove that feeling. Is that how you would explain it for yourself as well? Shala: Yes. And I will echo your sentiments. I will be right alongside you on this journey of trying not to people-please the rest of my life. And I think it's sitting with some uncomfortable emotions and it's really sitting with the uncertainty of "we don't know" what other people think. And it's easy, especially if you have anxiety to assume the negative because that feels like some sort of certainty. "Oh, they must not like me." That's actually sometimes a more comfortable thought than "I don't know," fit with "I just don't know." Kimberley: Right. Because when we tell ourselves "They mustn't like us," at least then we don't have a place to work from. We can gain control back. Whereas if we are not certain, that's a really uncomfortable place. I know as we were talking, do you think this shows up the same for folks with OCD as it does for folks who don't have OCD? Do you think there's a difference or do you feel like it's the same? Shala: That's a good question. I might only be able to offer a biased answer because I have OCD and I work with people with OCD. So, that's going to be the frame of reference that I'm coming from most often. I think that with OCD, it could come from a foundational place of really thinking that you're not worth very much. I think that comes a lot because OCD spends its days if you're untreated, yelling at you and telling you are horrible and nitpicking every little thing that you do wrong. And it's like living with an abusive person when you have untreated OCD, especially when it goes on for years and years, which happens to so many of us with OCD. And if you hear that for however long–months, years, whatever–you start to believe it. And then you don't think you are worth pleasing, and you almost feel like, "Gosh, maybe if I made people around me happy, maybe if I got this positive feedback from other people that they think I'm worthwhile, then somehow maybe all this in my head will stop." I think people-pleasing for people with OCD can come from that place where they just have internalized years of abuse by their own mind that they feel like they can't escape until they find exposure and response prevention and work through all that. But even after that, they can still have this foundational belief that "I'm just not worth anything." And that can drive a lot of people-pleasing behaviors that can linger even after somebody's gone through what would be considered a successful course in ERP. Kimberley: Yeah. That's really interesting. As you were talking, I was comparing and contrasting my eating disorder recovery. I was thinking about this this morning. My eating disorder didn't actually start with the wish to be thin. It started with pleasing other people. So, my body was changing and I was getting compliments for that. And then the compliments felt so good. It became like something I just wanted to keep getting, almost compulsively keep getting. And so then, it became, "How can I get more?" People-pleasing, people-pleasing. "Oh, they liked this body. Well, I'll try and get that body. Oh, they complimented me on how healthy my food was. Okay, I'll do that more in front of them." So, it's interesting to compare and contrast. People-pleasing was the center point of my eating disorder and the starting point of my eating disorder. So, that's really interesting. You talked about people-pleasing behaviors. What do you think that is for you? What would that look like? Shala: People-pleasing behaviors can be big or small. It could be something like a friend calls you to go out to dinner. You don't really want to go out to dinner. You really want to sit in and watch your latest Netflix binge show, but you feel like you can't say no. So you go out to dinner. That could be something on the smaller end, I think. Then there's on the really large scale, which I've done, and I talk about in more detail in my memoirs, Is Fred in the Refrigerator? about my journey with OCD, which is not breaking up with somebody because you're afraid to hurt their feelings. And you can take that all the way down the aisle, which I did. And so, I think that people-pleasing behaviors really can run the gamut from small seemingly innocuous things. "Oh, it's just an evening," to life-changing decisions about your partner, about how you live your life, about where you live, about your work, about how you approach, all of that. And that I think makes people-pleasing sometimes hard to identify because it doesn't fit neatly in a little box. Kimberley: Yeah. That's interesting. And I love the way that you share that. What's interesting for me is that most of my people-pleasing in the past have been saying yes to things that I don't want to do or things I want to do, but I literally don't have time for. So I'm saying yes to everything without really consulting with my schedule and being like, "Can I actually fit that in on that day?" Just saying yes to everything, which I think for me is interesting. A lot of the listeners will remember, is I got so the burnt out and sick, because I'd said yes to everything six months ago. Because six months ago I agreed to all these things, now I'm on the floor, migraines or having nothing because I just said yes to everything. And so, for me, a lot of that, the turnaround has been practicing saying no to plan for the future, looking forward, going, "Will I have time for that? Do I want that? Does that work for me? Is that for my recovery?" How have you as either a clinician or a human started to practice turning the wheel on this problem? Shala: It's hard for me to think how to the answer to that because there are so many ways to approach it and it's a complex problem. And so, I have approached it in a number of ways. The first thing that comes to mind is really boundaries because a lot of this is about setting boundaries to protect your own time and to protect what you want to do. So, that's one of the things that I have really worked on, is becoming clear on what I think is acceptable for me to be doing and what is not acceptable for me to be doing in terms of my own physical and mental health. It's so easy to say yes to things, especially if it's months down the road, "Oh, that'll be fine, I'll have time to do that." And then you get to, you're like, "Okay, I don't have time to do that." And then you're wearing yourself out and all of that. And I think that happens a lot with people-pleasing because again, you're putting your own needs, especially for rest and recovery on the back burner in order to do things that you think will make somebody else happy. And so, I think really working on boundary setting. So I'm coming from a perspective of having OCD and treating OCD. Boundary setting is an exposure. So, it is about creating an uncomfortable situation because it involves saying no. And if you say no, sometimes you're going to disappoint people. And if you're just getting into the process of saying no, and people are expecting that you're going to say yes because you say yes to everything, you can often get some pretty negative feedback. "What do you mean no? You've always said yes." Kimberley: You're the "yes" girl. Shala: And so then, that feels even more jarring, like, "Oh, see, it's coming true. People don't like me." And so, that becomes even more anxiety provoking and thus an even better exposure, but even harder. And I think that thinking of it as setting boundaries to protect your own times so that when you do say yes to something, you are there as fully as you can be because you're well-rested in terms of your body and your mind and your health and all of that. When you don't have good boundaries, you end up feeling very resentful because you haven't been able to take care of yourself. And so, in fact, by not setting good boundaries, you can't actually be there for people when they need you because you're too run down. And that is, I think, the big lie about these people-- one of the many big lies about this people-pleasing thing is that, "Well, I got to do all this to make people happy." Well, in essence, you're not putting your own oxygen mask on first. And so, you can't. Even if there was something you really could do that would really help somebody else, you don't have enough energy to do it. So, I think really realizing that boundaries are the way to not have that resentment, to allow you to be fully there with the things you do want to do with all your heart and energy. And so then, you are actually really achieving your goal because you can really help people, as opposed to saying yes to everything and you're spread so thin, you're not enjoying it, they're not enjoying it, and it's not achieving the goals that you had in mind. Kimberley: Yes. It's so exactly the point. So, boundaries is 100%, I agree. I'll tell you a story. You know this story, but the listeners might not. Once I did a podcast that got some negative feedback and I called you, understandably concerned about getting negative feedback, because I don't like-- I'm one of those humans that don't really love negative feedback. Shala: I'm one of those humans too. Kimberley: I had said to you, this is literally my worst fear. One of my worst fears is being called out and being told where you've made a mistake. What was really interesting for me is going through that and saying, "Okay, but I did, it is what it is. I wouldn't change anything. And here's what I believe." I came out of that instead of going and apologizing and changing everything. I came out of that actually feeling quite steady in my stand because I had acknowledged like, "Oh, even when things don't go well, I can get through it. I can stand on my two feet. I can get through those," which is something I hadn't ever really had to practice, is really standing through that. And I thought that that was a really interesting thing for me, is a lot of the reason I think I was people-pleasing was because the story I was telling myself was that I wouldn't be able to handle it if something went wrong, that I wouldn't be able to handle people knowing that I had made a mistake or so forth. But that wasn't true. In fact, all of a sudden it felt actually a bit of freedom for me of like, "Oh, okay. The jig is up. I can chill now." Have you found that to be true of some people or am I rainbow and unicorn? Shala: I love that because I think it's like what we do with people with social anxiety. They are afraid of going out in public in certain situations and having somebody evaluate them negatively. And one of the things that we do with those exposures is actually, let's go out and create some of these situations that your social anxiety is afraid of. Let's go into a shopping mall in the food court and spill a Coke on the floor while everybody's looking at you. And then process through, what was that like? Well, I just stood there and they came and cleaned it up and everybody went back to their meal and we went on. Huh, okay. That wasn't as bad as I thought it was. And I think that's very akin to what you're saying, is we build this up in our head that if we're rejected, if somebody doesn't like us, if we disappoint somebody, that's going to be catastrophic. And inevitably, it is going to happen unless you isolate yourself in your house, that somebody is not going to like you, somebody is going to give you a bad review, and being able to say, "Yup, that is okay. I don't have any control over that. And I can handle that. That doesn't devalue me as a person because they gave me a bad review or bad feedback or whatever." Because if we think about what we each do, like I've bought products before that I've written bad reviews for because I didn't like it or it didn't work for me. I think everybody has. And even if you didn't write a review, you thought it in your head. So, all of us have things we like and don't like, and that's okay. What you're talking about is you have those experiences and then you realize, "Wait, that is okay." And then you feel free, like, "Okay, look at me. I can make mistakes." You're less compelled. Continue doing this because you're like, "Wait, there's freedom on the other side of this where I don't have to try to be pleasing people all the time." Kimberley: Right. Or in addition to that was-- and this is true in this example of, I think it was a podcast that I had put out, was people cannot like what I did but still like me in other areas. That blew me away. I think that in my mind it was so black and white. It's like, if they don't like one thing, they're going to knock you out, where it's like no. People can hold space for things they like and things they do like. Shala: That is such important. Kimberley: Right. You also just said something and I want you to speak to it, is some people people-please by going above and beyond, but you also just brought up the idea of some people just don't leave their house. What would that look like, because they're people-pleasers? Shala: Well, I think that is the extreme case of any kind of anxiety-driven disorder, where you're trying to avoid having to be in a situation where others have expectations of you that you feel that you can't meet, and so you narrow your world down to avoid those situations to avoid the anxiety. And I don't think that's just with people-pleasing. That's obviously what agoraphobia is about—people not leaving their homes because they're trying to avoid situations that are going to trigger panic attacks. But I think people with anxiety disorders in general can start making choices to avoid anxiety that end up not allowing them to lead the lives they want to lead or to take care of themselves. Kimberley: Yeah. I mean, I think that's the question for everybody, even for those who are listening, I would say. If you're thinking, "Oh, this doesn't apply to me," it's always good to look like, "What am I avoiding because of the fear that I'll be disproved?" or someone will give you a bad review and so forth, because I think it shows up there quite often. Shala: Yes. And in fact, there is a really good article—maybe we can put a link in the show notes—that Adam Grant from Wharton Business School wrote in the New York Times about what straight A students get wrong. And I think it goes right to the heart of what we're talking about because he referenced people who are looking for straight A's, which is an institutionalized form of approval, will potentially take easier classes that they can get an A in versus something they really are interested that they might not do as well in. And so, they are not pursuing what's important to them because they're pursuing the A, and therefore head in a direction that maybe isn't the direction that would be best for them to have. Kimberley: Right. And you just hit the nail on the head because so much of recovery from people-pleasing is actually stopping and going, "Do I want this? Does this actually line up with my values? Am I doing it for other people?" I've heard many clients say, "I do what other people tell me to do and what they want because I actually have no idea of what I want." That's scary in and of itself. Shala: And that is a really tough problem for people with anxiety disorders because when you have an anxiety disorder, you're used to doing what the disorder says and the disorder can really run your life. When you get better from the anxiety disorder, it's easy to keep doing the things that you were doing that didn't necessarily seem compulsive but may have been because they're just part of your life, without ever stopping to step back and say, "Well, do I need to be doing this?" I'll give you a personal example. I live in Atlanta and there's lots to do in Atlanta. I've lived here for a long time. I think I felt a need that I "should" be out and doing things because I live in a big city and there's so much to do and I need to be doing it. And so I'd have this story in my head that I need to be out and visiting attractions, the aquarium, the restaurants. We have this really cool food court called Ponce City Market. While those things are fun and I do enjoy going to them sometimes, it almost felt like I should do this because this is what people do. They're out and about and doing things, almost like I'm pleasing a societal norm, like this is what you do if you live in a big city. Well, COVID actually has really helped me recognize, "You know what, I actually don't need to get up on Saturday morning and pack my schedule full of all sorts of things that I think I should be doing. I can actually just sit in my house and do things that I might want to do." And so as you know, I've been doing all sorts of things lately just to try stuff out. I'm taking an oil painting class, which still scares me to death. And I'm taking French lessons because I want to learn how to speak French. And I've bought these art magazines because I really like art and I just want to look at it. And I'm just letting myself explore these various things to find out what I do like. And then once I've been through this process and find what really floats my boat, then maybe hey, one weekend I can go to the aquarium because I want to, because it meets some value or need I have and do some painting instead of trying to meet this idea of what I should be doing that's trying to please society and what my role in society should be, which I think is very easy for people with anxiety disorders and OCD to do, is let other people make the rules, the disorder, your family, your spouse, the society in general, as opposed to just sitting back and saying, "What do I really want?" And the answer to that might be, "I don't know." And instead of rushing out to do something because it feels better to just be doing something than to sit with the uncertainty of "I don't know," letting yourself sit in that and go, "Well, what can I maybe try to see if I like it?" Kimberley: Right. And I will add to that because you and I have talked quite a bit and I've learnt so many inspiring things from you as I've watched you do this. What was interesting for me is, a part of that for me was choosing things that people don't actually like. Some of the choices I've made–things I want to do with my time or that I've said no to–do disappoint people. They do disappoint people and they might tell you you've disappointed them. And so, for me, it's holding space for that feeling, the shame or the guilt or the sadness or whatever the emotion is, but still choosing to do the thing you wanted to do. It's not one or the other. You don't do things just because you haven't disappointed someone. You can also choose to do something in the face of disappointing other people, right? Shala: Yes. And I think it's inevitable. You're going to disappoint them. Kimberley: It sucks so bad. Shala: Because you're not going to have the same wants and needs as everybody else. And so, it's inevitable that if you start figuring out what you want to do and trying some things out, you can't do all the other things everybody else wants you to do. Kimberley: Yeah. I know. And it's so frustrating to recognize that. But as you've said before, tens of thousands of people could love a product and tens of thousands of people could hate a product. Lots of people will like me and lots of people won't like me or the things that we do or the places we want to go and so forth. I think that's a hard truth to swallow, that we won't please all the people. Shala: Yeah. And I'll tell you a story that I think illustrates that, is I read this book for a small book club that I'm in, and one of the members had suggested it. I just went and grabbed it, bought it. I didn't really read what kind of book it was. And I was loving it. It was really good. It was like this mystery novel. And then we get to the last, I don't know, 20 pages. And it turns into this psychological thriller that honestly scares the pants off me, but it was wrapped up so well. I was just sitting in shock on the floor, reading this thing, like, "Oh my gosh." It was so good, yet so terrifying. So I got online on Amazon just to look at the book because it had just gone right over my head that this was a thriller, and I don't normally read thrillers. I just wanted to go on and see. And I was expecting, because I loved this thing, to see five-star reviews across Amazon for this book because I thought it was so amazing. And I got on, and the reviews for it were maybe three point something stars. I started reading and some people went, "I hated this. It was horrible." They hated it as much as I loved it. And that to me was just a singular example of you cannot please everyone. I love this book, other people hate this book. There were lots of people that were in between. And that doesn't say anything about the writer. The writer is a whole complete awesome person, regardless of what any of us think about what she wrote. Kimberley: Right. And she gets to write what she wants to write, and we get to have our opinions. And that's the way the world turns. Shala: And I think recognizing she doesn't have any control over what I think, I might even write a five-star review just for whatever reason and really hate the book. So, even if you get a positive review, you don't actually know that it's true. I think this is all about understanding that it's not about not caring about what people think because that's really hard. It just numbs you out and cuts you off. I think it's about going into the middle. It's not about people-pleasing. It's not about not caring. It's about recognizing you don't have control over any of that and living in that uncertainty. I don't know what people think. I don't have control over what people think. And even if they tell me one thing, that could actually not be what they think at all. And that's okay. Kimberley: Right. Such an amazing point. I'm so glad you brought that up because I actually remember many years ago saying to my husband, "I've decided I don't care what people think." Well, that lasted about 12 and a half seconds because I deeply care what people think. But it doesn't mean that what they think makes my decisions. And I think that's where the differentiation is. A lot of the people who are listening, there's absolutely no way on this world they could find a way to not care and not want to please people. It's innate in our biology to want to please people. However, it gets to the point where, is it working for you? Are you feeling fulfilled? Are you resentful? These are questions I would ask. Are you fulfilled? Are you resentful? Are you exhausted? What other questions would you maybe ask people to help them differentiate here or to find a way out? Shala: Am I really enjoying this? Do I really want to do this? Why am I doing this? Kimberley: Yeah. What emotion am I trying to avoid? What would I have to feel if I made my own choice? Yeah. There's some questions I would have people to consider. Okay. So, one more question. You make a choice based on what you want. You do or you don't please people. Let's say for the hell of it you dissatisfy somebody. What do you do with that experience? Shala: First, I think you recognize. You go into this, recognizing that is almost certainly going to happen. There are very few certainties in life. That's probably one of [ 35:11 inaudible ]. Kimberley: You will disappoint people. Shala: Yeah. You're going to disappoint people. And then I think really going to a place of self-compassion. And I'm going to turn it back over to you because you just published an amazing, amazing book that I cannot recommend enough about self-compassion in the treatment of OCD with exposure and response prevention. And I'd love to hear what you think about how you could incorporate self-compassion into this, especially when you do disappoint somebody because I think that's so important. Kimberley: Yeah, no, I love that you swing at my way. I think the first thing is to recognize that one of the core components of self-compassion is common humanity, which is recognizing that we're all in this together, that I'm just a human being. And human beings aren't ever going to be perfect. Only in our minds that we create the story that we were going to be. So, a lot of self-compassion is that common humanity of, I am a human, humans make mistakes, humans get to do what they need to do and want to do and that we're not here to please people, and that our worth is not dependent on people enjoying and agreeing with us. And I think that's a huge reason that my people, like you've said, people-please is they're constantly trying to prove to themselves their worth. So, I would recognize first the common humanity. And then the other piece is it hurts when you disappoint someone. And so, I think it's being tender with whatever emotion that shows up—sadness, loss, anger, frustration, fear. A lot of it is fear of abandonment. So I would really tend to those emotions gently and talk to them gently like, "Okay, I notice sadness is here. It makes complete sense that I'm feeling sad. How can I tend to you without pushing you away?" Again, I think sometimes-- I've seen this a lot in my daughter's school. I've seen this sometimes, the school has said, "When you're feeling bad about yourself, just tell yourself how good you are." And I'm like, that's really positive, but it actually doesn't tend to their pain at all. It skips over it and makes it positive. So I think a big piece of this is to just hold tender your discomfort and find support in like-minded people who want what you want and who are willing to show up. You and I have said before the Brené Brown quote like, "Only take advice from people who are in the ring with you." And that has been huge for me, is finding support from people who are doing scary things alongside me. Do you have any thoughts? Shala: Yeah. I think the more that you do this, the more that you're willing to take care of yourself, because I really do think working on people-pleasing is learning how to take care of you. And that's so important. And the more that you will do that and go through these very hard exercises of saying no and disappointing people, and then compassionately holding yourself and saying, "It's okay," like using the common humanity, recognizing we're all in this together. Everybody feels like this sometimes. I think the more you do it, then you start to disconnect your worth from other people's views. And that is where a whole new level of freedom is available to us. I think that sometimes people-pleasing, because it can be so subtle, isn't necessarily addressed directly in therapy for anxiety disorder. Sometimes it is when it's really over. But a lot of times it's not, and that's not the fault of the therapist or the client or anything. It's just, it's so subtle. We don't even realize we're doing it. And so, we finish therapy for anxiety disorders, we feel a lot better, but there's still a lot of this "should" and "have to," societal expectations or expectations of other people, which we feel we're driving our life and we don't have any control over. And really working on this allows you to recognize that you are a whole good, wonderful person on your own, whether or not other people are pleased with you or not. But that takes a lot of consistent work, big and small, before you can start to see that your worth and other people's thoughts about you are two separate things that aren't connected. Kimberley: Right. Oh, I'm going to leave it there, because that's the mic drop right there. I love it. Shala, thank you for coming on and talking about this. I really wanted your input on this instead of it just being a podcast of mine. So, thank you. I love your thoughts on this. Where can people hear more about you, your book? Tell us all the things. Shala: Sure. So, my website is shalanicely.com. So, anyone can go there, and I have three different blogs that I write, all sorts of information about how to manage uncertainty and OCD because that's my specialty. My memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life , in that I talk a lot about how I dealt with people-pleasing. And in fact, the chapter called Shoulders Back, which is one of the techniques—I said there were many that I used for people-pleasing, that's one of the techniques that I use—that chapter talks about my journey in learning about how to work through some of this by really putting your shoulders back and acting like all that stuff you hear in your head is relevant. So, that could be a resource for people as well. Everyday Mindfulness for OCD , which I co-wrote with Jon Hershfield, that also has some information on self-compassion as well if people want to learn about writing self-compassion statements. But again, I would also send people to your amazing brand new workbook, which is the only workbook that I know of, the only book that I know of, that talks about doing ERP in a self-compassionate way. So, it's completely integrated together. And I think that is so important for building a foundation for a good OCD recovery. So, I would definitely send people your way. Kimberley: Thank you, friend. Shala: You're welcome. Kimberley: Well, there are so many parts of the people-pleasing and the tools in your book as well. I know we've talked about that and it's one of my favorite books of all time. So, definitely for listeners, go and check that out. I am so grateful that you came on. Shala: Well, thank you. I'm just so honored to be here. It's always so much fun to talk with you about these topics. So, thank you. Kimberley: So important. Thank you so much, and I just am so grateful for you. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting cbtschool.com.

Nov 12, 2021

SUMMARY: Quite often, my clients forget to recognize avoidance as a compulsion. While you might be spending a lot of time in your recovery reducing compulsions such as reassurance-seeking compulsions, behavioral compulsions, and mental compulsions, it is important to recognize that avoidance is also a compulsion. In this episode, we address why it is important to address the things you are avoiding and find a way to incorporate this into your OCD treatment. In This Episode: Why Avoiding your fear keeps you stuck in the obsessive-compulsive cycle What is an avoidant compulsions? How to manage avoidant compulsions? Links To Things I Talk About: ERP SCHOOL Other podcast episodes about avoidance Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 210. Welcome back, everybody. I am so thrilled to have you here. How are you doing? How is your anxiety? How is your depression? How is your heart? How is your grief? How is your anger? How is your joy? How are you? How is your family? All things that I hope are okay and tender, and there's a safe place for all of those things to be. Today's episode is in inspiration of a session I recently had with a client—a client I've seen for some time. We are constantly talking about safety behaviors, ways that we respond to fear. I had mentioned to him that of course, one of the safety behaviors we do are from fear, and in response to fear is avoidance. We avoid things. And he had said, "Oh, I completely forgot about avoidance. I completely forgot that was one of my safety behaviors." Sometimes we put so much attention on the physical behaviors and the mental compulsions that we forget to check in on what are you avoiding and how avoiding things and fear keep us stuck. So, that's what we're talking about today. Before we do that, let's first do the review of the week. This is from Ks Steven, and they said: "Short and sweet. This podcast is one of my highlights of the week. It is short, sweet and so helpful. I look forward to each new episode. Episode 99 on self-compassion has transformed my relationship with myself. As I start each day to face my obsessions, I remind myself it is a beautiful day to do hard things." I love that review. Thank you so much. I love that. It basically is exactly what I want this podcast to be. I want it to be short, I want it to be sweet, I want it to be helpful, and I want it to remind you that it is always a beautiful day to do hard things. Before we get into the episode, we have one more part of the episode that we want to do, which is the "I did a hard thing," and this is from Anonymous. They said: "My husband and I have been going through infertility treatments for years. This year, we did IVF and it was triggering, maybe because it felt more "real." I was panicking that I didn't feel perfect enough since I struggled with some mental health issues earlier this year. I had the false narrative in my mind and major intrusive thoughts about not being a good mom, ruining my children, fearing postpartum mental health issues. I wanted to cancel our embryo transfer because of all of these intrusive thoughts and fears. But on Monday, I did it afraid and we transferred our embryo. We'll find out next week if I'm pregnant and I'm so glad I did it." Oh my goodness, I cannot tell you how impressed I am. I wish nothing but joy for you. You did that hard thing, and I hope that however that turned out that you are standing by yourself and you are gentle and kind and reminding yourself that you never have to be perfect. Never, never, never. We are not meant to be perfect. Okay, here we go. Let's talk about avoidance. I mean, listen, that "I did a hard thing" is exactly what we're talking about, so we'll even use that as a reference today. Fear is scary. Nobody wants to feel it. It's not fun at all, and instinctually, we go into fight or flight, and flight is a normal human response to fear that has us avoid danger. Now, this instinctual response is what keeps us safe. If a bus is coming for you, you run off the street. That's what we do. It's the right thing to do. However, if you are using avoidance on repeat, and if you're using avoidance to avoid the sensation of fear, not an actual current, real imminent danger, well then chances are you're going to get stuck. So I want to be really clear, if you are actually in physical danger, avoidance is not a compulsion. It's not a safety behavior. But if you're avoiding thoughts about things or you're avoiding things because there is a small or a medium probability of something happening, or even maybe even a large probability in some situations, chances are in this case, you're going to walk away quite unempowered. Because the truth is, life is scary. Life doesn't always go well. Bad things do happen. It sucks to say, but it's true. Bad things do happen. And so, it makes sense that we naturally want to avoid lots of things to avoid bad things from happening. But what happens when we do that is life starts to get really, really small. We have to be willing to take some calculated risk, and ideally, the calculating part doesn't take too much of your time either because we can spend a lot of time ruminating about potential risks, probabilities, uncertainties, and so forth. So what we want to do and what I want you to do when you're listening to this and after listening to this is reflect on, what am I avoiding? Is the avoidance helpful and effective? Or is the avoidance impacting my ability to live my life? Is the avoidance impacting my ability to grow and thrive? Is the avoidance impacting my family and their ability to grow and thrive? That's a big one, because sometimes our fears impact the people we love by no fault of our own. It's not our fault, but we always want to check in on this stuff. When you avoid, ask yourself, what specifically am I avoiding? Am I avoiding actual danger? Or am I avoiding fear or other sensations? Because if you're doing the avoidant behavior to avoid sensations or an emotion or some thoughts, the problem with that is what you suppress often comes more, what you resist often persists. So even your attempt of avoiding it so that you're not having to endure the discomfort often only increases the frequency and duration of the discomfort or the thought or the feeling or the sensation or the urge. And so, therefore, it's not effective. Some people avoid because they don't want to feel humiliated or embarrassed. But the problem with that is, once we start avoiding, what often happens is people start noticing that you're avoiding and then you end up feeling humiliated and embarrassed anyway. So what I'm trying to show you here is, while avoidance does give you some pretty immediate relief, it often has long-term outcomes that aren't that great that keep you stuck. As the "I did a hard thing" segment that we feature each week and as we see even in the reviews often or almost every time, people who face their fear, even though it's so painful and so uncomfortable, they leave that experience feeling empowered. They leave the experience saying to themselves, "That wasn't fun, but at least I know I can do it. Now I have proof that I can. Now I have proof that I survived it." And with that comes powerful cognitive learning. One of the best outcomes of ERP (Exposure and Response Prevention) is learning that you can survive really hard things. When we avoid that most of the time, the main thing we learn is when I can avoid bad things for you, but I can't handle hard things. That's what we really walk away learning. And our brain knows this. It's keeping an eye on this. Our brains are very, very smart. They're keeping track of this. And the more that we avoid, the more disempowered we feel and the more alert and hypervigilant the brain feels. "Oh, I avoided that. What else can I avoid? What else can I avoid?" So that next time you're put in a situation where you can't avoid, the chances are that you probably will panic even more. Panic is a huge one for people where avoidance shows up. It's a huge time where naturally of course—this is where I want you to practice compassion—you don't want to have a panic attack. Of course, you don't want to be uncomfortable. Of course, you want to avoid the discomfort because it's not fun. No one wants to go through that. I don't blame you. I do it myself. So we're never going to be perfect at this. I wouldn't expect you to be perfect at this. But there is this beautiful inquiry that we can deal with in ourselves or with a therapist or a loved one to go, "This isn't working for me anymore. I deserve to live a life where fear isn't running the show. So I'm going to choose to face this fear." It is a fierce, compassionate action. It is a badass, shoulders back. "I'm going to show up for myself behavior and action." It takes courage. It takes bravery. It takes a small amount of grit, I'm not going to lie. But I really want today to be about reminding you that you can do the hard thing. You can ride that wave of discomfort. It will be temporary. It will be hard, but it will rise and fall on its own. And with repetition, if you can gift yourself with the repetition of facing your fears, not avoiding them, you will feel so strong. You will learn that you can tolerate discomfort, that you are able to get through hard things. And so, next time, when you have to do a hard thing, you'll feel a little less afraid, or in many cases, you'll feel a significant degree less afraid. So, I'm going to leave you with that. Compassionately do an inventory on where avoidance shows up in your life. And then do your best to work through each and every one. This is what we do in ERP School. One of the first few modules is identifying what you avoid and then takes you through the steps of one by one by one. We're going to face each and every one of those fears. You don't have to have a therapist to do this. It's ideal, but you don't have to. We had an episode last week about people who do it on their own. It's so cool. So I want to really empower you to, number one, face your fears, but just always remind yourself, avoidance is a safety behavior or a compulsion as well. All right, I love you. It is a beautiful day to do hard things. I believe in you. I really believe you. I really want you to understand that you have everything you need. It doesn't have to be perfect. You don't have to show up perfect. You can face your fears imperfectly and you don't have to have it all figured out first, just give it a try. Throw yourself in there a little. Be kind. And I hope that this inspires you a little and reminds you that it is a beautiful day to do hard things. I love you. I believe in you. I hope you have a wonderful day. I hope you're being tender with your heart. I'm sending you all the love I have from my heart to yours. I'll see you guys next week.

Nov 5, 2021

SUMMARY: There is nothing I love more than sharing the success stories of people who are using ERP to manage their OCD and intrusive thoughts. In this week's podcast, I interview Taylor Stadtlander about her OCD recovery and how she used ERP School to help her manage her intrusive thoughts, compulsive behaviors. Taylor is incredibly inspiring and I am so thrilled to hear her amazing ERP Success story. In This Episode: Taylor shares how she learned she had OCD Taylor shares how she created her own ERP recovery plan and the challenges and successes of her plan Taylor shares how she used ERP School to help her put her ERP recovery plan together and how she now uses her skills in her own private practice. Links To Things I Talk About: Taylor's Private Practice: https://www.embracinguncertaintytherapy.com/ Taylor's Instagram: https://www.instagram.com/acupofmindfultea/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION Kimberley: Welcome. I am so excited to have here with me Taylor Stadtlander. Taylor: Yes. Thanks. I'm so excited to be here. Kimberley: Oh, thank you for being here. I am so excited about this interview. You're someone I have watched on social media, and it's really cool because out of there, I realized you were someone who had been through CBT School and I just love hearing the story of how you things get to me. I love that story. So, thank you for being on the show. Taylor: Of course. Thank you so much for having me. Kimberley: Tell me a little bit about you and your mental health and mental wellness journey, as much as you want to share. Tell us about that. Taylor: I'll start with, I am an OCD therapist right now. And I start by saying that because, honestly, if you were to tell me when I was in high school, that I would have become an OCD therapist, I would have laughed at you because I, at that time, was really when my OCD started in high school. Of course, now, knowing what OCD is, I can look back and I can see definitely symptoms back as young as eight or nine years old. But when I was in high school, it was really when I had my sophomore year, pretty intense onset of compulsions. And then, of course, the intrusive thoughts, and it really was all-consuming. But the interesting part, and I'm sure a lot of people can relate to this, is it was something I kept very hidden, or I at least tried to. So, a lot of the earliest compulsions I had were checking compulsions. So, it was these intense, long rituals before I would go to bed, checking that the door is locked, the stove was off, all safety things. I felt this immense amount of responsibility. And I remember thinking like, where did this come from? One day I was just so concerned with safety and all these different things. But no one would have known other than, of course, my family, who I lived with, and my sister, who I shared a room with, who of course saw me getting up multiple times at night to recheck things. But from the outside, it looked like I had everything together. I was the A student, honors classes, volleyball captain, lacrosse captain, and just kept that façade of that picture-perfect high schooler. I did end up going to a therapist and she wasn't an OCD specialist, but I have to say I got very lucky because I actually have some of the worksheets that she used with me back when I was 15. And it is in a sense ERP. So, I was very lucky in that sense that even though I wasn't seeing a specialist, because I don't think any of us knew what was going on, to even see an OCD specialist, I did get to-- and it helped. And that's where I was like, "Okay, you know what, I'm going to go to college and become at least major in Social Work." So, I went to college, majored in Social Work, got my Master's in Social Work, and my OCD pretty much went away and I thought I was cured or whatever that means. And I thought that, "Okay, that was a chapter of my life. And now for whatever reason, I had to go through that. Now I'll become a therapist and help other people." I say that because I had no idea what was coming. My first year out of grad school, I began working and I had the most intense relapse of OCD ever. It came back stronger than ever this time. We call it "pure O." So like mainly intrusive thoughts. And I had no idea what ERP was. It's sad because I went through grad school for Social Work and we never talked about that. I remember this one day, and this is circling back to even how I found you, I had stayed home from work because I was just for like a mental health day, and I didn't want to be on my phone because going on social media was triggering, watching TV was triggering, all these different things. But I was like, you know what, I'm sitting at home. I might as well turn on the TV. So, I turn on the TV, and an episode of Keeping Up With the Kardashians is on. I am a fan of that show, so shout out to them. And I remember watching and I was listening half not. I think I was trying to take a nap. And one of the family members had this OCD specialist on the show. And I remember pausing the TV because they had the name of the OCD specialist on the TV. And I wrote it down and it was Sheba from The Center of Anxiety and OCD. So I was like, "Okay, let me Google that." That was the first time I've ever even heard of an OCD specialist. So, I stopped watching the show, went on my phone, Googled her name and her Instagram came up and I just started scrolling. It was like my world, my eyes were just open and I was like, "Oh my gosh, other people have OCD, and there's a treatment, ERP." Then I just kept scrolling. And then funny enough, I came across your page, Kimberley. And through that, that's where I discovered CBT School. Anyway, long story short, at that time, I wasn't able to afford an OCD specialist. So, I was seeing a therapist, a different therapist from high school because now by this time I was married, on my own insurance, trying to navigate that. In the back of my head, I knew that I needed to see an OCD specialist. I just, again, couldn't afford it. So, I had a conversation with my husband. I'm like, "Look, I'm going to pay for this, the CBTS course." And I said, "I know it seems like a lot of money, but it's really not. If I was going to see an OCD specialist, this is probably what one session would cost." And that's how I learned about ERP. That's your course. It's how I learned about ERP. So, it honestly traces back to Keeping Up With the Kardashians. I love telling that story because it's so weird. And honestly, that changed my life because learning ERP, it finally clicked that, okay. Because I was just applying CBT techniques. Like, think of a red stop sign when you have an intrusive thought, thoughts popping, and things like that. And as we know, that was making it so much worse. So, I just dove into your course and taught myself through your course what ERP is, which then led me to seeing that at work, and then wanting to specialize in ERP, and now working with clients who have OCD. So it's really been an amazing journey, to say the least. Kimberley: I'm nearly in tears hearing this story. Oh my goodness, how funny, your story has gone from reality TV to here, and that's so cool. That just blows me away. Taylor: Well, and it really goes to show. I know that there can be negative sides, like technology and Instagram, but for me, most of, if not all of my education, initially about OCD and ERP was from Instagram accounts, like yours or Sheba's. And it was like, again, I knew that, okay, this can't replace therapy, but it was such a good in-between for me, especially being in the place where I was, where I was trying to navigate. Because it can feel like you're stuck when you either can't find an OCD specialist or you can't afford it. And I know what that feels like. So, to have that in between, not as a replacement, but just as a bridging point was so helpful for me. Kimberley: Wow. And for the listeners, I have not heard that story. This is new to me. So this is so cool. So, actually really, I'm so curious. So, when you took ERP PA school, were you like, "She's crazy, I'm not doing that"? Or what was your first take on that? Taylor: I think I was at the point where I was so determined to find relief, I was willing to do anything. And I had researched about ERP before I took your course. I wasn't like, "Oh, I'm just going to trust this randomly." Kimberley: Random lady. Taylor: Right. So, I did do my own research obviously. And again, I'm in the field and I have a degree in Social Work. It's just so interesting to me that that was not discussed, and I think that's lacking in a lot of programs. So, once I researched it myself, I was like, "Okay, this is the evidence-based treatment. This is the gold standard. It looks like I got to do this." I just remember I would come home. I was working at the time at a partial hospital program and I would come home from work. And that would be my routine. I would get my little notebook out, I'd pull my laptop out, and I treated it as if I was-- again, I know it doesn't replace therapy, but I treat it as if I was in an intensive program. I would spend an hour or so going through your videos and then printing out the worksheets. And that's just what I did. And I just started to do it. I had had before that a brief, very minimal understanding of exposures. And I think I was trying to do them on my own. But through your course, I was able to understand the response prevention piece. I was just exposing myself to all these things and then leading myself in a tailspin. But yeah, I see this again, even in my own clients now that there's just I think a certain point that you reach, that yes, it's scary to take this step, to start ERP, but because we're so determined to not feel the way we're feeling, it makes it so worth it. Kimberley: Wow. Oh my goodness, I'm seriously close to tears listening to your story. So, thank you for sharing that with me. I mean, wow, what an honor that I get to be a part of your journey, but how cool that you were the journey. You deal with these works. So, what was that like? Okay, so you said you would come home from work and you would sit down and you would go through it. Tell us a little bit about how you set your own. Taylor: I think I mentioned this, I was still seeing a therapist. What was funny is, I would come to my sessions and be teaching her about ERP, because in a way I was becoming this mini expert. And as I think a lot of our clients do, because it is such a unique treatment, you do have to become an expert. So, yeah. I mean, I remember using that worksheet where, okay, identify the what-if fear then list out the compulsions. I remember at the time I was like, "All right, I need to print out 10 of these because I have so many themes right now." I remember doing that. And then, yeah, I would just pick away-- I would write them and then go through the whole process really as if I was going through ERP treatment. That's what I was doing. Like the same process I do now with my clients is just what I did. And I'm so lucky and blessed to have a background in mental health to have that. And even the resources that I could have had self-taught myself ERP because I know that that's not everyone's situation. And then what was really helpful, and I think this is really important to mention, is my husband. And I think a lot of people can relate to this. We all have our one person who we seek reassurance from. So, when I was still living at home, that person was my mom. Once I got married, it became my husband. And so, he had to learn a lot about OCD treatment and ERP and not providing reassurance. So, the poor thing, I would have him sit down and watch your video, and he would. And he is amazing and just the best support system. But that was really helpful because again, even if you are in therapy and doing this as a supplement to therapy, to be able to have those resources to watch again and again, once you buy the course, you have it. And I still reference it to this day if I am for myself or even if I'm working with something with a client. So, that piece was huge because then I could say, "Hey, look this is the science behind what I'm doing. This is why you can't give me reassurance and things like that." Kimberley: Right. This is so cool, and it's so cool that he was able to watch it and wasn't intimidated by the whole process. I mean, he probably was, but he still went through with that, which was so cool. Taylor: 100%. Yes. This was about two years ago almost to the date actually. And because now I can look back on it, I think I do lose the anxiety that I had with starting it. And I'm sure him wondering, "What the heck are you doing?" But I think that's so important to have your partner or just your support system understand ERP because it can be very confusing to the outside. If you're doing exposures. What was very upsetting and hard for me that I really had to come to accept is, a lot of my harm obsessions were unfortunately targeted around him. So, I'd be writing these scripts and I would feel this guilt, this horrible amount of guilt and shame, similar to what I felt back in high school when I was trying to hide my compulsions. Here I have this amazing supportive husband and I'm writing these scripts. So, I would want to try and explain that. And him understanding it, I think made the whole process so much easier, for sure. Kimberley: Yeah. And those scripts can be hard, right? I even remember-- Taylor: I think that's the hardest part for me. Kimberley: Yeah. I even remember recording that and looking into the camera and saying, "You need to write a story about this." And I do these with my patients all the time, but thinking like, "Why would anyone trust me?" That's a hard thing to do when you haven't-- so that's really amazing that you did that. The good news, and I'll tell you this, you're the first person to know this, is we just renewed the whole imaginable script module. They're three times as long now. Taylor: Oh, amazing. Kimberley: Yeah. So, you're the first to know. By the time they start, everyone will know, but yeah, we tripled the length of it because people had so many questions about that process. Taylor: In fact, I had a session yesterday with one of my amazing clients and she's fairly new in the treatment and we were introducing the idea of scripts. And you're absolutely right. When you're describing it, you're like, "What am I saying? This sounds horrible." I was like, "All right, we are going to pretty much write out your worst fear coming true in as much detail as possible." And she was like, "What the heck is going on?" And sometimes I have to take myself back to that starting point, especially with working with clients, because now I'm like, "I have an intrusive thought come up. All right, I know I have to go write a script when I get home." So for me, it's become second nature. But I think remembering how painful it was the first several times to actually write down those thoughts and then not only write down them but say them out loud and look into them, that-- I was reminded yesterday, I can't lose sight of how painful that is initially, but then how rewarding it is once you realize it works. Kimberley: Yeah. You get so much bang for your buck, don't you, when you use those. This is so cool. You're obviously a rockstar. So exciting. I can't tell you how much this brings me such joy to hear. What would you say to somebody who's starting this process? What was important to you? What got you through? Tell us all your wisdom. Taylor: I think the biggest thing would be to know that you're not alone because I remember that was the biggest thing for me. Before I knew what OCD and ERP were, I thought that I was the only person on the planet experiencing these intrusive thoughts, these horrible, violent images or sexual intrusive thoughts or whatever it was. So, first and foremost, knowing that you're not alone, that there are so many of us who have experienced this, not only experienced the pain of it, but have gone through and are now in recovery. And that you don't have to let fear dictate the choices that you make because that's how I lived my life. I avoided things because of my OCD. So, I wouldn't be triggered. I let fear make the decisions for a lot of my life. And when you do go through ERP treatment, you get to be in control again and you get to live again according to your values. For example, I've always wanted to be a mom and I've always dreamed of having kids. And I remember so many times OCD in so many different ways that I can't even get into, say, "Oh, you could never do that." Actually, I'm in my first trimester right now, which is so exciting and has been such an incredible journey. That's a completely different topic for another day. I'm handling my OCD attached to that. But I was thinking and reflecting about it the other day of just like, wow, I now get to live life according to my values and not let fear and OCD make the decisions. Even though the treatment seems so scary and weird at first, it is so worth it because it works. And that's why I wanted to become really a specialist in this specific field because I fell in love with the treatment. I fell in love with the fact that it gives people their lives back. And that's so cool to witness. So, you're not alone. You're also not a bad person because of the thoughts that you're having. And I'll briefly share, I'm a Christian and I know that a lot of the thoughts that I've had for a long time, I just thought, okay, I'm a horrible person, or I'm a sinner. And whatever your faith is, whatever spirituality or anything, whatever morals you have, just know that you're not your intrusive thoughts. You are just a person with thoughts and that's it. Kimberley: Yeah. That's so powerful. So, number one, congratulations. I just love when people say, "I have OCD about it, but I did it anyway." Taylor: I know. Talk about facing your fears, it's like-- Kimberley: Right. And then the second piece where you're really, again, speaking from a place of values, even your religion, I'm sure got attacked during that process. And it's really hard to keep the faith when you're being harassed by these thoughts. So, I just love that. What motivated you to keep going? Besides you said just the deep wish to be better and well, how did you keep getting up? Was there lots of getting up and falling down or did you just get up every day? Taylor: Oh my gosh. In fact, there's times where I still feel like I am picking myself up because-- I'm so happy you brought that up because that was something that I wasn't prepared for, the feelings of relapsing I call it, where you feel like, oh my goodness, my symptoms have gone away, whatever. And then it hits you like a ton of bricks. And I always find that it comes back so strong. And it can be really discouraging at first. And I've even experienced that with the first couple of weeks of this pregnancy of just like, "Wow, I thought we were over this." Even themes coming back from when I was 15 or 16 and like, "Okay, looks we have to deal with this again." I'm able to laugh about it now, but in the moment, it's really hard. And so, I think the biggest thing for me that I try to keep myself reminded of in those moments where I do feel like I'm-- because it feels like you're taking a step backwards in a sense sometimes. And I always try to remind myself that so much can change in a matter of a day and that this is temporary. And even the worst moments of my ruminating or obsessing or the nights where I would literally spend hours completing compulsions, they always passed, if that makes sense. It sounds so cliché, but the sun always rose again. I always got another chance. And I would say that I am a naturally driven and motivated person. So I think that definitely did help me. But that's not to say that there weren't times where it's a hopeless feeling when you are living in your own personal hell of intrusive thoughts. The way I remember describing it to the first therapist I went to is that I was, and I don't play tennis by the way, but I was like, I pictured myself in a tennis court with a tennis racket and someone just throwing balls at me. And those are the entries of thoughts. And I walk one away and another one comes back. It was exhausting. But being reminded that-- And also now too, and I wrote this down, I definitely wanted to talk about this, was you have to find the community support and that has been so vital for me. And again, thank you, Instagram, I've been able to connect with so many people who have OCD or a related disorder who I text or DM and are now some of my closest friends. And we hold each other accountable on days where it's like-- because OCD can be really weird sometimes. And it's really nice to have people who understand and have been there. So, that's really helpful for me too on days where it's like, man, it just feels like I can't pick myself up. Kimberley: Yeah. It's so important. In fact, I'll tell you a story. A client of mine, who I've been seeing for a while, could do the therapy without me. And she knows it as well as I do. And we hit a roadblock and it kept coming up. I just feel so alone. And not having support and other people with similar issues, it was a game-changer for her. And I think we're lucky in that there are Facebook groups and Instagram and support groups out there that are so helpful. Taylor: Yes, totally. And that's one of the reasons I actually decided about a year ago to create a mental health Instagram because I knew how much Instagram and using that platform helped me. I literally remember saying, "Even if it helps one person." And at first, it was really scary sharing some of the things, talking about the more taboo themes and different things like that, and thinking like, oh man, what are my coworkers thinking of me or my family members when I post this. But what's been so rewarding is countless people have reached out to me who either I know and I've either grown up with my whole life or people across the globe really of just saying, "Hey, thank you for letting me know I'm not alone." And to me, that makes it totally all worth it. So, it's so important to find that connection. Kimberley: Yeah. And is there anything else that you felt was key for you? Something that you want people to know? Taylor: I think that it's so important to-- a huge piece of it too was incorporating act, like acceptance and commitment therapy, which I also believe I learned from one of your podcasts. So, thank you. And that was a huge piece for me too, because again, I think that-- to be very honest, I didn't even say the words "OCD" until two years ago. I knew in my head that I met the criteria in the DSM, but I never-- that label for me was so scary. I don't really know why, looking back, but maybe because it was just so unknown. So a lot of the work that I've had to do personally that's been really helpful is just acceptance of any emotion really, especially learning that acceptance doesn't mean that you have to love something, and it ties into tolerating uncertainty. Tolerating, I was talking about this with a client yesterday. Tolerating is not an endearing word. If someone says, "Oh, I tolerate that person," that's not a compliment. We were not being asked to love uncertainty or love the fact that we have OCD or whatever we're struggling with, but just learning to sit with it and tolerate it has been an absolute game-changer for me. As much as the exposures and response prevention was so new to me, that whole piece too was a game-changer. Kimberley: Yeah, I agree. I think it's such an important piece, because there's so much grief that comes with having OCD too, and the stigma associated. I've heard so many people say the same thing. They had to work through the diagnosis before they could even consider-- Taylor: And I also had a lot of anger in two ways towards the fact that I had to deal with this. I always thought, and of course, I think a lot of us think this about anything else, I was like, "If only I just "had" anxiety and not OCD, or just had depression, that would be so much easier to deal with," which I know is ridiculous. But in the moment, it's like, I think whatever we're going through seems so impossible. And then the other piece of the anger was just the misuse of people saying, "Oh, I'm so OCD," or seeing it displayed on TV or on social media in the wrong way. And I'm like, "Oh my gosh, if only you knew what OCD was, you would never say that." So now, it's been cool because I can turn that frustration more into advocacy and education, but that was a huge hurdle to jump to. Kimberley: Yeah. Well, especially because you're over here tolerating OCD. And then other people are celebrating and it just feels like taking the face. Taylor: Oh my gosh, yes. Kimberley: Yeah. I love all of that. Thank you so much for sharing that story. Number one, it brings me to tears that we get to meet and chat. I think that that is just so beautiful and I'm so impressed with the work that you're doing. So, thank you. Tell me where people can hear more about you or follow you and so forth. Taylor: Sure. So, my Instagram is acupofmindfultea, and there you can also find-- I definitely share my personal story, but just also ERP tips. I'm also very big on holistic findings. So, obviously, medication has been a huge part of my story as well and helpful, but I also love finding natural ways and different ways that have helped my anxiety and just building my toolkit. So, I share a lot about that on there as well. So, yeah, I would love to connect with you guys on social media, for sure. Kimberley: Yeah. I would have to admit, when I saw your pregnancy announcement, I was with my kids and I was like, "Woo-hoo!" And they were like, "What?" And I'm like, "Oh, it's just somebody I've never met, but I'm so excited for her." Taylor: Isn't that so great? I know, I love it. I feel the same way for other people. Kimberley: Yeah. Well, thank you so much. Number one, thank you for coming on the show. I love how that creates itself organically. And number two, thank you for sharing this because I think this will hopefully give some people some hope. We were overwhelmingly encouraged to have people with stories of their recovery. So, I think this is a really wonderful start of that. Taylor: Awesome. Well, thank you so much. I've been listening to your podcast for two years now, and it's been such an encouragement for me and such a huge form of education and help. So, this was truly special. So, thank you. Kimberley: Thank you.

Oct 29, 2021

The Self-compassion Workbook for OCD is here! Click HERE to learn more. This is Your Anxiety Toolkit - Episode 208. Welcome back, everybody. We are on the final week of the 30-day Self-Compassion Challenge. You guys, the growth has been profound to watch you guys, to hear from you guys, sharing what's working, what you're struggling with, the major strides you've made. I have loved every single second of it. I will be doing my best to compile all the audio. I think about 27 of the 30 days we did a live or the 31 days. We'll be doing lives and I will compile them into one whole little mini-course that will be free for everybody on the cbtschool.com. That is yet to come. I cannot wait to hand that over to you guys. We are on the final week and I wanted to address the elephant in the room, which is exhaustion. Today, I want to talk to you about managing exhaustion because the one thing I know for sure is you're exhausted. I'm exhausted. We're all exhausted. It's so hard to get motivation. It's so hard to keep going. So we are going to talk about it today. Here we go. Before we go, I wanted to do the "I did a hard thing." We do it every weekend. This is from A Life With Uncertainty. They said: "The last two years have been FULL of hard things. The hardest was telling my husband in therapy that our marriage was the main obsession during my worst OCD spike. I was scared and anxious. He wouldn't understand. It was such a huge exposure, and I pushed through without seeking reassurance. I CRIED A LOT, but so did he. The hard thing brought a softness to our marriage that I will always have, no matter what OCD tells me." This is beautiful. This is the work. Because what does anxiety take the most from us? The people we love. It impacts the people we love. It impacts the relationships and the things we get so much joy from. Holy smokes, A Life With Uncertainty, you are doing such brave, such courageous work. I'm so happy you put that into the "I did a hard thing." How incredibly inspiring. I just love this stuff so much. I really do. Before we get into the episode, let's do a quick review of the week. This is from Nervous Nelly saying: "I'm so grateful I found this podcast a couple of months ago. It has changed my whole approach to my own and my loved one's anxiety. This podcast provided so many tools that I practice using and learning to look at my anxiety differently. The biggest change is recognizing that when I'm having anxious thoughts more quickly before they go too far and the automatic responses that I wasn't even aware of, or should I say that I wasn't aware, were so counterproductive to my mental well-being. Thank you from the bottom of my heart and please keep doing what you're doing." Yay, I'm so happy to hear that. Nervous Nelly, welcome. I'm so happy you're here and let's keep going together, which brings me perfectly into this episode. As you know, we've been doing the 31-day challenge. I think I've been calling it a 30-day challenge, and I'm just looking at my calendar and seeing that there's 31 days in the month. We'll just be imperfect. We will move on. We are celebrating the launch of my first and only book called The Self-Compassion Workbook for OCD. One of the things I talk about most in that book and talk about most on this podcast and in CBT School resources is how to stay motivated because it takes so much to stay motivated. But what's interesting is, so many people in the comments this week said, sometimes it's not even about motivation. It's just about getting through the day. How do I get through the day? I wanted to share with you a self-compassionate concept that I use. It may or may not be helpful for you, but this is something I have dedicated my self-compassion practice to and I have really received some amazing benefits from it. I'll tell you guys a little bit of a story. As you all know, I have postural orthostatic tachycardia syndrome with a nice side of generalized anxiety disorder in which I manage really well most of the time. But when I am unwell and I'm having a flare-up, which recently I've been doing really well, but I recently went through a horrific flare-up to the point where most days I couldn't get out of bed. I was doing all my sessions from an upright chair where I had my legs elevated. I would go to bed at 7:00 or 6:15 in the evening. It was just rotten, rotten, rotten, rotten. I was exposed to a concept called "the spoons concept." This was written by a person who suffered with Lyme. I'll put it in the show notes, the original article. What she did was she was saying, "Someone wants to ask me, what is it like to have Lyme disease?" Well, she assumed they knew because this person went to all of the doctor appointments and was with her when she was sick. She wasn't quite sure what they were asking until she realized they were saying, "What is it actually like to leave in your body?" And she said, "Well, think of it this way." She got all of these spoons out. I think she said she was in a college cafeteria at the time and she laid out these 10 spoons. She said, "For people who don't have this problem, they have unlimited spoons in their day, and think of each spoon as a degree of energy to complete daily tasks. So one spoon to make your breakfast, one spoon to have a shower, one spoon to go for a walk, one spoon to get to work, two or three spoons or five spoons for doing the day of work, another spoon to make dinner, another spoon to do your taxes and so forth." She said, "Most people have unlimited spoons. It just keeps going until the evening is done. They don't even really have to consider their energy and how they expend it. But for me, I want you to imagine that I only get 10 spoons a day, and I have to decide every single day how I use those spoons." This was profound for me because what I was struggling with was like, how come everybody else gets to have energy at the end of the day and I am a complete disaster? How come everybody else has breakfast, gets ready for work, goes to work, takes care of their children, comes home, makes dinner, does the taxes, and they're still not a grumpy, miserable mess at the end of the day? I realized it's because me having POTS or postural orthostatic tachycardia syndrome meant that I too have unlimited spoons. I'm going to have to either refuse to accept that and keep using up spoons I don't have. One of the main concepts she talks about in this Spoon Theory is, if you go over your 10 spoons, it's not like you can replenish them. You're using them up for tomorrow. Basically, if you use 13 spoons today, you only have seven left for tomorrow. I've talked to a lot of my patients with OCD about this, and we really agreed not to become compulsive about counting spoons. I want to really make sure we address that upfront. This is not a science. It's a concept. It's a theory. But think of it through the lens of, if you overdo it today, you're going to have to accept that you've got less spoons tomorrow. I have found that I was living on minus spoons day in, day out. Well, in fact, month in, month out, maybe even year in, year out. No wonder I'm exhausted. No wonder I'm miserable. No wonder I'm anxious. No wonder I'm depressed. No wonder I'm exhausted. I have completely used up all my spoons. So now, I've had to accept that I only have 10 spoons and I have to make really skilled decisions on how I'm going to use them. It has also involved me renegotiating my day. I no longer choose to make breakfast and lunch in the morning. I do it the evening before. I asked for help. I do it in a way where I sit at the dinner table. I always finish first because I inhale my food. As my children and my husband eat their dinner, I'm making the kids' lunches for tomorrow. That way I'm not standing, I'm still communicating with them, but I'm getting something done, and that works for me. I've found many, many ways to manage this, but I also had to accept that some things literally had to go. The most compassionate thing I could do is to protect my spoons. Now, how does this apply to you? Well, the developer of this theory has now extended it to people with mental illness. She believes it's not just physical medical illnesses that mean people don't have a lot of spoons. People with mental illnesses also have unlimited spoons because their spoons are being taken up with fear, depression, panic compulsion. For you now, I'm going to ask you to consider, number one, you get to decide how many spoons do you think you get a day? Because it's not unlimited. If you have a mental illness, it's not unlimited. It's not possible. You will use up all your spoons and you will go over and feel worse tomorrow. So determine how many you have, and start to be very, very articulate and disciplined and intentional with how you use them. You're going to probably be like, "Yeah, I expected her to say this." But one for me is I'm no longer going to beat myself up. I don't have the spoons for that. Literally, that is my reason for not beating myself up. Besides the fact that it makes me feel terrible is I don't have the spoons for that. Sometimes people will say to me, "You need to do more in a certain area." I will say to myself, "Yeah, I wish I could, but I actually, at this time, don't have the spoons for it." Sometimes I opt out of major disagreements, not because I'm afraid of disagreements, but I don't have the spoons for a ton of conflict. I do that as an act of compassion to myself and an act of compassion for my clients and my family. If I burn up all my spoons, I'm a terrible therapist. No, that's not true because that's black and white thinking. I'm not at my best. I'm not at a place where I'm sitting, and I'm connected with my patient. So forgive me. I'm going to correct myself. I'm not a terrible therapist. That's black and white thinking. I am not connected as deeply as I would like to. What I do here is depending on the day, I may need to rearrange some things. For you, and I will give you a case study here. One of my patients had a huge exposure hierarchy. She knew she had to get it done. Her OCD was impacting her life severely. So we brought in her family, her husband, or her partner, and she had conversations with her family and her parents and said, "I'm about to embark on exposure therapy. It involves me doing a lot of physical and emotional work. How can you guys support me by helping me and managing some of the things I have in my life so that I can keep track of my own spoons, metaphorically?" Somebody dropped the kids off in the morning for her. She ordered in a meal service, if you have the finances for such a thing. Her immediate thought was, yeah, but come on, Kimberley. Everybody else can do it. Surely, I can too. I'll say, "In a perfect world, yes. In a perfect world where you didn't have OCD, you could do your OCD while dropping your children off. But you do have OCD, or you do have depression, or you do have a medical illness. For that reason, can you give yourself permission to ask for help, to redistribute your spoons? Can you do that for yourself?" Many times I'll give you a personal experience that happened to me. Just this week is obviously, I'm a little overwhelmed with the launch of this book. I also run a very medium-sized private practice. I have eight therapists who work for me. I have CBT School, which I'm so proud of, but does take up some of my time. I called my husband and I said, "I give up. I am in over my head. I don't know how I got here. I completely lost track of my spoons." He sat me down and said, "Open up your calendar. What's on your calendar for today?" I told him, and he said, "This one, this one, and this one, just cross it off. It doesn't have to happen today." My mind was like, "But come on, come on. It should be done today. It would be so much easier if it was done today. Life next week will be hard if it's done today." He goes, "Kimberley, you don't have the spoons for it today. You either rest today or you use up your spoons for tomorrow." And I'm like, "You're right. You're right." See, even I'm not so great at this sometimes. That's why everybody needs help. I'm never above the work here. I'm always learning myself, but it's dropping your pride. It's dropping the ego. It's dropping the expectations and saying the facts here that I'm exhausted. The facts here is I need a break, or the facts here is I need to shuffle things around so that I can do the thing I need to get done today for the future me. The example would be a lot of my patients say, "Well, if I take on the Spoon Theory, I have never got enough spoons to do ERP. It's just too hard." I'll say, "You need to do ERP so that you can get your spoons back. Because these compulsions are taking up a lot of your time, or your depression is taking up a lot of your time. We have to do your calm work. For your future self, something else has to go. Something else has to go." That might be that you don't get as much exercise. Or like I said, you get a meal service, or that you get your laundry done, or you slow down a little, or you don't see as many friends on the weekend. A lot for me has been in COVID. As COVID has started to loosen up a little, it's also going, "Wow, I'm feeling a little overwhelmed by all the social events." I still think I need to be protective of my spoons here. Not that I'm avoiding them at all, I'm just making logical, compassionate, informed decisions based on the facts of the spoons that I have. So I want you to think about this. Again, this is not science. I'm not saying ten spoons is all you get and all this stuff. It's not a science, it's a concept. I want you to think about it and see how it applies to you, because having a mental illness qualifies you for being someone who needs to take care of their spoons. Some people don't like the spoon concept and they prefer to use it like a cup. Like my cup is full of energy, or it's low on energy. How can I manage my energy levels? That's fine too. It doesn't have to be in this method. I just want you to think about how you can manage your exhaustion without letting everything go. The alternative is, get really clear on what has to get done and what matters to you and rearrange the rest of it. Let some of it go. Don't please all the people. Don't please anybody. For me, again, I'm really trying to not think black and white, because that uses up spoons that I don't have. Not to think catastrophic thoughts, like telling myself bad stuff is going to happen. I'm trying to not engage in that thinking because that uses up spoons that I don't have. Not ruminating about something I'm angry about. No, I don't have the spoons for that. The compassionate thing to do right now is to search the internet or to do what you enjoy. Do some crafts or take a nap, read, sit in nature, go slow walk, call a friend, whatever fills up your cup. All right. That was a lot. I think what I'm going to say here is, a big piece of that is acceptance. That when you're exhausted because you're handling a medical or mental or physical disorder, it's changing your expectations to more realistic expectations and accepting where you are, dropping the shoulds, dropping the I should and I could and all the things and start to take care of you. Start to ask for help. I love you. That being said, you know what I'm going to say. It's a beautiful day to do hard things, folks, and managing your exhaustion is a hard thing. Saying no is a hard thing. Saying yes is a hard thing. Please take care of yourself. Please honor what your body needs. Sending you all love. I'm here for you. I'm loving on you. I am shouting you on. Thank you for joining me for 30 days. Do not give up. This is a 31-day challenge, but I ask that you take it for the next 31 years or 61 years or 91 years, or multiply, multiply, multiply. Do not give up on this practice. This is life. We have to do this work. All right. Love you guys. Bye.

Oct 22, 2021

This is Your Anxiety Toolkit - Episode 207. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, everybody. This is a really exciting podcast today. We have back on the show the amazing Kristin Neff. Now, as you all know, we're doing a 30-day Self-Compassion Challenge and it is the perfect time to bring on Kristin Neff, who has written a new book called Fierce Self-Compassion: How Women Can Harness Kindness to Speak Up, Claim Their Power, and Thrive. Now, while the book is directed towards women, it actually is for everybody. So, we're speaking today in this interview about fear self-compassion and it's for everybody. It's particularly valid to those of us who are struggling with anxiety and have to really work hard at facing fears every day. I am so grateful we got to have Kristin on. She had so many beautiful things to say. If you like the episode, please go over and purchase her book. She too has a book out and again, it's called Fierce Self-Compassion, and it might help you really deep dive into this practice of fierce self-compassion . Before we get over to the show, let's talk about the "I did a hard thing" segment. This one we have is from Eric, and he has said: "I've been working on my anxiety about the heat by spending every day I can in the sauna of my gym. I work up a good full-body sweat, and it feels so uncomfortable, but I stick with it knowing it will pay off." Eric, this is so amazing. What an amazing way for you to stare your fear in the face, practice being uncomfortable. I love it. In addition to that, let's move right over to the review of the week. This one is from Emily. Emily says: "Kimberley consistently shares a genuine compassion across all of her podcast episodes. She's been a source of encouragement on my journey with OCD, anxiety, and depression because her message remains one of the consistent self-compassion while sharing a realistic perspective and the reality of mental health struggles." Thank you so much. You're so welcome, Emily. I am just so honored to be on this amazing path with you all doing such amazing hard things and really doing the hard work. It's really an honor to hear these stories and hear the hard things you guys are doing. That being said, let's move over to the show again. Thank you so much, Kristin Neff, for coming on. I just found this episode to be so deeply helpful with some profound concepts and I can't wait to share them with you. Kimberley: Welcome. This is an honor to have with us again the amazing Kristin Neff. Welcome. Kristin: Thank you for having me. Happy to be here with you again. Kimberley: Yeah. You have a new book out, which is by far my favorite. I am so in love with this book—Fierce Compassion. Yes. I actually have mine on my Kindle, so I was holding it up, going, "Look, it's right here." Kristin: Thank you. Kimberley: I loved this book. Thank you for writing it. This is so important for our community because you're talking about how to use compassion in I think ways that we haven't talked about before and is so important for those people who are suffering with anxiety or just any kind of severe mental illness or struggle. Can you tell me exactly what fierce compassion or fear self-compassion is? Kristin: Yeah. Well, self-compassion, in general, or compassion in general is concerned with the alleviation of suffering. It's a desire to help. It's the desire for well-being of others, and then self-compassion is of yourself. There are really two main faces that it has, the two main ways that it can express itself. There's tender self-compassion, which is really important, which is about self-acceptance. It's about being gentle, more nurturing, warm with yourself, soothing yourself when you're upset, really offering support, being with yourself and all your pain and all your imperfection, and really accepting a kind way. This is a hugely important aspect of self-compassion because most of us don't do this. Most of us think we aren't good enough or we criticize ourselves. We're really harsh with ourselves. This is huge. But it's actually not the only aspect of self-compassion. Sometimes compassion is more of a gentle, nurturing energy, almost like you might say a mother. Metaphorically, a mother or a father, but a parent. Fear self-compassion is more like mama bear, like fierce mama bear. In other words, sometimes in order to alleviate our suffering, we need to take action. Acceptance isn't always the right response when we're suffering. For instance, if you're in a situation that's harmful, maybe someone is crossing your boundaries, or someone is harming you in some way, threatening you in some way, whether it's society. Maybe it's racism, sexism, or some sort of injustice, or whether it's yourself. Maybe you're harming yourself in some way. Although we want to accept ourselves as worthy people, we don't necessarily want to accept our behavior. And so sometimes we need to take action to alleviate suffering. So, that could either be protection against harm. Sometimes it's providing for ourselves. This is especially for women, women who are told they should always self-sacrifice, they should always meet others' needs. Actually, sometimes for self-compassion, we have to say, "No, I'd really love to help you, but I've got something I need to tend to for myself." So taking action to meet your own needs. And then also motivating change. It's not self-compassionate to let behaviors or situations slide that are not healthy. So, really taking the action needed to motivate healthy change. But it comes from encouragement, not because "I'm unacceptable unless I change." The tender and the fear self-compassion, they go hand in hand. I like to say it's like yin and yang. We need both and we need them to be in balance. If they aren't in balance, it's a problem. Kimberley: Now this is so good because my first question was how to get it into balance, right? I love in your book, you have a little questionnaire. You fill it out, is there balance, and what side is that all? But can you share how people may get some balance if they're finding they're doing one of the other? Kristin: Yeah. It's a tricky question, right? Because sometimes we don't know, but we need to ask. Really the quintessential self-compassion question is, what do I need right now to be healthy, to be well? And just pausing to ask that question is huge. Usually, we're just doing our daily routine or we're striving to reach these goals that people tell us we need to reach. We don't even stop to say, "Actually, what do I really need to be healthy and well?" So asking that question is huge. And then you may not get it right at first. You may think, oh actually I thought I needed that, and I don't. Really self-compassion is a process. But it helps to know the different types of self-compassion. You might say, "Do I need a little tenderness right now? Do I need some acceptance? Do I need some softness and gentleness? Do I need to kick in the butt? Do I need to get going? Do I need to stand up? Do I need to speak up? Do I need to say no to people? Maybe I'm giving too much of myself in order to find balance." You really just have to ask yourself the questions. It's really the process of being committed to yourself that you're going to do the work necessary to be healthy and well. Kimberley: Right. You've outlined so many pieces of this puzzle, right? Particularly, and this is why I was just-- I think I reached out to you months before your book came out because I just wanted to hear your opinion on this. For people who are struggling with the inner bully, whether that be the disorder they have, or they're just very self- critical, it can be really hard to stand up to that. Almost feeling like it's just impossible. I've heard people saying like, "This is just who I am. I'm just going to have this voice." I'm wondering, you might maybe share where would somebody start with this practice? Kristin: Yeah. And then we also need to get in the different parts of ourselves, right? Because the inner bully, that's a part. We also have a part that's compassionate. We also have a part that feels bullied by the inner critic. So, we've got the person who's pointing their finger. We have the person that feels the shame. We've got all these different parts of ourselves. And really all of them need to be treated with compassion, but how that compassion manifests is going to be different. For instance, I have a compassionate motivation exercise in there, where sometimes what we need with an inner critic is we need to thank it. "Thank you for trying to help me." This may be the only language it has to try to help us, and it needs to feel listened to and heard. "Thank you so much for trying to help me." It's actually not been that helpful, but I appreciate your efforts. That's almost using more the tender self-compassion for the inner critic. But sometimes it needs the standing up. It's like the mama bear, like, "I'm sorry, I'm not going to listen to that anymore. You can't say that. It's not okay. I'm drawing a line in the sand." So that's part of it. But then also, we don't want to forget having compassion for the part of ourselves that feels criticized. People who say the inner critic, that's just who I am. Well actually, who they are is, there's a part of them that hurts from the inner criticism. There's a part of them that feels compassion for the pain of that. There's a part of them that's trying to help, keep themselves safe through criticism. Inner critics don't operate really to try to harm. They operate to try to help to keep us safe. I've talked about a lot in my book, my son has very harsh self-criticism and I can see he really believes-- by the way, I'm just going to turn this off. Sorry. It's going to be cooking for me the whole time. Kimberley: No problem. Kristin: My son really believes that if he's hard with himself, somehow, it's going to allow him to get it right not make mistakes. So, usually, our inner critic, some part of it believes that if we're harsh enough with ourselves, we'll get it right not make mistakes. And that's the safety behavior. So, we need to have compassion for that safety behavior at the same time that we don't want to be railroaded by it. It is complex. The human psyche is complex. Pretty much the answer is always compassion. But what form that compassion takes just depends on what the situation is. There's no one-size-fits-all. Kimberley: And I think that it's so important that you're addressing both the yin and the yang side. Because there are times when, let's say somebody's struggling with incredibly painful intrusive thoughts related to their OCD or their disorder, where they need to really just go, "Wow, this is so hard for you. I'm so sorry you're going through this." But there are other times where you have to be like, "Nope, we're not doing this today. We're not going to go down that road today." So, I think it's beautiful that you're bringing that Together. Kristin: It's funny, I have to use both sides with my son. He has both autism and OCD, as I was telling you, and anxiety just to make things fun. But sometimes what he needs is he needs my warmth and compassion. Just that caring, that tenderness. He knows always the bottom line is unconditional acceptance. But sometimes they need to draw boundaries. He's learning to drive, for instance, and he started having an episode while he was driving and I'm like, "No, you cannot do this while you're driving. It's not safe." Part of them doesn't have the ability to stop it, but part of them does. So, it is complex. Sometimes I need to appeal to that part of them that does have the ability, at least temporarily, to say, "I'm not going to go there. You need to choose. You need to stop up." Sometimes I say it almost really firmly and it shocks him, and it actually helps him to stop. So, it's complicated. Kimberley: It really, really is. Now, it's interesting because you and I were talking before, and I want to touch in because the first part of the book-- the book is directed specifically to women, but it also is addressed to anybody, I think. Kristin: Yeah. All people live both yin and yang. The reason I do it for women is because women are so socialized not to be fierce. And that's partly patriarchy. Women have been kept in their place by not getting angry or not speaking up. So, that's why it's written for women. But a lot of my male friends have read it and they say they get a lot out of it because first of all, all the practices are human. They're for all people, not just women. Kimberley: Right. But the reason I loved it is you did speak directly to getting angry, right? Kristin: Yes. Kristin: There's a lot in the front about getting angry. Is it helpful? Is it not? Do you want to share? I mean, I think a lot of people who are anxious are afraid of their anger or are afraid of that. So, do you want to share a little bit about how people can use these practices for anger? Kimberley: Yeah. Well, because part of the whole messaging of the book is anger communicates expression of compassion. Again, think of fierce mama bear, that ferocity, and think of someone who tries to harm someone you loved. There would probably be this arising of anger that comes up to protect. Anger is a protective emotion. Now again, anger can be problematic for sure. It's very easy. What's the difference between helpful and unhelpful anger? It's dead simple. Helpful anger alleviates suffering, unhelpful anger causes suffering. We know it can do both. But anger should not be undervalued as an important source of protection and compassion. It energizes us, it focuses us, it gives us energy, it suppresses the fear response, especially with people with anxiety. It's funny, my son is afraid of dogs. It's one of his anxious things. I taught him very early on that when a dog is threatening him to rise up and yell at the dog and flop his arms, scare the dog. He does that. It's funny, it also helps suppress his fear response for the dog when he does that because he's basically getting angry and yelling at the dog to back off. I have to say sometimes he overuses it, like he's done that with poodles at the park. I'm like, "Poodle is not a threat. Poodle will survive." In his mind, the poodle is a threat. So, being able to call on that fierce energy, one of the things it does is it does suppress the fear response. So, if you never allow yourself to be angry, it feeds into that fear response. That anger can actually be opposite to the fear response. Kimberley: Right. This is where this is so beautiful because actually, a lot of the work I do with my patients is, instead of being angry at the dog or expressing anger, is to talk to fear and set the limit with fear. You were talking in the book about the inner critic and the inner voice or it could be the inner fear. I often will have patients say, "No, fear, you can come with me to the dog park or you could come with me to this, but you are not winning," and getting really strong with an angry back at fear, which I think is another approach. Kristin: Yes, that's right. Again, you can say, "Thank you for trying to help me." In my son's script, "Thank you for trying to keep me safe, but you aren't helping." It's both. It's the appreciation. Because we don't want to feel that any parts of ourselves are unacceptable. If we make our inner critic or if we make our anxiety or OCD, or any of those parts of ourselves feel unacceptable, then we're harming ourselves. Kimberley: That's the key point. Kristin: We can accept it with love, with tenderness. Just because my OCD is not helping me doesn't mean it's not acceptable, and act as a way in which it's a beautiful part of me trying to keep myself safe. So, it's differentiating between us as people and particular behavior. Behaviors can be helpful or harmful, but we're always okay exactly as we are. Kimberley: Right. And that's the point. You just dropped the mic on that one. That's so important. This is actually a question more than a statement—as we're navigating, standing up to fear or depression is that we're not disregarding it or criticizing the fear that's inside us either. Kristin: Yeah. Because it serves a purpose. All these emotions serve-- and usually, it comes down to safety or the sense of belonging or some sort of deep survival mechanism because these are all evolutionarily-- they came from our brains and our brains designed to survive. So, they have a negativity bias, say they tend to get really anxious. They tend to use the fight, flight, or freeze response. Fight is the self-criticism, flight is the fear response or shame response, freeze is when you get absolutely stuck over and over again, like rumination. Interesting, which may be related more to OCD. I've never thought about that. But it might be that that loopy might be the freeze response where you're just stuck. All of these evolved as safety mechanisms as a way to avoid, like the lion chasing you, and they still remain in our brains, even though nowadays, most of us, at least in the first world, don't have those types of threats to our physical being as often. Kimberley: Oh, I love it. Okay. You already touched on this slightly and I just want to go over it quickly is, how might people use fierce compassion as a motivator and as something that encourages them? Because I think the way I conceptualize it is, you conceptualize the basketball coach who's like, "Get up in there and just go harder." It's motivating, but it's almost also very critical. Can you share a little on that? Kristin: Yeah. Self-criticism or harshness does work as a motivator. There are coaches like that who do get some results out of their players, but there's a lot of unintended consequences. Anxiety actually, believe it or not, is one of the poor byproducts of criticism because fear of failure, fear of not performing up to your ability, fear of making mistakes, that actually gets generated. When you know that you're going to beat yourself if you don't reach your goals, then that actually adds to your anxiety, and that makes it harder to reach your goals. Fear of failure, procrastination is a classic example. Self-handicapping, some people do that because they don't want to risk failure because they're too afraid of failing, because they know they're going to be so harsh on themselves if they do fail. But some people make the mistake of thinking that self-compassion is just about acceptance. Like, "Well, it's okay if you don't succeed. Well, everyone is imperfect." Although it's true, it is okay if you don't succeed, it is true that everyone's imperfect, that doesn't mean that you don't want to succeed. But the reason you want to succeed is very different. Some people want to succeed because if they don't succeed their failure, they're going to hate themselves, they're going to shame themselves. Other people want to succeed because they want to be happy. They care about themselves. They don't want to suffer. It's a much healthier form of motivation. It comes from the desire for care and well-being as opposed to fear of failure or inadequacy. And then because of that, when the bottom line is, "Hey, I'm going to try my best. I'm going to do everything I can to succeed. But if I fail, that's okay too," what that means is anxiety levels go down. There's less fear of failure. There's less procrastination. There's less performance anxiety. This is the key. When you do fail, you're able to learn from it. I mean, it's a truism that failure is our best teacher. If we shame ourselves when we fail, when we're full of shame, we can't actually learn. We're just hanging our heads. We can't really see clearly. We can't process. But when it's like, "Okay, wow, that hurts. Ouch. Well, everyone fails. What can I learn from this? It doesn't mean that I'm a failure just because I failed." That ability to learn actually helps your motivation and helps sustain your motivation. It's just much more effective. We know this with our kids and a lot of coaches know it. Not all coaches know, but a lot of coaches know their players. They may be tough like mama bear tough. But the thing about mama bear is you also know mama bear loves you. She's doing it because she cares. When she's just snarling at you, you don't get that sense of being cared for. You get that sense of being inadequate. We know the difference, including with her own internal dialogues. We know the difference. Does this come from a place of care or a place of shame? Kimberley: You know what's interesting, and you probably know this, probably experienced this, but as I was writing my book, I was saying nice things, but I caught myself saying them in a tone that wasn't nice. I was going, "No, I haven't said anything." I was saying like, "You could do it, keep going," but the tone was so mean like, "Keep going!" Do you want to share a little bit about that? Kristin: Yeah. Well, tone is so huge. One of the main ways, the idea that the feeling of compassion is communicated, especially the infants before they get language, is through touch and through tone of voice. Universally, we know the certain types of touch that feel caring and supportive and others that feel either indifferent or threatening in some way. Also tone, there's a certain quality to the voice when it's caring versus when it's harsh. Most of that is communicated to infants before they know how to speak. It's not just what you say, it's how you say it, and it's also how you hold your body. There's physical touch. But even just like, is your body slammed or is upright, physical signals of care are really important. We teach both right. Kimberley: I'm asking this actually for myself because it didn't occur to me right now is how might I be fierce with the tone? How does the fierce tone sound? Kristin: Yeah. It's firm, but it's not harsh. It's like, "No, that's not okay," instead of, "No, that's not okay!" It's not vicious. It's not, "No, that's not okay, you stupid idiot!" It's like, "No, that's not okay." Kimberley: Yeah. That's the nuance that I think I have to work on. Kristin: "It's not really okay. Is it okay?" It's like waffling and wish-washy. By the way, I'm saying this, it's not easy to get it right, and I get it wrong all the time. Fierceness and tenderness have to be balanced. My problem is, even though I was raised as a woman and for most women, they aren't allowed to be fierce, I'm actually probably more yang than yin just by nature, just by my genes. My problem is I am too fierce without being tender enough. I'm always apologizing and saying, "I'm so sorry, please forgive me," because I get out of balance the other way. Sometimes I just say it so bluntly and I forget to cushion it with some sort of niceness or reminder that I care. And that's not healthy either. It's a process. It's not like a destination, you get there and you're done. It's like, "Okay, I got it wrong this way, got it wrong that way." You always have to be trying to recorrect. But as long as you allow yourself not to have to be perfect, then you can keep going. You keep trying. It is a process. It's a process of compassion. The goal isn't to get it right, it's just to open your heart. So, as long as we do all of this with an open heart, out of goodwill, the desire to help ourselves and others, then it's okay. But it is tricky, and I would be lying if I said that it wasn't. It is. Kimberley: Yeah. Here I am thinking that I'm really good at this stuff, and I was hearing my tone and going, "Wow, that's not cool. You're saying kind things, but not with a great tone." I have two more questions or things I want to touch on really quickly. Will you talk about these two topics of fulfillment and equanimity? I know you touched on them in the book, but I loved what you are to say. Kristin: Yeah. Fulfillment is also an aspect of self-compassion. So, if we want to help ourselves and be well, we really need to value what's important to us. First of all, we need to know our values. Is it just what society says? You have to earn a certain amount of money. You've got to look a certain way. You've got to be popular. What's really important to us? Sometimes it's personal, like music or art or nature. Sometimes it's honesty or sometimes it's helping others. But we know our inner values. Part of compassion is asking ourselves what's really important to us and valuing ourselves enough to actually fulfill our own needs. Again, there's a gender difference. Men have raised feeling entitled to get their needs met. It's not really the question. Of course, I'm going to get my needs met. Isn't it to everyone? Well, actually, not necessarily. Class, and a lot of things go into this, but gender certainly does. Women are valued for being self-sacrificing. Women are valued, especially toward their kids, for denying their own needs and helping others. That's how people like us. That's how we get our sense of worth. So that sets us up in a situation that in order to feel worthy, we have to give up what's important to us, which actually undermines our own sense of self. Sometimes the term we use is "Give to others without losing yourself." Part of that is knowing what you need to be happy and fulfilled and giving yourself permission to take the time, energy, effort to meet those needs. It's not instead of other people, it's in addition to. It's including yourself in the equation. My research shows that self-compassionate people, they don't subordinate their needs, but it's not like my way or the high way. They actually are more likely to compromise and say, "Well, how can we come to a solution that meets everyone's needs?" And that's really what we need to do to be balanced. Kimberley: Yeah. I loved that. I really did. Oh my goodness, this is so good. Before we finish up, would you tell us where people can hear about you and your book or your books? Tell us where we can get to you. Kristin: Yeah. Probably the easiest place to start is just my website, which is self-compassion.org. If you Google it, you'll find me. I got in early, so all the algorithms come to my website. Just type self-compassion, you'll find me. On that side, I've got, for instance, if you want to test your own self-compassion level, you can take the scale that I created to measure self-Compassion. I have guided meditations, I have practices, I have exercises. I have a new page on Fierce Self-Compassion that especially has fierce self-compassion exercises. I have research. If you're a research nerd, there's hundreds and hundreds of PDFs of research articles on there. There's also a link to the Center for Mindful Self-Compassion, which is really the nonprofit I started with Chris Germer that does self-compassion training. That's also a really good place. You could take courses online. You can get training really easily now. Kimberley: I've taken the training three times and in three different ways. One was a weekend. One was the eight-week course. One was a two-day. I think that can meet everybody. Online, I did one of them that was finished online because of COVID. Really, really great. So, thank you. Is there anything you feel like we've missed that you want to make sure we cover before we finish up? Kristin: I just like to encourage people just to try it out. I mean, the research is overwhelming in terms of the well-being and strength and resilient self-compassion can give you. Life is tough and it's getting tougher every day with this pandemic and global warming. I mean, everything is really, really tough. So, we have this resource available, this resource of friendliness, of kindness, of support, just available at any moment. You don't have to sit down and meditate. You don't have to even go to a class. You just have to think, what do I need to care for myself in this moment? You can actually do it. It's like a superpower that people don't even know they have. It's just like to tell people, "Hey, you've got this ability. It's right in your back pocket. You just need to remember to take it out." Kimberley: I love that. Thank you. Thank you so much for your time. I'm so grateful. Kristin: You're welcome. Thanks for having me. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting cbtschool.com . Links: Kristen Neff's Website https://self-compassion.org/ Fierce Self-Compassion https://www.amazon.com/dp/006299106X/ref=cm_sw_em_r_mt_dp_BT4GGYF8XFE1TJ7DPGBT?_encoding=UTF8&psc=1

Oct 15, 2021

This is Your Anxiety Toolkit - Episode 206. Welcome back, everybody. How are we doing? We are on week 3 of the Self-Compassion Challenge. So welcome if you are new and you haven't caught up with our Self-Compassion Challenge. We are doing a 30-day Self-Compassion Challenge for everybody, so everyone can dabble in their self-compassion practice, maybe strengthen their self-compassion practice, and hopefully thrive with their self-compassion practice. Today, we're going to talk about the roadblocks to self-compassion. Now, this is coming directly from my new book called The Self-Compassion Workbook For OCD . However, even if you don't have OCD, this will apply to you. I did a poll on Instagram with almost a thousand people who wrote in and polled on the biggest roadblocks that they're having, and I've compiled it. Thankfully, I used it in the book. The cool news is there were so many people who agreed on those top eight roadblocks. So I wanted to share them with you today. We're going to go through each and every single one. But before we do that, I would like to first do the "I did a hard thing" segment. Now, for those of you who are new, welcome. The "I did a hard thing" segment is where you write in and you tell me the hard thing that you have done. Today's is from anonymous, and they have said: "I just got on a ship for a daily trip and I forgot to take with me my medication. I don't use the medication that much, but I do feel safe when I have them with me. This makes me anxious, but I am choosing to manage my anxiety." How cool is that? Sometimes things don't go as we plan, and we have to rely on all of our tools and it sounds like Anonymous is doing that in an amazing way. All right. I have been doing a review of the week for people who submit a review for the podcast. However, as I'm recording this, the reviews have started to come in for the book and I couldn't help myself but share the very first review for the book. It made my heart explode. I was taking a walk. My friend called me to tell me there was a review, and I basically burst into tears. So here we go: "I've read a number of books on OCD in the past, but Kimberley's emphasis on self-compassion and its place in the ERP process is so, so refreshing and so very important. This is a must-read for anyone with OCD or anyone helping a loved one through OCD. It is a beautiful day to do hard things." Thank you so much for that amazing review. The reviews literally are changing my life. Oh my goodness, I can't tell you, when you write a book, there is so much anxiety involved, at least there was for me. And so to have people enjoy the book is just literally the most amazing thing. The most amazing thing. I had no idea. Number one, total massive respect to any author of any kind. Writing a book is very, very hard. And so, I'm just honored to be able to help people in that format as well as this format, and in addition to CBT School and in my practice. What a joy. All right. Let's get to the show. Let's talk about the Common Roadblocks to Self-Compassion. Now, the first one is related to OCD. Like I said, if you don't have OCD, stay with me because the rest are really going to maybe resonate with you, but this one is very much hands down, was the number one roadblock people reported who have OCD to have a roadblock with self-compassion. 1. "I do not deserve self-compassion because of the content of my obsessions." In the book, we go through each and every one of these in detail, but today I'm just gonna quickly knock each one of them out. So here we go. Your obsessions do not determine whether you are worthy or deserving of self-compassion. The minute you say that, you're giving too much importance to your thoughts, feelings, sensations, and urges. So the big thing to remember here is, your job is to have these obsessions and not respond to them as if they're important, and to practice taking care of yourself, whether you have them or not, that this idea that you're not deserving of them is completely false. In fact, we talk a lot about calculations in the workbook. Some people like we have these weird algebraic calculations where we go, me + obsessions = undeserving, or me + intrusive thoughts = I'm a bad person. I want you to keep an eye out for these little nuanced calculations that you have in your mind because they are dead wrong. Your thoughts are thoughts. Your feelings are feelings. Your sensations are sensations. You are not disqualified from being treated with respect and kindness because of them. 2. "I am not worthy of self-compassion because I have a mental illness." Now in the book, we use a case study where we talk about this idea of stigma around mental illness. I really want to urge you, as I do in the book, to start to break this belief that there is anything wrong with you for struggling with a mental illness. We have to be the change here. We have to lead by example. If you have a mental illness and someone has shamed you, or you've experienced the stigma of that, your job is to be the change by treating yourself how you would treat anybody else who was struggling with a mental illness. And that would be with kindness and respect and care and nurturing. You're not disqualified, again, because you have a mental illness. There is nothing wrong with having a mental us. That doesn't mean you're less worthy, less valuable, less successful, less lovable. We have to break through all of those faulty beliefs we have around mental illness because it's no different to a medical illness. In my belief, the more you suffer, the more you tend to that suffering with kindness. It's not like, oh, well, some suffering is okay. We'll give some of my suffering kindness, but not the ones with mental illness because society has told me that there's something wrong with that, which is absolutely incorrect. 3. "I am too preoccupied with anxiety, panic, and uncertainty to practice self-compassion." This is a common one, and I fall into this category as well. Sometimes when we're anxious, we rush too much, we speed along, we try to push it away, and we don't stop to go, "Wait, maybe I could be just kind. Maybe I could just be really gentle with myself while I feel anxious. Maybe I could slow down and tend to my anxiety." Maybe that's the answer instead of trying to push it away or have it be gone, because that is the answer. 4. "It feels wrong to practice self-compassion." Now, this is a really good definition of what we would call "emotional reasoning." It goes under the cognitive distortion that, just because I feel it, it must be true. Now, just because things feel wrong doesn't actually mean they're wrong. It's often because you've been taught for many years based on society or your family about what's right and wrong, and we've never stopped to question, is that even true? Because it's not wrong to practice self-compassion. In fact, it's effective to practice self-compassion. It's helpful to practice self-compassion. We've already sort of declared you're worthy and deserving of practicing self-compassion. So your job is, even though it feels wrong, do it anyway. Do it anyway. It might feel awkward and weird to start with, do it anyway. It might feel bizarre and self-centered, do it anyway. That's what we want to do. 5. "Self-criticism and self-punishment are how I motivate myself." Whoa, this one is so strong for some people. So many of my patients and clients have told me in the past, "If I don't beat myself up, I'm going to turn, you know, it's the only way I get myself to do things." And I often say, "Okay, maybe that's true. It might work. You might find that self-punishment and self-criticism does motivate you. But is there possibly a more effective way? Is there possibly another way that you can motivate yourself? And yes, self-compassion can be used as a motivational force. Is there another way you could do it that actually doesn't create more problems?" In the book, one of the main concepts I talk about is compassionate responsibility, which is where you honor what your needs are, and sometimes that you do need to get things done. So you practice motivating yourself using what we call a kind coach voice instead of a critical voice. Both have the same outcome. Both are motivational. One tends to bring you down and the other one tends to cheer you on and make you feel empowered. Let's choose the latter. Let's choose the voice that says "You can do it. Keep going. You've got this. Keep trying. It's okay that you fell down. Just one minute at a time, get up and keep trying," instead of the critical voice and the punishing behaviors and voices. 6. "What if self-compassion makes me lazy?" This goes together with the last one. A lot of people are afraid that if they're self-compassionate that they'll just become some sloth that doesn't do things and lets themselves go. I'm here to say, no. If that's what happens, that's not self-compassion anyway. Self-compassion is doing what you need to live a good life. It's not letting yourself off the hook all the time. Sometimes it can be to say, "You've had a rough day, it's time to rest." But a lot of the time it's saying, "Yeah, you've got some hard things to do." Let's be so gentle and so encouraging of you as you do those hard things. The whole phrase "It's a beautiful day to do hard things" is a self-compassionate statement. You just didn't know it yet. We didn't call it that, but that's what it is. The thing to remember here is, maybe you want to check your definition of lazy and weak. For me, this has been a huge part of my recovery, especially having a chronic illness and mental struggles. Is taking time off to rest really the definition of weak and lazy? No, it's just what human beings do. Humans need to rest so that they can restore themselves to go and do amazing hard things. Sometimes we're taught to believe that you should never rest, and you should never be lazy. And so you don't give yourself that basic need of restorative rest. So, so important. 7. "What if practicing self-compassion makes me snap or lose control?" Now, this is a big one, particularly for people with anxiety. This comes under the misconception that we must constantly brace ourselves for the worst. We must constantly be hypervigilant and hyper-aware of all the possible dangers. And so we have to constantly be scanning for danger, looking for danger, what's going on, what could go wrong. We know, number one, that that's compulsive in nature. It keeps you stuck in anxiety. But it also is a block, a roadblock to your ability to tend to your suffering, tend to the sensations that are uncomfortable, the feelings that bring pain to you. So an exposure, we want to actually practice not engaging in those hypervigilant behaviors and practice being uncertain on whether you will snap or not, or lose control or not, and just tolerate the uncertainty of that. Sometimes self-compassion is an exposure in and of itself because when you're practicing self-compassion, you're not engaging in those compulsive rituals that keep you stuck in that cycle. It's really, really cool that it can be both an emotionally intelligent behavior, but also be an exposure. It's like to bang for your buck, I guess. 8. "Practicing self-compassion makes me self-centered." Now, we've had amazing guests on the podcast who have addressed this, but I will address it again. Being self-centered is not the definition of self-compassion. Self-centeredness is this idea that we're egotistical and everything has to be about me and so forth. What I have found in my own practice is, the more self-compassionate I am, the more I'm able to tend to other people's needs and be aware of other people's struggles and difficulties because I'm connected to my suffering. The more I am aware and meet my suffering, the more I can acknowledge and be in relation with other people when they're suffering. I can sit with them and go, "Yes, me too." I can tend to their pain without having to make it about me because I'm there for myself. I don't need other people to make it about me anymore because I have already tended to my needs. I have unconditionally been there for myself, so I can be there for other people. It's so, so important. So that is the top 8. In the workbook, I have room for others. There's lines where you could add your own and you might find you have your own roadblocks. They are valid too. Identify them and keep an eye on them. The main work here is once you catch them, and you know they're happening, you can then move on to dismiss them and correct them and move towards tending to your discomfort, being kind while you ride the waves of uncertainty and anxiety and discomfort. It's so, so important. It's so, so important. Let me go right to the top. You deserve this. YOU. Yes, you. I'm talking directly to you. I'm looking you right in the eye. I'm going to conclude this episode by saying YOU DESERVE SELF-COMPASSION. You are valuable. Your pain matters. You deserve kindness and respect and tenderness in your suffering. Your suffering is important. It's not irrelevant. It's not silly. It's not childish. It's important. You deserve to tend to that kindly. I'm talking to you right now. I hope you're listening. All right, folks sending you so much love. I hope that you're finding this Self-Compassion Challenge helpful. Continue to follow on the lives on Instagram . That's where we're doing tons of live work. Continue to look at the emails. If you're not signed up for the newsletter, please do. You can go to cbtschool.com and click on Resources and we can sign you up there. Or you can click on the show notes, we have links there where you can sign up and you will get all the challenges that you need for each day and each week. They're Monday through Friday, we take the weekends off because that's the self-compassionate thing to do. All my love to you. Really go and be gentle. Go and be kind. Go and honor and respect your own experience. It's so important. I'll talk to you soon.

Oct 8, 2021

This is Your Anxiety Toolkit - Episode 205. Welcome back, everybody. We are on week 2 of this Self-Compassion Challenge. For those of you who are new to the podcast, or didn't hear last week's episode, go back and listen to that. We are on week 2 of a 30-days Self-Compassion Challenge. My whole goal is that you learn how to treat yourself kindly and compassionately as you move through difficult times. We are doing this to celebrate the launch of my very first book ( The Self-Compassion Workbook for OCD ), which I am so proud of and so excited about. Thank you to everybody who has purchased the book, supported me on social media, shouted me out to their friends and fellow followers. I cannot tell you how grateful I am. If you have got the book and you're enjoying the book, please do go and leave a review over on Amazon, share your honest opinion or share your thoughts on social media or with anybody you can, because the more people I can help, the happier. I am. We are moving on today in this episode onto the second most important part of self-compassion in my mind. Now, this is taken directly from the book, even though the workbook is called The Self-Compassion Workbook For OCD . This is a concept I talk to all my clients about. It's something I constantly check in with myself about, and it has been probably one of the most important parts of my recovery in mental health in many, many ways. So I am so excited to share this with you. Before we do that, I do want to go over and share the review of the week. For those of you who are new to the podcast or are old to the podcast, I love your reviews on iTunes. It helps me reach more people. So this week is from Looney Lovey. It says: "A gift of a podcast. I am so incredibly thankful I found this podcast. I have experienced OCD since I was 10, and this has been one of the most amazing tools. I seriously thank God for leading me to this podcast every day. It is like having a therapist in your pocket. Kimberley is so sweet, and her openness and kindness make the listener feel so welcome." Thank you, Loony Lovey. The next thing I wanted to share is the "I did a hard thing." Now, let's take a step back here and really look at self-compassion as really being a hard thing. And so, a lot of you have actually written in and said, self-compassion was one of the hard things that they've been practicing. However, this week we have a hard thing from anonymous and they've said: "I have a fear of disease. I recently had two close friends get a diagnosis where this would make me feel fear for myself and my family. I chose to show up for my friends and continue on a daily basis, working on my mental boundaries, not making their illness about me, and my fear is about that stopping me from supporting them. I struggle with feeling everyday body sensations in myself and wonder if I am next. But this is so amazing, this whole 'I did a hard thing.'" Anonymous, amazing work. It sounds like you're really showing up and letting your values make your decisions, not your fear. This is so cool. This is just so cool that you've done that. Look at you go. Doesn't that just show that fear doesn't win, right? That love and connection and values win every single time. I just love this one so much. Thank you so much for sharing. I have a ton of submissions, but I will share again very soon where you could put those submissions in if you're wanting to put your name in. Okay? All right. Let's get over to the meat and cheese of the whole episode today. So we're talking about a concept. Now, this is not scientifically proven, I have to disclose. This is my conceptualization of one of the main things that get in the way of self-compassion. I'm going to tell you a quick story. When my son was in kindergarten, the teacher had this system called the clip chart. I want you to imagine the clip chart is just a piece of cardboard, and in the middle of the piece of cardboard, it's like a long narrow rectangle. In the middle is a peg. And the peg is put right in the middle and there is just a normal neutral face. Above the peg are these different ladder rungs. There's a smiley face, there's "You did well," then there's a bigger smiley face. And then at the very top, there's this huge smiley face saying, "You get a treat." Now under the peg is a sad face. And then under the peg is an even sadder face. And then under that sadder face is a really, really sad, but almost mad face. And next to it, it says, "Call your parents." This is a ladder system that if a kid isn't listening, they get clipped down. If a kid is doing really well, they get clipped up. At the top, if they get clipped up enough times, they get a special treat, some toy from the toy box. If they get clipped down enough times, the teacher calls the parents. This is what we would call a behavioral modification tool to help encourage kids and motivate children, usually five-year-olds, on how to act and how to behave. It's incredibly efficient. As long as it's not done in a shaming way, it can be a really motivating way of keeping kids feeling like they're being motivated in courage. They've got something to look forward to. They're working towards something. The problem with this is, even if you haven't got a clip chart and you weren't given one in kindergarten, our society runs by a metaphorical clip chart. If you act well and you put a smile on your face and you get good grades, you get clipped up. If your body looks a certain way, you get clipped up. If you make a certain amount of money, metaphorically, our society will clip you up as if you're doing well. Now, likewise, if you're struggling, often we clipped down. We do this to ourselves. Not only society, but we also clip ourselves down. "Oh, I didn't do well in that test. I'm going to clip myself down." Sad face. "Oh, I'm struggling with my panic today, or my anxiety today. I'm going to clip myself down. I did compulsions today. I'm going to clip myself down." We use this metaphorical motivation system all the time. Now within society, we also have this inbuilt view on mental illness. This is also about racism, and there's so many different levels of the way your body looks, social media followers. Again, like I said, how much money you make. There's socially so many expectations put on us, that we also buy into that. Sometimes, because we rely on this metaphorical clip up and clip down system, we use only this system to motivate ourselves, which ultimately means we're constantly on this checklist of how much we can get done so that we can feel good about ourselves. We're constantly clipping ourselves up and down as if worth depends on it. And that's the piece I want you to remember. We do this, and we make this calculation, that if I'm clipping up, I'm worth more. If I'm doing my homework well, I'm worth more. If I don't have a mental illness anymore, I'm worth more. This is not true. This is all lies. This is one of the main points I make in the book, which is, when we're stuck in a clip chart way of seeing ourselves, our identity, our worth, our value, we're constantly anxious. We're constantly afraid of dropping the ball. One of the most compassionate things we can do is to drop the clip chart system completely, to recognize. This is what I say to my patients all the time. You're always at the top of the clip chart. Nothing you can do is going to drop your worth down – no mental illness, no body shape, size, color, hair color, short height, tall. None of that changes your worth. None of it. I'm specifically here talking about your mental struggles. You do not get clipped down worth-wise because of all of the struggles you have mentally. I have had so many patients and clients tell me they don't deserve self-compassion because they're struggling so much with this mental illness, because it's putting their family out. It's impacting their loved one's lives because it causes them to do compulsions all night long. And therefore, they deserve to be clipped down. I don't agree with that respectfully. Everybody is at the top. You're having a bad day? You're still at the top of the clip chart. You're having a good day? You're still at the top of the clip chart. Every single day, you deserve a treat, a fun, joyful experience. A pleasure, a reward. You got through the day. Celebrate. You don't get clipped down. We have to throw out the clip chart system. Now, does this mean you have to give up trying? Absolutely not. Does that mean that you don't study for your test and you don't show up to work and you don't try to make life better for you? Absolutely not. You do the things that you value. You do the things that fill up your heart. If you value getting a good grade in school, put in as much effort as you can because you value it, not because you're on this conditional worth system where you're just trying to prove that you're worthy and good. Don't do treatment. I talk with my patients, why are you doing ERP? Are you doing it because you want your life back from OCD? Or are you doing it because you feel embarrassed or ashamed for having to do compulsions? Neither is wrong, but the compassionate thing to do here is to move from a place of values, what matters to you, what makes you feel like it gives you purpose in this life, what keeps you connected to your loved ones – instead of clipping yourself up and down on this worth ladder, because that's temporary and it's conditional. We want our self-compassion practice to be unconditional. That's why we throw out the clip chart. It's unconditional. You're having a hard day? You get self-compassion. You're having a good day? You get self-compassion. You're having a day where everything went wrong? You get to have self-compassion. We don't clip you down because of that. And that is the real important piece I want you to take away. I want you to think about, if you had a clip chart, what are some of the things you've been telling yourself? I want you to write this in your journal, really reflect on this. What are some of the things that you clip yourself down for? What are some of the things you clip yourself up for? Do you get engaged in this sort of mental worth calculation? "Oh, I'm worthy today because I A, B, and C?" Because that's not true. You're worthy whether you did that or not. Do you beat yourself up because of things you've done? That's you clipping yourself down. You've said, "I've done something wrong. Therefore, I need to be punished." The whole work we're doing this month is to move towards like we talked about last week, asking yourself, what do I need in this moment of suffering? The clip chart is usually one of the main reasons people don't give themselves what they need, because they say, "Oh, I did A, B, and C today. Therefore, I don't deserve it. I clipped myself down." I have to keep saying to my patients and clients, "No, no, no. You're at the top. You're at the top every single day. You deserve kindness and care and compassion and treats and pleasure and joy. But most of all, compassion." So that's the concept of the clip chart. I want you to draw it out. Put the system. What do you have to do in order to be at the top in this metaphorical clip chart? What do you have to do when at the bottom? What bad things do you consider yourself clipped down to the bottom? And really reflect on, is this really kind? Is this a compassionate way for me to treat myself? If it were up to me, my advice is, put yourself at the top. You get compassion every single day unconditionally. Throw out the clip chart. It works for five-year-olds in a classroom, but it doesn't work for you in a lifetime. It doesn't work for you in your life. You deserve more than that. You deserve kindness every day. So let's take a minute. Let's slow it down and just check in, and just sit with this idea that no matter what, no matter what happens today, no matter how you acted or behaved or performed, no matter what grade you got on the test, no matter how you showed up, let's just reflect and honor that unconditionally, you deserve self-compassion. If you hear a voice saying, "Yeah, but blah-blah-blah," whatever the blah-blah-blah is, is where your work is. If it says, "Yeah, but my thoughts are horrendous, therefore I'm disqualified from this," there is your work. You're doing too much judgment around your thoughts. If you go, "Yeah, but I did this one bad thing, it's unforgivable," I go, "Okay, send your compassion around that. Go hard on that. Because that's the thing that's getting in the way of you really tending to your pain and suffering the way that you deserve." You might say, "Yeah, but I've got too much anxiety. I'm too sick. I'm just too unwell. I'm too messed up. I'm too hopeless. I'm a failure." We'll do some work around that. Reflect on that, because that's the roadblock, which we will be talking about in other episodes to come. Alright. I love you guys so much. Really take a minute and receive the love I'm sending you right now, the compassion I'm sending you. I hope you're taking care of yourself. I hope you're facing your fears. I hope you're tending to your suffering as best as you can. It is a beautiful day to do hard things. You knew I was going to say it. So I want you to lean in here. Double down on this practice. You deserve this. Have a wonderful week, everybody. I love you. Talk to you next week.

Oct 1, 2021

Hello everyone! Today is the day that my very first book is out in the world for you to get. I could just die of excitement. So, for those of you who don't know, I spent a large part of 2020 writing my first book. It is called the Self-Compassion Workbook For OCD: Lean into Your Fear, Manage Difficult Emotions and Focus on Recovery . I could cry. I am so excited that it is finally here. It was such a huge project in my life. Now I'm just thrilled to share it with you guys. Now, what does that mean for you? You can go and purchase the book wherever you buy books. You may order it on Amazon if you don't have a bookstore near you. But in addition to getting the book, which is literally like, ah, I put my whole soul into this project – what you can do in addition to that is this month, for the month of October, we are going to do a self-compassion challenge. Now, before you turn the stereo or your iPhone or your iPod off, stay with me because I really strongly believe that this challenge could change your life, whether you have OCD or not. I really want to focus this month on improving your relationship with yourself, improving your relationship with self-compassion, working through the roadblocks that you have. I'm going to be doing a lot of live instruction on Instagram and hopefully on Facebook as well, depending on technology. But if you don't follow me on Instagram, head over there, if you're not signed up for the newsletter, head over there, because my goal is to really nurture you through this process and get you having a self-compassion practice that is rich and fulfilling and healing. So, so, so important. Today, we're going to kick it off right away. We're going to talk about the first main point I want you to do. Before we do that, let's do a couple of important pieces. So first thing, we're going to do the "I did a hard thing" segment. This one is from Elle and she has said: "I sat outside in 92-degree weather to eat my croissant. Even though being in overly hot places makes me anxious, I just wanted to be outside." Thank you so much, Elle, for that submission. Really what I hear you saying is you were willing to tolerate heat, which is often a really big trigger for people with anxiety, but you did it because it's what your soul was asking for, which is a huge piece of what today's podcast is all about. Now we'll move on to the review of the week. This is from Cynthia. She said: "I'm so excited to share these podcasts with my clients. I was first introduced to Kimberley's clear and compassionate teaching style when I took ERP School for therapists, which is the CEU course. In the past three weeks since taking the course, I recommended both the course and podcast to my clients. So helpful. Thank you, Kimberley." Yay, I'm so happy to hear that, Cynthia. All I have to say, it's all coming together. I feel like years of hard work of the podcast and courses and the book, and I feel like so many people are getting on board and they're starting to face their fears and they're learning these skills and it makes me so overjoyed. So, thank you so much, Cynthia. Thank you, Elle. I'm just feeling such gratitude right now. Okay. Here we go. We are on Day 1 of the 30-day challenge to self-compassion. Now, I know I've done a lot of work on self-compassion before in the podcast. You can go back and listen. I've interviewed the most impressive people on self-compassion. You can go back and listen to those episodes. But for today, I want to go straight to the most important piece. We'll work through some other things later through the month and some roadblocks, but here is the main tool for this week. Are you ready? I want you to take a couple of breaths. I want you to check in with yourself. You can do this in the form of meditation. If you're driving, please keep your eyes open on the road. But if not, you may close your eyes and check in with yourself. Where is the discomfort and the pain in your body? Where is the suffering in your body? Is it in your chest? Is it in your shoulders? Is it in your head? Is it in your heart? Is it in your stomach? Is it in your fingertips? Is it in your legs? Where is the suffering? It could be all over your body, and that's okay. But just check in on where it's at. And then I want you to ask yourself this one question: What do I need right now? I don't want you to argue with yourself. I just want you to honor what first comes up. What do I need right now? Sometimes our instincts are to say, "I want this pain to go away." But a huge part of self-compassion is honoring what's really happening. It's really this truth-telling practice where you have to accept, okay, that's not an option right now. Otherwise, you would've done it, right? You would've done the thing to remove the discomfort. If there's an itch, you probably would've scratched it by now. Often the pains that we feel, the ones that cause us the most suffering are the ones that we can't simply get rid of the anxiety. We feel the depression, we feel the headaches we have, the stomach aches we experience, the grief, the loss, the anger. All the things, right? So instead of bargaining with whether it should be there or not, I just want you to radically accept that it's there and ask yourself: What do I need right now? And often what you need is kindness. Some tenderness around the suffering. And that might be the thing that you come up with. Before I segue to the next step, it might be to take a deep breath. It might be to slow down. It might be to rest. We're going to be talking about that throughout the month. It might be to actually give yourself some time to fill up your cup. It might be to set a boundary with somebody. It might be to say NO to something, as long as it's not something that you've previously been doing as a compulsion. We don't want to use self-compassion as permission just to do more compulsions, but really check in on what do you need right now. And then, this is the next main piece of the homework for today, what do I need to hear right now? What do I need to hear? What would I love to be told? What would nourish me? If a warm kind loving friend came in the door right now, what would they say to me? What do I need to hear? Your homework for this week is to say the thing you need to hear, all the time. It might be, "I'm here for you." It might be, "It makes complete sense that you're feeling this way." It might be, "I have your back." It might be, "I see your pain." It might be, "Your pain is important." It might be, "You are enough." For me, I will tell you the thing I have really had to listen to. I actually just had a conversation with a dear friend who's a therapist. I put my hand on my chest and I say, "Dear sweet one, just be with your body and trust that it will hold you and carry you through this moment." You'll hear that some of the statements I'm using, they're not saying, "We're going to make everything okay." They're saying, "I've got you. I'm going to be there for you. Your pain matters. It's important. It's valid. There's nothing wrong with you." That's the message I want you to encompass and embrace. But it's going to be different depending on the moment. So what I'm going to say here is the advice that I need right now in this moment of suffering is going to be different in an hour. The advice I give myself in an hour, that compassionate check in is going to be different to what I need tomorrow. And so your homework is ideally, get yourself a journal or a notepad or a Google doc form or notes in your phone, and I want you to do a check in every day, at least once, and write down: What do I need to hear right now? And put in what you need to hear right now. Because what you'll do is you'll gather a list of things that you can rely on, sayings and statements you can rely on, at times where you're so anxious and you can't even access your compassion itself, or you're just needing some guidance. These small statements can be a monumental part of your recovery, particularly when you're totally frazzled and panicked, and you've lost all ability to see the rationale. So that's what I want you to practice. Your compassion practice, again, isn't an attempt to remove your discomfort, but to tend to it, to lean into it, to practice being your strongest supporter through your discomfort. I want you to strengthen that voice. It might be very, very, very, very, very shy. It might be very, very timid. It might be very insecure at this time. But with practice, this is a skill that you can learn so that voice in you sounds more like a mama bear, a strong mama bear than it does a timid, uncertain person. That's your homework. I want you to check in, I want you to get yourself a journal and I want you to start to document this stuff. Dabble with it. See what works, what doesn't. Some of the things that I've shared today might help, and some of it might not feel right to you, and that's totally okay. It's different for every person. That's why we ask the question: What do "I" need? Not "What does Kimberly need? What does the neighbor need?" but "What do I need?" Because I matter, and you matter. So, so important. So, that's it. That's your homework. I want you to practice it. Come on back as much as you can to the newsletter, Instagram, social media. I'm going to be doing as much as I can, really trying to double down on people's self-compassion practice. You don't have to have OCD to be a part of this. I'm doing it in celebration of the book. Now that I have it in my hands, you could see me right now, imagine me holding it, like gripping it, like so excited. Now that I have it in my hands, I feel like a light shone on these important practices and I just want you to take them on and have them in your life. So, there you have it. I'll meet you back here next week and we will double down on the next piece. And the next piece is my absolute favorite topic, the favorite part of the chapter in the entire book. So I can't wait to share that with you. Okay? All right, team. Go and be kind. Check in, strengthen that voice inside you. And I will see you next week for another episode of Your Anxiety Toolkit. All my love. Don't forget. You know what I'm going to say? It's a beautiful day to do hard things. I don't ever want you to forget that. Have a wonderful day, everybody.

Sep 24, 2021

This is Your Anxiety Toolkit - Episode 203. Welcome back, everybody. Today's episode is all about why it is so important that we expose ourselves to our fears. It's one of the most common questions I get asked from my clients, right? Which is, why do I have to do this hard work? Why? Why of all the treatments is mine the one where I have to face my fears. Because my clients ask this all the time, I wondered whether you needed a quick pep talk just to get you back on track, to remind you why and to motivate you towards facing your fears, because it is probably the most valuable change of behavior that you will do. Welcome back. I am so happy to have you here with me today to talk about that specific topic. Before we get started, I would like to quickly dive in to really set the scene today. We're going to talk about the hard thing, the "I did a hard thing" segment. Today's hard thing is from anonymous, and they have submitted saying: "I haven't drank coffee for over two years since my OCD breakdown because I was too scared. But today, I went to Costa and I had a caramel latte. I got heart palpitations for a few hours, but I sat with it. This is exactly what I'm talking about. So, Anonymous, this is so good. I am so proud of you. This is the work that we do. And I'm going to use Anonymous' example here throughout the podcast to really tie this together. All right, one more thing before we get moving, I want to do a shoutout to the review of the week. This one is from Hahajack, and they said: "This is the best short therapy lesson. This podcast is amazing! I love that episodes are short and succinct. You can't say that you don't have time when episodes are as short as 10 to 30 minutes. If you are struggling with OCD or anxiety, this is a great podcast to listen to for extra therapeutic support in addition to therapy. I treat OCD and I learn so much every time I listen to Kimberley's podcast." Thank you Hahajack for that amazing review. We are still doing the drive for reviews. So if you can go over to Apple podcast, leave us a review or wherever you listen. Once we hit a thousand reviews, we're giving a free pair of Beats headphones. I cannot tell you how much I love, love, love, love your reviews. Thank you. It helps me help more people reach more people. And that's what I'm here to do. All right, so let's get to the meat of this episode, right? I, in the past – I think it's Episode 86 – did a whole episode called the Science of Exposure and Response Prevention. You can go back and listen to that episode once this is done. We talked about the science behind ERP, and I'm going to be using a lot of that reference to talk about why. Why do we stare fear in the face? Instinctually, when we have fear – I'm just going to give you a quick education here – when we experience fear and our brain sets the signal off to say, "There might be danger, there might be trouble, please be alarmed," – when the anxiety hits our body and our cognitions, our natural instinct is to remove ourselves from the perceived danger. And that has kept us alive. It is an important process that we humans have and other animals have. It's an important piece that keeps us alive, like I said. The problem is, that behavior, the removal of anxiety, the avoidance of the thing that created the anxiety is only effective if the danger is imminent, not just a thought about a possible danger, right? And so, if, like I said, there was a real thing that was happening in your life that is dangerous, yeah, you may want to remove yourself from it. But if you have a brain that's anxious like mine, where your brain sets off alarms quite often telling you, "Ring, ring, ring, something bad might happen. Ring, ring, ring, the future may have some problems. Ring, ring, ring, you're a bad person," and so forth – when we instinctually try to remove that, we actually reinforce the fear, the faulty fear. We reinforce the thought, right? And then what we are in a cycle of is thought, reinforcement of thought, thought, reinforcement of thought, thought, reinforcement of thought. The whole reason we choose to face our fear is to break that cycle, right? If you have a thought about imminent danger or threat, and you respond to it as if it's important, your brain will continue to perceive it as an important and an imminent threat. If you have a thought about something that is imminent and dangerous, and you don't respond to it as if it's imminent and dangerous, your brain starts to learn not to set that alarm every time you have that thought. Your brain learns not to ring the alarm bell and send out all those anxiety hormones throughout your body. Right? And that's how you break the cycle. And we do that by – if you just happen to have the thought, you could do that by being aware that you're having the thought, observing the thought, and then not engaging in the avoidant or reactive behavior, right? That's hard, right? It's doable, but it's hard, right? Because you have to be aware and you have to be very mindful and you have to have a lot of motivation in that moment. I still strongly encourage you to try that and practice it every single day. But what we can do to really help that process is, instead of waiting for the thought and then practicing not just engaging in that thought as if it's real and imminent, what you can do is purposely expose yourself and purposely bring on those thoughts by facing your fears. Right? Think of it like, you wouldn't just show up to a football game or a tennis game or a track and field event and just run and hope that your body will keep you going. No, we don't do that. When we know there's an event happening, we train for it. In a situation, we simulate the scenario, right? So we simulate the track and field event, or we simulate the soccer practice so that you can practice strengthening those muscles. This is why it's so important that we choose to expose ourselves to our fears on purpose. You're training your muscles to respond differently. When it does have a thought, your brain's going, "Oh, she actually purposely had that thought yesterday. So maybe I don't need to set off the alarm bells this time. Maybe it's not as imminent as I originally perceived it to be." That is why it is so important that you expose yourself to your fears. Now, like I said, there's lots of science behind that. You can go back and listen to the episode – it's number 86 – to get a little bit more, right? But the thing here to remember, and I always try to remind you, is it is hard. This isn't easy, right? So what you want to do is, as you go to face your fear and expose yourself to your fear on purpose, you want to keep in mind for yourself your own why. Why would I purposely do this hard thing? We could use the example here of the hard thing, right? They wanted to have a caramel latte. They don't want to feel uncomfortable, but they want the outcome. They want the delicious, warm caramel latte, right? For you, be really clear on what you want to get back by facing your fear. Sometimes it's more time with family, it's to be able to get to work and not have to manage mental compulsions with work. For some people, it's to be able to get through school without having to double-check your work. For some people, if you have an eating disorder, it might be so you can be with friends and have freedom around food. If it's panic disorder, it might be so that you can do the things you want to do without panic-making your choices, right? If it's hair pulling and skin picking, it might be so that you can do your normal grooming without engaging in these behaviors. Right? So there's so many reasons why we would practice facing your fear. And I want to give you this call to action, which is, get really clear on what you want, how you want your life to be. Identify what things you're going to need to face in order to get that life. And then go and face those fears. That's exposure and response prevention in a nutshell. In a nutshell, and it might feel really silly. You might be thinking, oh, I've got to do so many steps just to be able to get out the door or go to school, or to be able to have a dinner party or even get out of bed. Okay, that's all right. Break it down into small baby steps. For every time you face your fear, you're strengthening that muscle of being able to tolerate discomfort. It's so important. It's so empowering. It's why I always say, it's a beautiful day to do hard things, because it's a total flip flop on what your natural brain wants to do, your instinctual brain, which is, it's a beautiful day to run away from hard things. So really remember that. It is a beautiful day to do hard things. Really think about what you want to be able to do with your life. Write down what fears you'd need to face to do that, and then go and face those fears. That's what I'm going to encourage you to do. That being said, I, myself, am about to embark on a very, very hard thing, which is the exciting news. I'm almost done with this episode. I'm going to drop you my exciting news, which is the book, the Self-Compassion Workbook for OCD comes out literally next week. You can go to wherever you buy your books to get it. It's called the Self-Compassion Workbook for OCD . It is literally the example of facing your fears. I have quite a large degree of anxiety about this, but I am going to face it every step of the way. That being the case, because I am so insistent on facing my anxieties about it, sort of feels like I'm putting myself out there a lot – next week, I am going to announce an exciting, what would we say celebration of the book. It is going to be a month-long celebration. I hope you come along for the ride. In order to really benefit from this celebration, you will need to sign up for the newsletter because I will be sending tons of resources for you. I'm going to try and get you to engage in self-compassion like you have never done before. I want to use this as an opportunity to teach you and deep dive into the practice of self-compassion like you've never done before. You can go at your own pace. I strongly encourage you to sign up for the newsletter. You can go to cbtschool.com to sign up and it will give you tons of information. But next week's episode, I'm going to tell you all about it, and I am so excited. So, so, so excited. If you want a ton more information, you can go and follow me on Instagram. I'm going to be doing a ton of lives, talking about the book, reading through the book, showing you some of the exercises. I'm just so excited. I'm almost a little too excited. I'm probably going to burn out midway, but I'm going to do my best not to do that. But please do stick around. I cannot wait to share that with you. I will give you all the information next week. Yeah, so excited. And go ahead and get the book if that's something that would be beneficial for you. Well, that is all I have to say for today. That is the core of this podcast – facing your fears compassionately, willingly, in a joyful way. Even I encourage you to make it in any way possible, joyful. That is what I want you to do, and I'm really so excited to hear all of the hard things that you guys are doing because that's what we're here for. If that's the one big impact I can make in my career, I'm going to be a happy camper. All right. I am sending you so much love. I hope you are well. It is a beautiful day to do hard things. I love you so much. Take care of yourself and I will see you for a very exciting episode next week.The Self-Compassion Workbook for OCD is here! Check the link HERE for more information.

Sep 17, 2021

This week we interview Drew Linsalata, an amazing friend who has written an amazing book called, "Seven Percent Slower" Click the link below to hear more about his book! https://theanxioustruth.com/seven-percent-slower/ Kimberley: Welcome, everybody. This episode is for you, the listener, but it's actually for me, the podcaster, more than anything. Today, we have the amazing Drew Linsalata. I've talked about Drew before. We've done giveaways. We've done a bunch of stuff together on social media. I am a massive Drew fan. So, thank you, Drew, for being here today. Drew: Oh, you're so sweet. Thank you, Kim. It's my pleasure to be here. Kimberley: Okay. So, you, you are amazing, and I would love if you would share in a minute to people a little bit about your lived experience with anxiety. Drew is just the coolest human being on the planet. So, I'm so excited to share with everybody you, because I think everybody needs Drew in their life. Drew: Wow. Kimberley: But in addition to that, we are today going to talk about something. I'm actually going to try and drop down into my own vulnerability, and not just be the host, but also be the listener today because you are talking about one particular topic that I need to work on. So, first of all, tell me a little bit about your background, your story, and we'll go from there. Drew: Sure. So, unfortunately, I lived in experience with panic disorder, agoraphobia, and intrusive thoughts and things of that nature, clinical depression, on and off, from the time I was 19 years old – 1986 all the way to around 2008, in varying degrees. So, it was a very long time. I was in and out of those problems. They came, they went. I did all the wrong things for a lot of time, trying to fix those problems, even though I knew what the right things were, because I've always been a bit of a behaviorism and cognition geek. And it took me a long time to come around to actually solving those problems. I did the medication thing that didn't work out for me. And then I really just took the time to learn what I needed to do behaviorally, cognitively, using those evidence-based things that I know you talk about all the time. And I just used them on myself and I learned as much as I could from very smart people like you. And I went and did the work and managed to get myself through the recovery from panic disorder and agoraphobia and depression and all of those things. And along the way, the things that I learned, I just started sharing with other people, which is nothing that I invented. I never claimed that I invented any of this stuff. I just became a really good messenger, I guess, in terms of explaining. Well, I learned this and then I used it this way. And that led to just helping people online back in 2008, 2009 as I was going through it. And that led to continuing to do it. And that led to starting my own podcast back in 2014, like talking to nobody with a $4 app on my phone. But it just seemed like the right thing to do to try and pay the help forward, because I had a lot of supportive people who rallied around me. And that just one thing led to another. And here we are, and the podcast is just kept going and it has led to writing two books about this stuff. One is my story, and one is the recovery guide that I wrote. And here I am, still educating about this topic and advocating and supporting where I can and just trying to contribute to the community because I felt like the community, in its form that it was in 10, 15 years ago, was so helpful to me. And I just feel like I want to give as much of that back as I can. So, yeah. Kimberley: So you've written-- I'm giggling. So, for everyone listening, if you hear me giggling, it's not because it's particularly funny. It's just so ironic to me. You wrote a book called Seven Percent Slower. Drew: Yes. Kimberley: Now I probably tell my clients every single day they need to slow down. I have done a podcast on slowing down, but it is probably the safety behavior I fall into the most. And I don't do a ton of safety behaviors anymore that this one is just so ingrained in me. So, I read your book. Thank you so much. Not only is it an amazing read, but you're hilarious. I was texting Drew yesterday, just cracking out at some of the things that he says because it's my type of humor. I just love it. So, can you share with me why this one topic? Of all the things you could have written, why is this one topic? Why was it so important to you and why is it so important? Drew: It's a good question. Up until three, four months ago. I would have not thought that I would write this book. There was no plan to write a book about learning to slow down. But what I discovered was, Seven Percent Slower is the thing that I just came up with as a little silly mental device for me when I was struggling in a big way. I knew that part of what would happen when I would get really anxious and I would begin to panic, and I would just associate that with all those nasty things, I would start just really speed up. I would rush around like crazy. And I knew I was doing that, and I knew that wasn't helping me, but I was having a hard time catching it. And one of the things that my therapist at the time, she was like, "Really, you got to start to learn to slow down." So she gave me that good advice. Again, I didn't invent any of this. And I used to have to remind myself, I would literally walk around trying to remind myself like, "Slow down, moron. Slow down." I would be talking to myself. The no self-compassion there, like, "Slow down." And I was trying and trying and trying. And then for some reason, because I'm a fan of the absurd, the idea of trying to go 7% slower was born in like 2007 in my stupid brain. And it was just easy to remember, "Oh yeah, just go 7% slower. And it was just a little mental trick not to actually go 7% slower. Just remind me again to slow down. And it proved to be really helpful to me like that stuck in my head because it's silly. It's just a silly, arbitrary number. And I forgot all about it. I use it. I still use it to this day, but not really thinking of it consciously. And I have to tell so many people in the community surrounding my podcasts and my books that slow down. One of the things to do slow down – I started telling people, "Well, just try going 7% slower." It came back to the surface again. And the response that I got from it was astounding, like, "Oh, that's so great. Yes, I'm using it. I'm doing the 7% slower thing and it's really helping me." And I'm like, "Oh, there's a book. I need to write this." And that's how I dragged it back up from 10, 15 years ago. And I said, "I should probably write about this and tell people what it is." Kimberley: So, tell me how you implemented it in-- you've talked and I've heard you talk about exposures and some of the experiences you did. Can you just give me upfront for people who, first of all, want to hear about your story, what were some of the exposures you engaged in and how did slowing down impact it, both for how did it make it easier and how did it also make it more difficult? What was your experience? Drew: So I'll give you a typical morning for me. My biggest issue was-- again, my official diagnosis would have been panic disorder with agoraphobia, right? So I had a real problem leaving the house or being alone by myself or going any appreciable distance from the house. And so, a typical exposure for me, a typical morning for me when I decided I really have to fix this as I would get up, the minute I open my eyes, I put my feet on the floor, I would already be in a state of very heightened state of arousal and anxiety at that point because I knew it was coming. I was going to get dressed. I was going to get ready. I was going to hurl my butt out the door and start driving, which is the thing I was terrified to do. So, I did that every day, every single day. And right away, I learned within the first week or so like, okay, I get the principle of this, but I'm walking out the door in a blind panic. So I need to dial it back and start to work on just preparing to walk out the door first. So, I need to really acclimate to this first. And that's when I really started using the "Slow down, slow down, slow down." So, I would get up and I would be trying to get ready and rush around and drink water and do everything I had to do to get out the door like I was on fire and it was crazy. And I started to slow down that way. And it really was a huge help, but you're right, it also made it worse because-- and this is so funny because it came up in a live I did the other day on Instagram with Jen Wolkin. She talks about mindful toothbrushing. And that is really-- the act of brushing my teeth in the morning is where Seven Percent Slower really began to shine. I wrote about it in my first book. The first thing I did before I learned to drive again was to learn to brush my teeth slowly and mindfully while I was in a complete state of panic. Yes. And just the act of slowing everything down, all I have to do is take the cap off the toothpaste. All I have to do is put the paste on the brush. All I have to do is put the cap back on. All I have to do is pick up the toothbrush. I literally would have to break down my getting-ready routine into the tiniest, little tasks and just focus on each one of those and literally act as if I was in slow motion. So, I wrote in Seven Percent Slower that one of the ways I learned to actually do that was to exaggerate it in a huge way. To me, it felt like it was brushing my teeth in slow motion. I probably was, but it really helped because it was the opposite action. So, my amygdala is screaming, "Go fast, go fast, go fast." And I'm like, "No, no, no, I'm going to go slower and slower and slower." And it did change my state over time. And I was able to go out and start my drive and my exposure and panic all over again. But at least I was leaving the house at a level 5 instead of a level 8. But it did make it harder because when I slowed down, I would just feel all of the things. I just have to let them come and let them come. You know the deal, and your listeners, I'm sure, know the deal. So, it was tough, but it was also tremendously helpful to me. Slowing down was one of the biggest things that changed my situation, for sure. Kimberley: Yeah. And the reason I think this is so important, this one thing and I love that you're just looking at this one thing, is I think in that moment, for the listeners, we're constantly talking about how to reduce mental compulsion. And I think the slowing down helps with that too, right? I think about there's exposure, but there's also the time before the exposure and after the exposure where you have to practice not doing the compulsion. And if you're rushing, your brain's rushing and everything. And so, I love that you're even talking about before doing the exposure, you had to slow down. Drew: Yeah. I mean really, before the exposure was exposure itself, there's no doubt about that. And I had to come to the realization that like, well, the exposure right now isn't the driving. The exposure is literally putting my shoes on right now while I panic, putting on my coat while I panic, brushing my teeth while I panic. And in Seven Percent Slower, I wrote about accidental emergency multitasking, which that's the thing that I forgot. We were talking before we went in there. I forgot I wrote that. And I'm going through my editor's notes, and I'm like, "I wrote that, how about that?" But that's true because when you-- Kimberley: Good for me. Drew: Yeah, right. Good for me. go through. So, I remember really thinking that, like when you're in that crazy terrified state, I was trying to solve every problem at once. So, there was a lot of mental compulsion in there. I was trying to go through the drive in my head. I was trying to anticipate each turn. I was trying to beat back the panic before it even happened in my head. I was thinking about yesterday's drive and how difficult that was. And slowing down, meaning it put things-- it made me focus on what was going on right now. So, it was also accidental or backdoor water down sort of ghetto mindfulness practice. I'll take it though because it worked. It put me in the present moment and it took me out of emergency accidental multitasking mentally and physically. Kimberley: I think it's pure mindfulness, right? Drew: Oh, it definitely was. And there was no-- I mean, I wrote about this in the book too. I'm not trying to read the whole book to you guys, but yes, it is part of it. There's a whole chapter called Is This Mindfulness: Do I Need to Meditate to Slow Down. It's literally one of the chapters. And well, it kind of is. If you start to learn to go slower, you will accidentally become more mindful without having to go through all the overwhelming things that sometimes people feel mindfulness is. "I have to become grateful and of the present moment, and I have to learn to appreciate the now." No, you just have to slow down, and you'll automatically mechanically become more mindful. The rest of the stuff is window dressing. It doesn't matter. I wasn't grateful for brushing my teeth at all, but I was mindful of it, and it got me out of those compulsions in that crazy, anticipatory anxiety cycle. Let me do the exposures more effectively. Kimberley: Yeah. So, one of the things I love that you did-- and I actually did the homework. You'll be so proud of me. Drew: You did the homework. Did you use index cards? Kimberley: Huh? Drew: Did you actually use index cards, like I wrote about? I'm so old. Kimberley: I did. Usually, when I read a book, I do not follow their instructions because I don't like to follow instructions. It's not my style. Drew: I feel you. Kimberley: My husband always cringes when I go to make an IKEA piece of furniture because I am bringing out those instructions. Drew: It's going to be an extra draw leftover. We just know it. Kimberley: Oh, I could show you some photos. You would love, I tell you. But I did your homework. And this is what I thought was really interesting. So, I want to walk through. I'm going to try to be vulnerable here. I have noticed in the last week, since returning back from vacation, that my hyper-vigilance is going up a lot. I was noticing my anxiety wasn't so high, but I was engaging in a hyper-vigilant behavior. I think mostly because I'm now thinking about COVID, how to protect my children, and all the things. When we were away, we were far, far away from anybody. We didn't see anybody. So, I sat down, and I wrote the things that I do that I need to slow down at, right? And I'm just sharing it because I do the homework. I'm so proud of myself. Drew: I'm proud of you too. Kimberley: So number one is in the morning, I wake up and I sit up and I just go. I don't ease into the day. And then you talk in the book about how speed is like an escape response, right? You don't want to be in your discomfort. So, I thought that was interesting. These are ways that I've caught myself, right? So I jumped out fast. Like how can I not feel my discomfort about the day? Another one is I rushed during emails. And the big one, which I'm not happy about, is I multitask. Now I want to get your opinion on this as my dear friend, excuse me. Most people are probably multitasking, but why would multitasking be bad for anxiety? Drew: Okay. So, I will preface this by saying, I used to think that my ability-- and I will multitask like a mofo. I'm good at it. I know that cognitive scientists will tell me that I'm not because there's no such thing. We're literally tearing down our cognitive models and building new ones every time we switch from test to test. I understand all of that. But I will tell you that I'm good at it anyway. I'm going to stick with my guns, right? So, I wore it like a badge of honor. And when I have to, I can still do it. However, it absolutely fueled my anxiety state. There's no doubt about that because there's a sense of urgency that comes with multitasking. There really is. You are not present in anything when you're trying to do everything. So, that really in the end is that. And multitasking is not just physical. It's also mental. So, I'm answering an email while I'm thinking about the next email. I see your face. You know what I'm talking about. You've been there, right? You were probably there today. Kimberley: Like I said to you, I'm so grateful that you wrote this because it's so important. It's so important for the quality of our life. Last week I was exhausted at the end of the week and it's because I was rushing. I just know that's why. That's why I'm such a huge fan of what you're writing. Drew: As I was writing, things came out because I'll be honest with you, when I thought of this as my own little mental device many, many years ago, I didn't flesh it out. I just did it. You know how it goes. I didn't invent a thing. But as I was writing about it, I had to think. And this speed to me looks like both an escape-- it's both a fear response, sort of involuntary, and a safety behavior at the same time, like it keeps us from feeling the feels, right? So, yes. And I think the other thing that multitasking does is it makes us sort of-- we can put our attention to the places that we want it to be at because they're the easier things, even practically, like, I don't really want to answer this email because this is a hard email. So, I'll skip that one, mark it unread, and then go back to this one and I'll just keep marking that. You know what I mean? So, it keeps-- Kimberley: You just described my whole week last week. Drew: I hear you. The day I got to inbox 0, which was years ago – by the way, I'm not there anymore. Not even close – I was on top of the world. I was convinced like I'm now qualified to basically run the UN if I need to, because I'm at inbox 0. But I'm very guilty of that stuff where I was for a long time. I still fall into the habit. There's no doubt about that. But yes, when I find my-- sometimes I do it intentionally because I need to, and there's a time and a place for it. But when I find that I'm feeling extra stress, because one thing that I noticed about this book is that it doesn't just apply to anxiety and anxiety disorders, but it applies to stress management in general, because I still use seven percent slower, I just didn't remember that I was. And when I find that I'm feeling the effects of the stress, much of which I create myself by taking on so much, slowing down and stopping the multitasking, like close all the apps, run one app at a time, do one thing at a time, it really brings that down. It doesn't solve all my problems, but it keeps me from being overwhelmed by the physical responses that come with stress. Why am I holding my breath? Why does my neck hurt? Well, I know why. Because I'm stressed, and I got to back off. It helps. It really does help to slow down. Kimberley: It does. The final one that I listed, and I really want you to talk more on, is just a general sense of worrying, right? I mean, I think you can actually give me your opinion on this, but sometimes we do have to solve problems, right? We have to make decisions. This was a big one for us last week, is deciding whether we wanted to put our kids back in school or homeschool them, back and forth. Sometimes you do have to make those decisions, but there is a degree of just general worrying that happens. And then you can start to worry on speed at the highest speed ever. So, did you have to apply this to the speed in which you worried or try to solve problems? You're talking about physically slowing down, but did you also apply it to mentally slowing down, or they go hand in hand? Drew: That's a really good question actually. And if I think about it, the way it worked for me personally, my personal experience with this particular method or whatever you want to call it, is that it was first the physical slowing down. But then I discovered that that started to spill over. So, when I was physically going slower and being more mindful and deliberate in my behavior, it became a little easier for me to recognize that I am literally thinking about 17 problems at one time right now. I can't solve them all at one time. Some of them I can't solve at all. Kimberley: We could probably resolve or solve them already. Drew: Exactly. And it really helped me clarify that habit that I have. I'm just going to think, think, think, think, think. I'm thinking all the time. I think anyway, but I was thinking very maladaptively in those days in a big way. I was a prisoner to my thoughts and the thinking process. And it really helped me break that cycle. It's always important to me to say, slowing down and going 7% slower is not a cure for all of this or anything like that. It's not magic. It was just one part of the puzzle. It turned out to be a big part of the puzzle for me because it unlocked a lot of things, but yeah, it did slow down my mental behavior too, my ruminating, my worry, my thinking. Kimberley: Right. Yeah. I keep saying, I'm such a fan of these. And I think for me, I mean, you guys know I'm very well recovered, right? I'm mostly very healthy, mentally healthy. You might question me now that I've totally got that upside down. But I consider myself to be pretty level. What was interesting for me is, that for me is usually the first sign that you're starting to go into relapse, right? When you start to speed up. So, that's why I thought last week, I was like, the gods have all the stars aligned because I've come out of this very beautiful, long vacation where I'm managing my stress and everything. And the first thing my brain did when it got home was speed up. And if I hadn't caught it being hypervigilant, I think I would have gotten snowballed, right? And I think it's a great way, a tool to keep an eye out for your relapse as well. Drew: Yeah. I mean, actually, these are hard things to catch, don't get me wrong, because so much of it is automatic or it's a little bit beyond. The initial speeding up is beyond our control. My assertion in the book is initially, you will probably automatically speed up, but you can catch that and then change it. It takes work. And I really talked about like-- in fact, today's Instagram post is all about that really. Not that anybody has seen it because it's a podcast for the future, but it was about that. Like, "Hey, look at these. Here's 10 signs." I did a 10 things posts. Now I'm disgusted with myself now that I think about it, but I have a list with 10 things like here is-- I think there's actually 11, to be honest with you. But here's a thing, if you find yourself doing this, if you're stumbling over your words, if you're shaking, if you're dropping things, when you're walking, if your stride length has shortened, because that's what I would do. I have reasonably long legs, but I'd be taking these little tiny penguin steps because I was rushing like crazy, like running. So, there's a bunch of practical things that you can really look at. This is what my rushing habit looks like. So I can be aware of those things and catch them and then start to slow down. Kimberley: Right. And that was what you said in the book. Write them down, identify the behaviors in which you're doing, which I thought was brilliant. Drew: Thank you. Kimberley: Yeah. Okay. I wanted to touch on, because I loved how you really talked about that, the side effect of slowing down is that you have to feel uncomfortable. Bummer, you totally ruined it. Drew: I did. What a buzzkill. Kimberley: We're going so good. Drew: Yeah. It's true. I think that was one of the chapters. I specifically wrote an entire chapter about why you probably don't want to slow down, right? Kimberley: Exactly. Drew: One of the reasons is that we view rushing around as some sort of badge of honor and achievement. If you run around like a speed demon, it must mean that you're busy and achieving things, which is not true. But also, if you slow down, you feel all the feels, and we hate that. And I'll use the word "we." Humans are not really-- we're designed to be creatures of comfort. We don't want to feel crappy stuff. But you know that. I'm not telling anybody anything they already know. If they're listening to Your Anxiety Toolkit, you already know this, but you have to move through the crappy stuff to get past the crappy stuff. And slowing down is a good way to allow yourself to do that. Kimberley: Yeah, I agree. Drew: Yeah. Accidental happy side effect. Kimberley: I love that you brought this up. So, let's go through like, okay, slowing down. You can even maybe share your own experience. Slowing down, for me, I think it's not that I have to feel physically uncomfortable as much as I have to have a lot of uncertainty, right? I have to be uncertain, which is typically, at the end of the day, still just sensation and experience. For you in that, when you were practicing this during your exposures, what did you have to feel when you slowed down? Drew: So for me, when I would slow down, I would feel the physical sensations of panic. The one sensation that never leaves me – it's the memory of a sensation. It's not that I feel it. I rarely feel it anymore – was the feeling of my heart thudding in my back. You feel like all my chest was pounding, but it would feel like it was beating so heavily when I was in a panic that I could feel it almost beating along my spine. It was a really uncomfortable sensation. And traditionally, when I would feel that, I would do everything I could to try to not feel that – wiggle around, change position, lay down, stand up – try anything that I could to not feel that. One of the key things-- and I felt all the physical sensations, but that one sticks in my memory was when I started to slow down, I had no choice but to let my heart pound lead against my spine, and it was so uncomfortable. And I remember really just having to reason with myself as best I could like, "Just get through it for another 10 seconds. Just give it another 10 seconds. Just give it another 30 seconds." And then it was just, "Just give it another minute." And then it was like, "Oh, this isn't so bad." So, it was a gradual habituation to that where I stopped being afraid of it. And slowing down meant I had to feel that. There was no more shield against feeling it. If I'm going to stand in the bathroom and slowly brush my teeth, I'm going to feel that. But I also heard the thoughts very loudly when I slowed down. And the thoughts would be panic-type thoughts, like, oh my God, what if it's not anxiety this time? What if I'm having a heart attack? What if this is a stroke? It does happen to people. Even though I'm only 30 years old or whatever it was at the time, this can happen. What if, what if, what if? Those thoughts were already loud. And when I slowed down, I essentially turned down all the other sounds. So those thoughts were really, really, really loud. And I would literally have to practice. It forced me to practice like that could be, but it's not likely. I would have to say that all the time. "That could be, but it's not likely. It could be, but it's not likely." Yeah. And it just forced me to practice. So, I would feel the physical sensations and hear my thoughts so much louder. Hated it. Kimberley: Right. Yeah. I'm so glad that you mentioned that. I mean, I can only imagine too. When we have those symptoms that aren't textbook, like you feel your heart in your back, it's hard to just let that be there, right? You and I have joked a lot, the old Instagram posts about like, these are the 12 ways to feel a panic attack. But when you don't have something on that list and when you have something additional, that's scary, right? "Oh, crap. I've got six things that aren't even on that list. What does that mean?" Drew: Here's an interesting thing that you just made me think of now. The other thing that slowing down accomplished, and this was a happy accident also, is I like to look at it as imagine anxiety as a room. So, when your lizard brain, when your amygdala is in charge, it fills the entire room, so prefrontal cortex stuff has no room. It's pressed against the walls. It's being pushed out the door. There's no reasoning at all. When I slowed down, I actually made a little bit of room for prefrontal cortex to chime in. Winston and Seif, they will talk about wise mind in their writing. Wise mind had a chance to chime in where I was able to say, "Okay, Drew, yes, this isn't on the list of the usual stuff, but you have felt things like this 10,000 times. And all indicators are: you're healthy as a horse, you're in great shape. It's okay." And it allowed me to tolerate that uncertainty a lot more because I was able to reason a little bit more. I was unable to talk myself off the ledge, but I was able to insert just enough reasoning because it gave me a little bit of room to work in. That helped also. I was able to actually do that, whereas before I was just frantic. That was like, "You're okay. You're okay. It's okay. It's nothing, it's nothing." But your amygdala doesn't care. It doesn't believe you. But in that case, I was able to actually say, "Okay, hang on. I felt this zillion times before. This is likely nothing. Okay, I can go with that. I'm going to roll the dice on that. I'm good with it." Kimberley: Right. You can see the trends that have been playing instead of thinking like it's the first time it's ever happened, even though it's happened a million times. Drew: Yeah. So, practicing slowing down gave me a little bit of space for that stuff to get a little foothold, a little handhold, and then it grew. Kimberley: Yeah. So it's interesting because I'll share with you, a big part of my recovery has been considered what I have been calling a walking meditation. So, I did a lot of meditation training in the latter stage of my recovery. And I don't love to sit and meditate because it's uncomfortable, right? But what I love to do is this end practice of walking meditation. And so, I've often called friends and said to them, this is an accountability call. I have to do a walking meditation all day. And then when you're writing this, I'm like, "That's what I was doing. I was slowing down." And I've been just calling it something different. So, I thought that that was really fascinating because in the Zen practice, you do a lot of walking meditation, right? Being aware slowly as you engage in the day. Drew: Which is something that I think a lot of people have a hard time putting their brain around. In the beginning, I think it's hard to do that – being mindful in motion. So, to me, meditation, I always say mindfulness to me is like meditation in motion. I don't know if that makes any sense, but that's-- Kimberley: It is what it is. Drew: Okay. So, that's the way I've always thought of it for myself. Well, firstly, I learned to meditate and then I put it in motion so that I can be meditative even in a meeting or on a phone call or driving my car. That's possible, but that's the thing you have to learn. But that's part of slowing down also. When you do your walking meditation, you're intentionally slowing down. Kimberley: Yeah. I would even invite the listeners to think about when are you the most calm or coping the best is when you're actually slowed down. For me, it's when I'm with a client. When I'm with a client, I can't multitask. I am so with them, and it's their pace, which is not my pace. I can't speak at a rapid, two times speed formula in session. And that's where I feel the most connected. And that's where I feel just wonderful. And there it is right there. It's forcing me to slow down. So, I think it's helpful also to look at where are you actually being slipped, where are you forced to slow down, and how are you coping in those situations. Drew: Yeah. When you have no choice, you can actually try and remember, well, what does it look like for you? It'd be like, what does it look like when I'm in session? I just have to do that. When you're not sure, well, let me just go to what that feeling is. And those things to me also-- the last chapter of the book is called Beyond Seven Percent Slower because to me, that skill that I developed accidentally years ago serves me well now. So, one of the things in business that I get told all the time and people always say, the building could be on fire, and you're just-- I mean, I was a dude that couldn't leave his bathroom. I was so panicked and so agoraphobic, and they're like, "No problem. You do this, you get a bucket, we'll put it out. Everything's going to be cool." That's the slowing down. And when you learn to do that, and you cultivate that skill, not only can it help you in your recovery journey, but it stays with you for a long time and it brings out the superpowers. We sometimes think that rushing and multitasking is the superpower – not really. Slowing down and letting each of your individual strengths and skills shine through because they can because you've given them space, that's where your real superpowers come out. That's probably where you are the most effective as a clinician is when you slow down and you're in that session. Kimberley: Or as a parent or as a wife or as a human, everything, right? Drew: Yeah. So, not to get all preachy about it, but I think it goes well beyond just the anxiety and stress thing. It's a good life skill in general. Kimberley: 100%. Okay. I have one more question. Drew: Sure. Kimberley: I've purposely not tried to go down the tips and tools because I just want people to actually buy the book and just go through it, like I did writing it down and really addressing it. But you talk about one thing that I wanted to talk about, which is the 92-second timer. Drew: Okay. I have to search through my Ulysses app, where did I write about 90 seconds. Kimberley: See, we just did this today. Let me tell you what I found was so helpful, is you said you set a reminder every 90 seconds to slow down. Drew: Yes. Kimberley: So, tell me, how important is that? Does it have to be 90 seconds? Was that a big piece of you retraining your brain? What did that look like? Drew: Again, that was my own-- yeah, that's right. I did do that, and I did write about it. So, I know we talked about it a little bit. That's fine. What I did was, I had an original iPhone, like OG iPhone, and I had this stupid timer. And I had this timer in there for 90 seconds. I use 90 seconds. I don't care what you use. I don't think the number is magical in any way. But when I was getting into that panic state and when I started doing my morning routine to prepare to do my driving exposures, I would just set the timer and it would repeat every 90 seconds. And that silly little timer would bring me back to slow down, slow down, slow down. It was just a cue. That's all. It was a silly little mental thing. Do I think it's critical for people? Some people might not need it. But if you do need it, I don't see that there's any crime in using it. And you could do it every 30 seconds, 60 seconds, every two minutes. It doesn't matter. It was nothing more than an auditory cue to remind me to slow down, slow down, slow down, slow down. Kimberley: The reason I bring it up is that has been crucial for me in all of my recovery, no matter what it is, is reminders. I think that it's easy to go on into autopilot. And I love that you mentioned that because I am a sticky note fan. I talk about it in my book. I love reminders. That's a crucial part of my existence. So, I just love that you brought that up because I think that we always have sticky notes like don't forget to get eggs and you've got to make a phone call. And this is the opposite of that, which is like, "Slowing down, hun. Bring it down a notch." Drew: Kind of, because our reminders are usually to remind us to do things faster, now, don't forget them, get them done. Whereas-- Kimberley: Urgent, urgent. Drew: Yes, urgent, urgent. One of the funny things about this, the thing was, I don't have my phone with me here, but the sound was that stupid submarine alarm, like errr, errr, errr, which you would think I would have made a silly little, I don't know, like chimey, gentle thing. But I intentionally did the errr, errr because it was jarring. I needed it to jar me. And so, yeah, it was weird. I did not have to use the 90-second timer for months and months on end. It was in the beginning. It became very helpful to me. And then I spread the timer out to two minutes and then five minutes, and then we just didn't have to use the timer anymore. So, it was adaptive. I don't want anybody to think like I live my life based on this silly timer going off all the time. That's not the way it works. Kimberley: And I get that. I think that that's the cool piece here to the story you're sharing. And I would make this a big piece of what I want everyone to take away, which is, like anything, this sucks to start. It sounds like for you and it has been for me, although, like I'm saying, I'm owning up to falling off the wagon here a little, which I'm fine with. It can be a 90-second timer to start. But then that's where that muscle gets strong. It sounds like that for you, it's pretty strong now. Drew: Oh, it's really strong. It's automatic now. Yeah. It's almost automatic, but again, that's a lot of practice and repetition and really taking this to heart. It's not an overnight thing. And I still make mistakes. I just catch them faster now. Now, there's zillion things to do to get ready to launch this book. Yesterday, I fell absolutely into the trap. Totally did. Around three o'clock yesterday, I felt terrible. I was just agitated and all the stress stuff and anxiety stuff was like, oh, wait a minute here. So, I can see at least that that's the benefit of it. It's taught me to see what I'm doing and then correct it when I need to. Kimberley: Yeah. And it's great to have that. You're modeling that beautifully, right? That it's not going to always be the hardest thing. It's like something that you can learn to strengthen, which I really appreciate. Okay, tell us about where we can get this amazing book. Drew: Well, I think I made it pretty easy being a techie guy that I am. You could just go to sevenpercentslower.com, which you can either spell it seven or use the number 7, sevenpercentslower.com. We'll get you right to the page on my website that tells you about the book, which should come out plus or minus September 15th. So, I don't know when this podcast is going to air, but it's either out or not. If it's not, just get on my mailing list and I'll tell you when it is out. And yeah, that's how you got it. It's nice, friendly, short. You read it pretty quickly, I'm sure. It's not a giant 400-page monster like The Anxious Truth. It's friendly, easy, I like to think funny, easy to remember. Kimberley: It's so great. I'm actually so in love since the summer. I read all these amazing, just like short, really goes straight to the point. I cannot stand books that tell you something they could have told you in 100 pages. So I love that. I think it was exactly what I needed to hear. So I'm so grateful. Drew: Oh, I'm glad that you find it helpful, and thank you so much for giving me this little spotlight to talk about it and appreciate you. Kimberley: Of course. I probably a hundred episodes got on and went on a big lecture about how everyone has to slow down. And this is perfect timing. I think we all need it right now. Drew: Very good. Well, go get it. Sevenpercentslower.com. Hope it's helpful for everybody. Kimberley: Thank you, Drew. Drew: Thanks, Kim. Anytime. https://www.amazon.com/dp/B09G227B1Z/ref=sr_1_9?dchild=1&keywords=coping+skills+for+anxiety&qid=1631488551&s=digital-text&sr=1-9

Sep 10, 2021

In this week's podcast, we talk with Allyson Ford about her journey with OCD and an Eating Disorder. Allyson shares how her journey with OCD began when she watched ERP SCHOOL , our online course for people with OCD. Allyson quickly realized that she had not only been working through an Eating Disorder but had also struggled with OCD. Allyson Ford shares these 3 main points on OCD Recovery: In recovery, don't wait for the fear to be gone. You must take the action while scared/anxious for real growth to happen. It will feel counterintuitive but that doesn't mean you are doing it wrong. ERP is terrifying and it's worth it in the end. It's so empowering to realize you can have anxiety and do the things you love anyways. Because it is so scary, you need a therapist that you can really trust- who is both skilled in ERP and compassionate/warm. Shame and myths about OCD keep us suffering for much longer than we need to. Two major turning points for me were learning about what real OCD is- I quickly identified signs and symptoms within myself since 8 years old. The next game-changer was finding a community of other therapists who live with OCD. I felt so embarrassed to be a therapist struggling with these issues- I felt broken and ashamed. It made work really anxiety-provoking. I attended Pure O Chrissie's Gamechangers retreat and that changed everything for me. I suddenly felt empowered and hopeful; this propelled my ERP treatment forward. Learning and applying skills for intrusive thoughts was also a game-changer. Learning that everyone gets intrusive thoughts and that they don't mean anything, learning mindfulness skills (bookshelf metaphor) for rumination and one-upping my thoughts/power stance were the most helpful. Knowing that the theme of my thoughts only points to what I value most was also helpful- it always boils back down to my work. I care so deeply about making a meaningful impact on my clients, and that seems to be what my OCD attacks the most! Allyson Ford, MA, LPCC is an Eating Disorder, OCD, and anxiety therapist with lived experience. Allyson graduated with her Master's degree from New Mexico State University and has since worked in a variety of settings including hospitals, schools, residential programs, and now private practice. Allyson provides virtual services throughout California and also does part-time work at The Eating Disorder Center with Jennifer Rollin. Allyson has a passion for integrating social justice throughout her practice and has a podcast available on Apple and Spotify called Body Justice. Allyson utilizes ERP, DBT, CBT, ACT, and IFS in her practice. You can find her on Instagram at @bodyjustice.therapist and her website: www.allysonfordcounselingservices.com This is Your Anxiety Toolkit - Episode 201. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, friends. I am so happy to have this special time with you. Thank you so much for giving me your very valuable time. How are you all doing? Just checking in. I know it's been a really hard year. I know we talked a lot last week about suffering and how to manage that. If you didn't hear that episode and you're struggling, please go back and listen. Hopefully, it will connect with you and land up with you in a way that is validating and kind and builds some space for you and some safety for you. This is going to be a wonderful episode. It's actually an interview I have done with somebody who I met through ERP School, interestingly enough. I am so honored to have this week Allyson Ford. Now Allyson is an LPCC. She is an eating disorder specialist and OCD specialist and anxiety specialist. She has lived experience, which she shared, in those areas, and she shares her experience of finding out that she has OCD, talking about her eating disorder recovery. And the cool thing is, like I said, she will reflect a lot on how ERP School, one of our online courses that teaches you how to practice ERP all on your own and learn about ERP – she shares how that was a big game-changer for her. So I'm so excited to share with you this amazing interview. We talk a lot about the overlap between eating disorders and OCD. Even if you don't have one or both of the disorders, I encourage you to listen because I think that there is some amazing story and I think it's really cool to see stories of clinicians who have actually walked the walk. They don't just talk the talk. So I'm so, so excited to share that interview with you. Before we do that, let's go ahead and do the review of the week, this week's review. If you want to ever leave a review for your anxiety, you can. I would love to see it. We feature one review a week. This one is from StrongMom and she said: "A big virtual hug. I don't know how I found this podcast, but I'm so glad I did. Kimberley's compassionate and honest conversations about anxiety and OCD provide tools and strategies for facing fears, anxiety, and BFRBs. Her friendly, nonjudgmental tone about the challenges are so helpful to me." Thank you so much, StrongMom. I love hearing that the podcast is helpful. Before we get over to the main part of the show, we'd like to do the "I did the hard thing" segment. This is actually from someone you guys have had on the show before. This is from Alegra and she says this: "I let go of someone who I really cared about because it was the best thing for me, even though it deeply hurt." I think that that is such an important "I did a hard thing" because sometimes we talk about it as just doing exposures, right? Facing our fear. But sometimes the hard thing is letting go of something. Sometimes the hard thing is setting a boundary with somebody. Sometimes the hard thing is listening to our own needs and following through with our needs. So I loved this submission for "I did a hard thing." Okay. That being said, thank you to you all for being here again. I am so grateful. I know I say it and I want to keep saying it. Thank you. Thank you for spending your time with me. I'll head over to the show. ----- Kimberley: Welcome, everybody. I am so excited for this episode. We have with us Allyson Ford. Thank you for being here. Allyson: Of course. I'm so excited. Kimberley: Yeah. Okay. So, let's tell this story, and this is where I get so geeked out, is when I hear of people who've taken ERP School or taken one of my courses, and they'll either post it on social media or something to say, "Oh, this was really helpful." And then literally my life is like done. I feel so good. I'm so happy. And that's how I met you, Allyson. So, I'm so grateful to have you here. Would you tell us a little bit about you and anything you want to share about your own recovery? I'll ask questions as we go. Allyson: Yes, absolutely. So, my name is Allyson. Like Kimberley said, I am a licensed therapist in California. I work primarily with eating disorders and anxiety, and I have my own recovery journey with an eating disorder. I just recovered from anorexia years ago, and it wasn't until this year that I realized I also have OCD. For anyone that's listening, it's common to have both symptoms, symptoms of both. They really overlap. And so, I see it a lot in the clients I work with, and that's what prompted me to take ERP School. I was looking for resources to become more trained to work with clients with OCD. And then through taking the course, I was like, "Oh my gosh, I have a lot of this." And then I sought out an ERP therapist to work on things that were coming up for me, and it's been really rewarding. And so, now I really enjoy working with OCD as well. Kimberley: Wow. I have such big goosebumps on that. That's so fascinating to me that you would be doing continuing education units for yourself and helping your patients, and then realizing you had symptoms yourself. When you took the course or when you considered this learning, what did you think OCD is compared to now what you know about OCD? Allyson: Yeah. That's a great question. Because I went to graduate school, I knew that OCD was obsessions and compulsions, and I knew that the compulsions had to take up a certain amount of time of your day. But what was unclear is, what is an obsession and what is a compulsion? So, I still had this stereotypical image of OCD being like hand washing and checking the stove. And yes, those can be symptoms, right? But I was thinking about this the other day and I wish they would change the name of OCD in the DSM. I wish it was like Intrusive Thought Disorder because obsession, to me, sounds like, you think of it as something you like. Like, "Oh, I'm obsessed with this." We don't think of it as something negative. Like, an intrusive thought is scary. It's frightening. It's so unsettling. I wish I would've known that it meant something totally different than just not just hand washing and cleaning. Kimberley: Right. Exactly. Yeah. Like I said to you, that made my day to hear that because a big part of our mission is to help educate people who do think it's like organizing your cupboards nicely and hand washing and lining things up evenly and so forth. So, was that a great realization for you? Or was that a sad realization for you to be like, "Oh, there's more to it than this and maybe this includes me"? Allyson: Oh my gosh, it was terrifying at first. Actually, when I was taking ERP School the first time, I was like, I knew this wise part of me was like, oh my gosh, yeah, these are some things you're struggling with. But then there was a lot of not wanting to face that. So I think between the time I took ERP School till I actually got help was still like six months, and there was a lot of like reaching out to ERP therapists and then backing out. I was so scared because I knew through taking your course that I was going to have to face my fear. When you go through one major mental health disorder in your life – going through anorexia, I was so terrified to go through something like that again. I'm so scared to have another label. Especially being a therapist, there's like this extra stigma that we shouldn't suffer. And so, that was a huge part of it. Just the stigma of having a mental health diagnosis again. But yeah, it was completely and totally scary. Kimberley: Yeah. Isn't that sad though? And I agree with you. I resonate so much with what you're saying. Isn't it sad that as therapists, we're made to believe, or we take on the belief that we aren't supposed to be human? For me, everyone on my account and my listeners know I had anorexia as well, but I did a tremendous degree of compulsive exercise, and it always felt OCD-like. As soon as I learned about OCD, I had a similar feeling of like, this is exactly what I used to do. I had a fear, and to remove this fear, I would do this one specific calculated move. And so, I get what you're saying. You had already gone through treatment. Now that you know about ERP, did your treatment now look a little bit like ERP? Because for me, my anorexia treatment felt like ERP at the time. Allyson: Yes. I would say it was a blend. It was a lot of facing the fears, reducing the compulsive behaviors, but then there was a huge relational component too. And that's something I've been reflecting on with ERP, that sometimes I feel it's missing in terms of ERP training. It's like, we forget the fact that the relationship is the most important thing. Going through my own ERP, it being so terrifying, I needed to have a therapist that I really trusted that like, this is actually going to help me. So, yes, it was, I would say, a mixture of behavioral, but also just relational. Kimberley: Yeah. So, true. So, if you're comfortable sharing, would you share a little about the area of OCD that you have experienced? Allyson: Yes. So, I've pretty much experienced all of them minus symmetry and contamination. But other than that, I've had pretty much all the themes. The ones that have been the stickiest in terms of the most impactful on my daily functioning have been real event OCD, which is – and you can correct me – but when something has actually happened and then you fear it like happening again, right? Kimberley: Yup. Allyson: That one was the one that actually propelled me to take ERP School. And then I've had harm obsessions, like fearing that I was going to hurt someone, fearing I would blurt something out really mean. That's been a really big one for me. And then in the past, now that I know what OCD is, I can see that growing up I had fear or harm obsessions. Those were the main ones, but I've had all the intrusive thoughts. Kimberley: Yeah. And that's why I think it's true. I agree with you, in terms of the word, obsession is very misunderstood. Isn't it? It's very much related to this unwanted experience. And I think that was a really different-- maybe you could share as well for a lot of people with eating disorders. Would you say that the eating disorder was an unwanted thought or a wanted thought? Allyson: Yeah. So, that's where it gets a little tricky. So, we talk a lot about egodystonic versus egosyntonic, and I would say in general, egodystonic is anything that you don't like, right? You don't want to be thinking that. With eating disorders, it's tricky because you think you like it. But if you actually sit down and you ask the person, "Well, how is this impacting your daily life? Isn't this behavior in line with your long-term values?" they will say no. I've never had someone say yes. Even though it feels like you like the thought or it feels congruent with who you are, it's really not when you look at the long-term picture. I think that's an important distinction to make. Kimberley: Yeah. So important. And that's why I love that you're here because we don't talk enough about eating disorders here on the show as much as I would like. I think that those little nuances are so important clinically to be able to understand. So, thank you for telling us. Okay, you took ERP School. What was your main takeaway? You obviously had the takeaway of like, "Oh, this could be a part of my symptomology," but in terms of just what you've learned, what was the main takeaway for you? Allyson: The biggest takeaway was that in order to get better, I had to face my fears. I had to take away the compulsions, which were mostly mental for me. And that was really hard to wrap my head around, like learning mindfulness skills to stop ruminating. I just thought everyone obsessively ruminated. So, I just didn't know that that was a mental compulsion. So, identifying those and then retraining my brain. It was so hard. Like you said, I think in ERP School and in your podcast, you talk about how you might have to do it 500 times a day, like redirecting your attention back to the present – that was so true. It felt exhausting. So, those were my biggest takeaways – you need to face your fear and don't expect this to be comfortable. Kimberley: Yeah. I'm glad that's what you took. I got goosebumps listening to that in terms of you talking about how exhausting it is. I'm curious for your experience, was the treatment of the OCD portion harder than the eating disorder? I mean, it doesn't really matter, but I'm curious to know what that was like for you. It's so exhausting, right? Facing your fear is so exhausting. So, did you feel that same level of exhaustion in your eating disorder treatment? Allyson: Yeah, totally. I think it's hard to compare the two and I've done a lot of reflecting on it. Let's say, if I had to choose, do you want to go through the eating disorder again or the OCD, I think I would choose OCD only because it was so egodystonic feeling that I was really motivated to get better. The treatment took me a lot less time. Whereas with the anorexia, because our culture reinforces so many of the values of anorexia, you could say, it was really hard to change those behaviors because you're fighting yourself and also everyone around you. Whereas with the OCD, it wasn't that way. The culture wasn't reaffirming the values of OCD. Kimberley: Right. I agree. Allyson: But I would say that facing the OCD fears, it felt scary. And I don't know if it's just because it was more recent. My anorexia recovery was like eight years ago, but it felt more intense. We were just ripping off the bandaid. Whereas with my eating disorder recovery, it was a lot more gradual. My therapist was like, "No, we're going all in. I want to flood you with anxiety." Oh, this was scary. Kimberley: It really is. It really is. You know what, I'll tell you an interesting story. A little bit off. But I was talking with a really, really somewhat high-profile influencer on social media the other day. I was actually asking a question about something specific. She had looked at my account and she'd said, "I find it interesting--" we were talking about microlearning, which is ultimately like teaching in very short, small 32-second blocks. She said, "I noticed that you talk a lot about disorders and you keep telling everybody how hard it is." She said, "I find that a little depressing." But that was just some feedback that I had said to her, my response was, "I'm in the trenches with people at the beginning. And if I don't tell them, it's going to be hard, they're going to question themselves on why it's so hard." I thought that was such an interesting reflection of someone who'd be like, "Your account is depressing." But I had only ever seen it through like, no, that's validating. So, I 100% agree with what you're saying. Allyson: I find that very validating because yes, when I went through my own ERP, I already knew it was going to be hard from taking your course, from reading your content, right? But until you're in that moment doing ERP, you don't realize how hard it is. If I was going into it with the expectation that it was going to be easy and super cheery and helpful, I would have collapsed. The fact that I knew it was supposed to be hard I think definitely helped, and my therapist validated that too a lot. Yes, if it's scary, if you're flooded with anxiety, you're doing it right. That was the biggest difference from anorexia recovery because an eating disorder recovery, I think we focus so much on coping skills for anxiety that we miss the point that we can teach clients just to tolerate the anxiety. You don't have to do anything about it. That was a game-changer for me. Kimberley: I agree. It takes all the wrestling out of the work, doesn't it? Allyson: Yeah. Kimberley: Yeah. So, I just thought that was a really funny story because I'd never once considered myself to be having a depressive social media account, but I totally get that perspective for people. I think it's because they're not looking at it through the lens of, if you have to face your fear every day, you do need that reminder. And I really appreciate you mentioning that. Was there anything that surprised you during your original training in ERP? Was that shocking to you? Or did that actually be like, "Oh no, that sounds bright"? Allyson: I think once I was taking the course, I realized, yes, this makes sense. It wasn't necessarily shocking, but learning about the OCD subtypes, that was the most eye-opening to me of, "Oh, this is what real OCD is, not everything we've been conditioned to think it is." So, that was I think a huge turning point. Then I could pinpoint like, "Okay, where am I struggling the most? How is this manifesting for me? What do I need to do about this?" Kimberley: Right. Yes. Will you share with us some of your exposures and what that was like for you? Walk us through. Allyson: Sure. Yeah. So, I think the funniest exposures in terms of listeners listening to this would be the blurting out ones. And I say fun in a sense that they sound funny, right? Because OCD does not make sense. It's not logical. It attacks things that we know we care about, but OCD makes us question ourselves. So, when I had these fears that I was going to blurt out, people's like-- let me backup. Social justice is very important to me. And so, the fears of blurting out were fears that I was going to blurt out, people's like marginalized identities. For anyone that doesn't know, OCD attacks what you care about most. So, it felt so scary to me to have these thoughts of blurting out these obscenities to people. Some of the exposures that I would do, that my therapist had me do, was first like watching videos of people blurting out stuff. I had this fear that like, what if my brain just broke and I started blurting out stuff? So, she made me watch videos of people with brain damage and things like that. And then I wrote out a lot of scripts, writing out my feared outcome, listened to that 30 minutes a day over and over. And that was terrifying. And that I got from ERP School. And then the other one, I think what helped the most was my therapist had me write out my feared outcome on sticky notes and put them all over my room. So, when I woke up in the morning, I was flooded with anxiety, just seeing all the intrusive thoughts all over my walls. If you would have walked into my room, not knowing I was in ERP and stuff, you would just think I was a total weirdo. Kimberley: That's commitment, right? You were so committed to your recovery. I'm so proud. That's so cool. Allyson: I just wanted to get it over with. They say this is going to work, so I'm going to trust these professionals. I know the science myself. I was just so motivated because living with OCD is harder than going through the treatment. Kimberley: Yeah. So, I have a question, which I think is a question that my clients commonly ask, and you've gone through it, so I'd love to hear your thoughts. Often you are really into social justice. So I'm sure the idea of saying these words was horrible, right? It went so against your values. So, when you were doing the exposure, was it hard for you? Did that feel like you were going against your values to do the exposure? Or how did you manage that piece? Because I've had clients say or people from ERP School say like, "But I don't like these words. I actually disagree with these words." Maybe it might be a racist word or so forth, then that was really, really upsetting for them. And so, the idea of doing an exposure to something that they wholeheartedly do not value and in fact, they are disgusted by is really painful. So, how did you navigate that? Allyson: Yes. Well, to answer your question, yes, that was very hard. And higher up in the exposure hierarchy, I actually had to write out the obscenities while I was talking to someone. So, I'd be like, let's say, I'm talking to you right now, and then my exposure would be taken on a sticky note or on my phone, type out the word that my OCD is saying I should say. And it felt so opposite to my values. It felt so wrong on every single level. Even just remembering it, I'm going to get a sick feeling in my stomach. It does that disgust, that guilt, that anxiety. It's so all-consuming. But I think I had to have blind faith and trust the process, as cliché as that sounds. Trust that this is supposed to habituate my brain and not I can tolerate it. So, yeah, it felt totally opposite. But then once it started getting better, meaning it started causing me less anxiety and less feelings of disgust, I started believing that like, "Oh, this is what I'm supposed to do." And it was easier to keep going with it. But that first week was excruciating. Kimberley: Yeah. I bet. I'm so grateful you did the work, but I'm sorry you had to go through that, right? It's not easy. Yeah. And you're right, and we share this all the time, is it does attack often the things you value. Moms have to do pedophilia exposures they are disgusted by, or the dad has to do harm. I'm not picking a gender for any reason, but just using those as examples of a dad who have to have harm exposures and have to expose himself to his own aggression. And these can be so painful. So, I love that you're sharing-- particularly, I love that you're sharing about the social justice piece because I'm seeing that a lot in my practice. Because of how aware we are now of making sure that we are politically correct, or even the Me Too movement, I think a lot of people are reporting anxiety about if they said something or if they touch somebody inappropriately. I think it's becoming more and more prevalent. Allyson: Absolutely. And that was something I really had to learn in therapy. There's all these cognitive distortions with OCD and just like thinking errors, right? And one is that we are hyper responsible for everything we say and do, and that we have to say things perfectly, it's very black and white. There's no room for error. And that was a part where I had to accept that just like everyone, I'm imperfect. Sometimes I am going to have a thought that is not aligned with my values of social justice. But that doesn't mean I'm bad. And it's learning that that's okay. I'm only human. It's not my job to save the world. Kimberley: Right. And that we can be imperfect, right? Allyson: Right. Kimberley: Yeah. I think that is so, so true. So, so beautiful. I'm so glad that you mentioned that. Okay. So, tell me a little bit about skills. Actually, I wouldn't be totally happy as we go if you want to compare and contrast the skills you used in eating disorder treatment compared to OCD treatment, but what are some of the skills that you either learned through CBT School or ERP School and through your therapist? What were the skills that got you through the most? Allyson: Yeah. So, I can tell you the top two that were the most impactful, because my compulsion is where mostly mental – learning not to ruminate and using mindfulness to do so, which you explained very well in ERP School. And so, basically, this is how I pictured in my head, is where let's say, I'm talking to you and I'm starting to get intrusive thoughts that I'm going to blurt out something mean. I picture this little monster in my head, which is the OCD, and I just in my head and say, "Oh, okay, hi, you're there." Acknowledge it. But then come back to the present, like constantly refocusing my attention to the present. So, not trying to push it away, not trying to figure it out. That was a huge game-changer for me because when you're caught up in your thoughts trying to figure it out, then you're totally removed from the present. I wouldn't be able to focus on what you're saying. But to learn like you can think four things at the same time. We do that all the time anyway. I could be thinking about my lunch right now and I'm still focused on you. So, learning that was huge. And I will say it wasn't easy to learn though. In the beginning, I had to do it over and over. And then eventually, I feel like it's like a muscle. Your brain gets more used to it. And now I can do it pretty easily. But it took me a while to get there. And then the other one, it was one-upping my OCD, and you talk about that in ERP School. Also, I went to Chrissie Hodges' Gamechangers event and Alegra Kastens was talking about one-upping and just giving examples of how she does it in her daily life. I started using that and just really standing up to my OCD. So, for listeners, what that means is, let's say I get an intrusive thought that I'm going to blurt out something really mean to Kimberley. What I would say to my OCD is, "You're right. I am. I'm going to do it and it's fine. I'm just going to do it. You're right." And just like, kind of what you would say to a bully, just rebel. And when you do it, standing in a really confident posture really helps me, just overpowering it. "You're right. I'm going to blurt out today. I'm going to ruin my reputation. I'm going to go down in history as the worst person ever." Just make it really dramatic. Kimberley: Yeah. I love it. I do. I do. And I do agree with you on the posture piece, right? I think that power pose we take against OCD or fear can make OCD or the fear back down pretty quick. Not that it makes it go away, but it means you are in charge, not him. Allyson: Exactly. Because OCD and anxiety and eating disorders make you feel really small and powerless. When we feel that way, our body reflects that. And then brain chemicals change that make us feel more like that. So when you change the bodily stance, yeah, it really does work. Kimberley: So curious, did you have that fear about the podcast today? Allyson: No, actually I didn't. I mean, as we talk about it, the thoughts can come up, right? But I didn't go into it that way, which is incredible. Kimberley: Yeah. Would you agree that had you not gone through your own exposure and response prevention, this setting would be something that would be triggering or is it more just face to face with people in your daily lifestyle? Allyson: It totally would have been triggering. Yeah. Because it's any situation that's a bit anxiety-provoking or that's really important to me. So, this is very important to me, right? Or talking to people in my life that are super important. It would come up in those moments. Or with the pandemic, I hadn't seen family for a long time. Then when I finally saw them, I was a little bit anxious and I had these thoughts towards them. So, it's any situation where I feel anxious and sometimes OCD feels like it could be completely random. Kimberley: Right. Oh, it's so good. I like it. I just cannot tell you how rewarding it is just to hear you say. I just love when someone will say like, "Oh, I didn't know I had OCD," until they found ERP School or something or a podcast or something. So, I just love that information is getting out there. Before we finish up, is there anything that you really want the listeners to know? I know you've already outlined these main key points, but is there anything that maybe we've missed or you want to reinforce a message that's really important for you that they would hear? Allyson: Yeah, absolutely. I think just reflecting on the different journeys of anorexia recovery and OCD recovery, I will say that it is so important to learn that you can tolerate discomfort and anxiety because in anorexia recovery, there was so much focus on coping skills that I use so much distraction and reassurance and then all the compulsion to deal with recovery that I think if I had learned, that you can just tolerate anxiety, you can have a good day with anxiety, that would have prevented so much pain, mental pain. Because now when I get anxious, I'm like, "All right, I'm going to go to work just today, I guess," or "All right, I'm going to do this anxious," but it doesn't automatically mean your day is going to be terrible. And that's what OCD, anxiety, those disorders all try to make you feel that way. And it's so empowering to know you can do this. Yeah. You can be an anxious mess and still have a great podcast. Kimberley: 1000%. I love that message so much. I could just keep going. I'm actually really, so I'm going to, of course, give you a chance to share about where people can find you. But all I want to hear is I love hearing the contrast between the eating disorder and the OCD treatment. I think that that's something we're not talking about enough. We should propose a conference talk or something on that because I think it's so important for people to understand those differences and why they're so important and how ERP can actually work for eating disorders as well. So, so cool. Tell us where people can hear more from you. I know you have your own podcast. Tell us all the things. Allyson: Yeah. So you can find me on my podcast. It's just called Body Justice. It's all about social justice, eating disorders, anxiety, all of that. And then on my Instagram @bodyjustice.therapist, and then my website, www.allysonfordcounselingservices.com. And on TikTok too, @bodyjusticetherapist. I'm getting into it. Kimberley: I can't get into TikTok, but I will watch and learn from you. Allyson: It took me a while, but now I'm like, this is a bit easier than Instagram. Kimberley: Oh, is it? Allyson: Yeah. Kimberley: Well, I really am so grateful for you. Number one, I'm so grateful that you're out now as a clinician, training other people how to do this, which makes me so happy. We need more OCD therapists. So, that makes me so happy. But I'm also just grateful that you're here to share this story. I think it's so important that people hear your story and, yeah, I'm just so happy. Allyson: Yes. I'm so grateful too, Kimberley. You've been huge in my journey to recovery from OCD. So, super grateful to talk to you today. Kimberley: I'm so happy to hear that. We'll be hearing more from you in the future. It sounds like you've got some amazing things to share. So, keep up the good work. Allyson: Absolutely. Thank you. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .

Sep 3, 2021

This is Your Anxiety Toolkit - Episode 200. Oh my stars, you guys, Episode 200. So exciting. Welcome back to Your Anxiety Toolkit. I am so thrilled to have you here for Episode 200. Oh my stars, you guys, this is a huge deal for me. In fact, let me set you up for today's episode. So, in Episode 100. We actually invited all the guests that we had previously had on the podcast and we had a celebration. If you want some fun, you should go over there and listen. It is such a wonderful episode. I was thinking about what I wanted to do for Episode 200, and I'm not going to lie, nothing landed. Nothing. I just couldn't bring myself to throw a huge party for it. And I think that's what I wanted to talk with you guys about today in this episode, which is, who's suffering? Who's struggling? Who is having a hard time? Because I know I am, and I'm guessing you are in some way or another. I wanted to use this episode as just a time where we can talk about suffering and we can talk about what that looks like and what that means and what we can do when we're struggling. And so, let's talk about that today. Before we do that, let's first do two new segments. In fact, one is new and one is a return of an old segment we used to do. And the first one is where I would like to read you a review of the week for the podcast. This week's review is from Katie. Thank you so much for your review, and for all of you for writing a review. You guys do know that I'm giving away a pair of free Beats headphones once we hit a thousand reviews. We have a long way to go, but I am committed to getting there. And so, in the meantime, let's celebrate each of you as we go. Today's review is from Katie and she wrote: "This podcast is a great resource that has helped me before I was brave enough to seek treatment. It's nice to know that I am not alone. The tools and conversation are authentic, helpful, and hopeful. Grateful for Kimberley's generosity in sharing." Thank you, Katie, for leaving a review, and thank you to all of you for leaving a review on the podcast. It helps me to get reach ultimately, and that helps me to help more people with this free resource. Alright, so the second part of the podcast is a return to the "I did a hard thing" segment. Now, we have actually upgraded this segment. And what we're going to do from now on is I have a form on my private practice website, where we launched the podcast. It's called KimberleyQuinlan-lmft.com. If you go over there and you click on Podcast, right there is a way to submit your hard thing. And so, we used to do it on social media and we used to do it via email and it was very, very messy. And so now, you get to submit your "I did a hard thing." We will take a look at them and we will do one per week. I am so excited. I really believe that the "I did a hard thing" segment is literally the basis of this podcast. When people tell me or they DM me or they message me, or they tell me in person that they did a hard thing, they tell me as if this is a new concept to them that they've never, ever been encouraged to do. They tell me as if it's life-changing. And that's why I really feel like this is the core of this whole podcast, which is to come together as a group to do hard things. And maybe the hard thing isn't something that's hard for other people. That's totally okay. That's the whole point. If it's hard for you, it's hard for you. And I love celebrating that because sometimes, out in the world, we don't have people to celebrate with. And I think that needs to be such a huge piece of the work that we do, and it is such a part of the work that we do here. So, to get us started, I'm actually going to do the first one. Now, I want to encourage you to think of your hard thing as just something that's hard for you. And then we can talk about here in a second what that may mean. So, my hard thing for this episode is this, and I'm so excited to tell you this, is that Your Anxiety Toolkit Podcast hit 1 million listens. 1 million downloads, 1 million times people listen to this podcast and I could not be more excited. And this is why I think this is so important, is because as I went and I learned of this wonderful achievement, immediately, I heard a voice that says, "Yeah, but such and such got there in way quicker time," or "Yeah, but I know that some people who have way more successful podcasts than you do, they're going to look at that and they're going to be like, 'Oh wow, just a million?'" And immediately, that voice came in. And so, what I want to encourage you to do is catch that voice when you recognize that you've done a hard thing. Because when you can catch the voice, you don't have to then engage with the voice and go, "Yeah, you're right. No point really celebrating that because other people got there easier and faster and better and all the things." So, here today, I am going to celebrate this milestone. Thank you so much for you guys for supporting me because I never would have gotten there without you. And I want to invite you to go over. I will put a link in the show notes below where you can submit your hard thing, and there will be no judgment here. If your hard thing is getting out of bed, that is a massive win. If your hard thing is going to therapy like Katie's was, then that is amazing. If your hard thing is doing the 10 out of 10 exposure on your hierarchy list, then that is amazing. And I want to make sure every single week, we are celebrating one of you at least with your "I did a hard thing." Okay. So, those are the two segments we needed to get started on. Let's talk about suffering. So, here it is, you guys. I know you guys know a lot about my story and I was so lucky to have this beautiful summer where we got away, and I had so much time to heal and rest and be with my kids and it was magical. I'm not saying that to brag. I'm just sort of saying that if you have 10 minutes even to spend with yourself and rest, I cannot promote that enough. The resting is so important when it comes to our recovery. And then when I returned back to LA, we had to come back and prepare for my children to return to school. The thing that really got to me is– let me just share with you really quickly about our vacation really quick – we decided to leave LA for the summer. We took seven weeks and we got in our SUV and our raft. We didn't get in our raft. We towed our raft and we brought that around and we traveled eight states over seven weeks. We rafted 65 miles as a family. It was wonderful. We rested, we played, we sang a lot of annoying children's songs. We listened to a lot of audiobooks, so that was wonderful. But it was really interesting as we left Oregon down into California. The minute we crossed the border, all of a sudden, we were hit with smoke, and it was like driving into the apocalypse. Smoke was everywhere. We couldn't see 100 feet in front of us. And the closer we got to LA, the more I noticed my anxiety rising and my sadness increasing and dread and all the feelings. And then I got back to LA and really wanted to spend some time readjusting with my family. But all I could think about was, wow, everybody is suffering so much – COVID numbers and the fires and earthquakes and political issues. I wanted to really slow down for you guys enough to validate your distress to validate the suffering and struggles you have. Chances are, you're dealing with all of that on top of some type of mental struggle or medical struggle. And so, I wanted to first just give you permission to take some time and validate that this is hard. I find that when I speak about suffering with my patients and my clients, a lot of them often diminished their suffering by saying, "Yeah, but other people have it worse," or "My thoughts are irrational, so I shouldn't be this distressed," or "I have a home," or "Whatever it is, I shouldn't be sad." But I want to remind you of this core important fact, which is, all forms of suffering are enough and are valid. Don't get into the comparison trap of who's suffering more and who deserves to suffer more and who deserves help and who doesn't. You deserve help. This is a very difficult time and we must hold our suffering and our struggles in a warm, nurturing position. You know, you guys, I always sort of make the joke of imagining you are holding a beautiful, yellow baby chicken and their little bones are like, oh my gosh, toothpicks, but not like toothpicks because they're so frail. And if you were to hold them, you would be so gentle with the baby chicken. Your touch, your facial expression, your warmth in your voice would be so gentle. I want you to hold your struggles as silly as it seems like a baby chicken. Beautiful, tender, warm, kind, respectful tenderness. I really hope that you can do that. The other thing I would encourage you to do – and I don't know if this will help you, it was incredibly helpful for me over the last two years – is to continue to remind yourself that suffering is a part of being a human. Often I get caught – and this was a big lesson for me at the beginning of COVID, which was a part of me, and also when I got diagnosed with postural orthostatic tachycardia syndrome, I know a lot of you have struggled with this when you've been diagnosed with a mental disorder, whether that be OCD and eating disorder and anxiety disorder, a depressive mood disorder – is we want to sort of stomp our feet and say, "This shouldn't have happened to me." And by all means, please stomp your feet. Please have as much time to grieve that as you need. Again, there's no reason for us to invalidate our own suffering, but for me, it was really important to remind myself that humans do suffer. As COVID happened, I had to keep reminding myself, COVID, while it's a huge issue and as harming so many people, is-- and I noticed I was like, "This shouldn't be happening. This is wrong." And I had to keep reminding myself, like, who says, it's wrong? Who said it wasn't supposed to happen? Who said that we were supposed to have a life that's only easy? Who said that we weren't supposed to struggle with mental illness? When it comes to mental illness, that's what we would consider internalized ableism, which is, this idea that we should always be in tip-top shape. We should always be thin. We should always be smart. We should always be able. We should always be capable and handle things well. That's just not human. It's never been that way. it should never be expected to be this way. You're allowed to suffer. You're allowed to have troubles and struggles and pain, and you're allowed to stumble as you try to navigate that. And so, what I really want to remind you out when we talk about suffering is really taking away expectations that it was supposed to be easy and that it was supposed to be a free run. Now, I put in a caveat here, which is, you don't deserve this either. You don't deserve this suffering. It's not a form of punishment. I know a lot of people come with that belief that they are being punished for something bad they've done. You didn't do anything wrong. You didn't ask for this. This is painful stuff. And I really hope that all the compassion practices that we've talked about here on this podcast have given you the tools you need to support yourself as we continue to suffer and struggle. Now, there's one last thing I want to mention, and that is hope and faith. I have had to wrap my head around these concepts during the last three years. How can I be hopeful when we have global warming or pandemics or hate against minorities? How can we be hopeful about this? This is where I'm going to encourage you to find hope in you, find hope in the community and the support around you. This community, if you haven't got a supportive community, look and focus in on this community and the people who are doing the hard things and who are searching and struggling and working through what it's like to have a mental illness. Bring your attention to those who've done what you are wishing you could do. There are so many advocates, you guys. I look to them every day. People who have lived experience, who have been through really difficult things and have come out on the other side – I look to them for hope and I use them as a little lighthouse for where I may need to go next. And I hope that I can be that for you. But I really encourage you. As you're navigating your suffering in this time, I really encourage you to look to the people who are doing things the way you wish you could and just use them as your shining light. You don't need to do what they're doing. You don't even have to stop there but use them as a beacon of hope that together we can get there and that you will get there, and that together we can hold space for each other's pain tenderly, compassionately, respectfully. That is my hope for today. So, that being said, Happy 200th Episodes. I always end the episode by saying: It is a beautiful day to do the hard thing. And I know you're all struggling. I'm struggling. I get teary just talking about this with you, but every day I say to myself, this is a beautiful day to do the hard thing. I'm just going to do one step at a time. I'm going to ask for help. I'm going to find my community. I'm going to celebrate my wins. if you can maybe put your attention there, I hope you can – maybe that will make the day a little lighter and the suffering a little less difficult to bear. Have a wonderful day, you guys. I love you. I will see you for the next hundred episodes or more, the next million listens or more. I really am just honored to be on this journey with you. Have a good day.

Aug 27, 2021

This is Your Anxiety Toolkit - Episode 199. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, everybody. Oh my goodness, I am so excited about this episode and so deeply honored. So, for those of you who know me, you know how completely-- oh my gosh, I get so excited about meeting my mentors – people who have taught me so much as a clinician, who have taught me so much as a human being. Today's one of those days, you guys, I am so excited and so grateful to be able to have, like I said to you, my biggest mentors on the podcast. Today, we have on the podcast talking about shame, Dr. Christopher Germer. So, if you guys may remember, I did interview Kristin Neff before COVID about self-compassion, and Christopher Germer, who we have today, has co-founded the mindfulness self-compassion concepts and tools. They have workbooks, they have trainings, a website, and the work they're doing is so important. I strongly encourage you to go over and check out the work that they're doing, because it is life-changing. But today, what I'm so excited about is sharing with you a conversation I had with Christopher Germer about shame, and he really breaks down all of the things we need to know about shame. We talk about some things that I myself have still got a lot to learn. Some of the things he said today – I had to do everything in my power, not to be like, wait, stop, I need to be able to think about that for a second. I need you to say that again, because he just drops so many truth bombs, and he is so amazing. So, I'm going to stop going on about how excited I am because I have a total fangirl experience right now. I literally just got off the phone with Dr. Germer, and I'm going to share this with you. So, I hope you enjoy it. If you are somebody who has struggled with shame, you are going to love this episode and take a lot away because it is such an important part of all of our recovery and all of our well-being. So, enjoy the episode, everybody, and I will see you all next week. ----- Kimberley: Welcome. I am so honored, and I have such deep respect for today's interview guest. We have today Dr. Christopher Germer. Thank you so much for being here. Christopher: Thanks, Kimberley. Great to be here. Kimberley: So, I've actually been dreaming of having you on for some time. I really wanted to hear your thoughts about shame. I was at a presentation or a training you did in December, right before COVID started, and I loved what you had to say. So, this is the topic of today. Can you share with us, just give us a brief description of what shame is? Christopher: Well, shame is probably the most difficult human emotion. Shame is probably the most hidden human emotion, which is also why it's so difficult, because if we can't see it, we can't work with it. But shame is primarily-- it has two main aspects. One is it's a self-conscious emotion, which means we're kind of seeing ourselves in the minds of others, and there's also negative self-evaluation. So, what we're seeing in the minds of others, it's usually some scorn, something negative. So, those are the two main characteristics of shame. Shame also has a kind of-- there's kind of a global negative evaluation involved. In other words, we don't just think a part of me is kind of needing to be tweaked a bit. It's like, I am fundamentally bad or unworthy or incompetent or helpless. So, there's a kind of a global evaluation. So, that's shame. But at the end of the day, what shame really is an attack on the sense of self. So, guilt is a criticism of one's behavior. In other words, I did something wrong. Shame is "I am wrong." So whenever there is a self-attack, there's usually an element of shame involved. Kimberley: Right. And I think that's so interesting that you say, because it's such a huge component of someone who's struggling with a mental illness, or even just emotions, in general, is a lot of us when we're having a hard time, we move immediately to like, "There's something wrong with me." Christopher: Yeah. So, shame can either be the cause of different forms of mental distress or the consequence. So, when we think badly of ourselves because we're struggling, say with an anxiety disorder or depression, then that's an element of shame – thinking badly about ourselves, right? The self-attack. Or if we get negative messages from the culture, like if what we're struggling with, it's stigmatized or if it's a burden on somebody in our lives and they start to criticize us for what we're going through. So, in that way, shame is a consequence of some internal distress, but it can also be a cause. If we are beating up on ourselves or something that happened to us in childhood, and inevitably, for example, if we suffer a lot of criticism or neglect or abuse in childhood, we basically blame it on ourselves and we carry shame through our lives. Shame takes the form of self-criticism. It takes the form of self-isolation. It takes the form of self-absorption. Any of those ways of being have a serious effect on our mental health. If we isolate ourselves, then we get lonely. If we criticize ourselves, we can get anxious or depressed or anything. So, shame can be a cause or a consequence of mental illness, mental distress, and certainly anxiety. Kimberley: Right. I love that you identify that. So, I think a lot of us understand that you would experience shame and have some self-criticism in relation to that. Can you share a little bit about why you think we would alternatively isolate? Christopher: Well, it just goes along with the shame. Kimberley: It just happens. Christopher: Isolation is a hallmark of shame, but maybe one way of looking at it is evolutionarily. In other words, we have shame because in human evolution, it served the function, and the function it served was it kept the tribe together, and tribes that stayed together survived. So, when somebody sort of broke the rules, it jeopardized the tribe, it jeopardized the individual, and that wasn't good. So, what shame is, is a really intense emotion that we feel when we break the rules, and then the tribe excludes us. And that became hardwired in us through evolution because those people who basically felt shame stayed in the tribe and survived. So, therefore we have shame. The problem nowadays is that we could feel shame for just about anything that has nothing to do with survival. We can feel shame because my body type or my sexual orientation or gender identity, anything we could feel. The interesting thing, Kimberley, is that actually, we are more likely to feel shame when we are being devalued in a social context than when we do something wrong. It's quite possible we do something wrong, even something that violates our own standards. And we just feel just a little bit of shame. But when people treat us in a devaluing way, then we have a lot of shame. So, the question was isolation. Shame has always been associated with isolation. But what's really interesting is that in the tribe and among our ancestors, the way they got us back into the tribe, fortunately, was by making us feel bad, not by beating us up. If they had to beat us up to get into the tribe, that would be not good for the survival of the tribe. So, we learned the fine art of shame, and it feels like we're getting beat up and we just want to get back. We want to get back into the good graces of our friends and so forth. So, bottom line is that it's just the central part of shame to feel extra – kicked out of the tribe alone, desperately alone. Kimberley: See, that's so fascinating that you said. I'm going to have to relisten to this, this term around like, it's true. We could be physically hurt, but there's that emotional when someone says something about us and they attack us emotionally. That can be the most painful, heavy load. That can create a cycle of shame and all of those and isolation and criticism. That's so interesting. I've not heard it being explained that way. Can you tell me about self-absorption, though? Christopher: So, in a moment of shame, two things happen. One is we are stopped dead in our tracks. There's like a startle. There is a fear response. Sometimes there's like a moment of panic. So, that goes with shame. And then there's instinctive turning inward. This also makes good evolutionary sense because then the idea is you would turn inward, and then you would take inventory of what you did wrong and then fix it. So, that turning inward is a part of shame, but it's only helpful, Kimberley, when it's mild shame. In other words, if you, I don't know, mistreat somebody, and then you stop, you turn inward, you realize what you did wrong. And then you basically stop feeling ashamed, and a little bit, you start moving a little more into guilt, and then you apologize, right? People in the midst of shame, they can't apologize. They're too self-absorbed. But when it turns to guilt, then you can step out of yourself. You can apologize. And then the beautiful thing is when you are basically forgiven, or you're welcomed back into the tribe. So, that turning toward oneself, turning inward is part of how shame develop. But when we have not state shame or temporary shame or mild shame-- but when we have a trade shame, shame proneness, intense shame, chronic shame – we get stuck in self-absorption. We get stuck in turning in on ourselves. We get stuck in rumination. We get stuck in obsession. This is a direct fruit of the shame experience. So therefore, when people ruminate in a-- I say, if you're having obsessive-compulsive disorder or something, and you're just ruminating all the time, there's often a shame component because this is just how we're wired. Kimberley: Right. It's so interesting that you say that, and it is. I even know, I can say personally, if I've done something wrong, there is sort of a-- I think what you're saying is the self-absorption isn't in a critical way. You're saying it as criticism, it's more of that you're just stuck on "Did I, could I, why did I, should have I, why did I do that?" And you're stuck in that cycle. Christopher: You get stuck in the cycle. And when we can see the shame in, we can address the shame, then we can get unstuck. And seeing and addressing the shame – so shame is the idea that "I'm bad," or "I'm incompetent," or something. We can't just say, "Oh, no, I'm not bad, I'm good," because that's intellectual. That's in the higher cortical process. It just doesn't work to try to convince ourselves of something that is so anchored emotionally. So we need to do something really different to address the shame. We need to actually warm up the conversation. This is what Paul Gilbert figured out back in the year 2000 with compassion-focused therapy, is that you can't necessarily exchange a critical thought with a positive thought just because you want to, because your attitude has to change, the tone, the way you talk to yourself has to change. you have to warm up the conversation as he says. I think it was just a really profound insight, which is the centerpiece of compassion-focused therapy. But the bottom line is that when we-- say, if we're obsessing, and shame is at the root of this, first of all, we need to recognize that it's the root of it, but then how do we change that loop? We do it by actually learning to be kind to ourselves because we're obsessing, not as an effort to drive out the obsession or to fix ourselves or to stop this or stop that. We need to just put down our defenses and just say, "Honey, this hurts." You are suffering and learn to love ourselves as a kind of a wounded or broken person. I can tell you, in my own personal life, that's precisely how I got into self-compassion because I had public speaking anxiety, and I was technically an expert in anxiety disorders after I wrote a dissertation on it and so forth. For 20 years, I couldn't deal with my public speaking anxiety, although I knew everything that one should do about this. To put it simply, until I learned to love myself as a wounded healer, as a broken person, as somebody who could do nothing about his public speaking anxiety, just to love myself because I had public speaking anxiety, not as a way of driving out the public speaking anxiety. And when that happened, miraculously, I lost my public speaking anxiety. That was like in 2016, after 20 years. I'm sorry, 2006. I, more or less, haven't had much public speaking anxiety for the last 15 years because self-compassion addressed the shame by warming up my inner experience and embracing myself as a person suffering with anxiety, not trying to do some sort of slick strategy of fixing or overcoming or tricking anxiety out of my system. That didn't work. Kimberley: Right. Can you share with us? Because I think that's such a real-time experience. Can you share with us what that looks like for you? Of course, we can always, in our heads, picture the person who's presenting and has a lot of anxiety. I think we all know that feeling. What was the shift for you when you were on the stage and then it moved into that? Or did you have to practice it on stage? Can you share a little bit about your experience? Christopher: Yeah. So I guess, one thing is I've been practicing meditation for decades, but I never practice self-compassion meditation. Four months before I had a really important talk, which is that Harvard Medical School, the conference that I had, helped to organize on meditation and psychotherapy. Four months before that, I started to very deliberately practice loving-kindness meditation for myself for the first time in my life. So that meant just saying really nice things to myself over and over again, like, "May you be safe, may you be healthy, may you live with ease," and things like that. Just over and over, like a mantra. And that became a new voice in my head. It sure was a new voice. And then when I got on stage at this conference, when I got up the usual terror arose with me, but there was a new voice. So, in these months running up to the conference, I would sit in meditation and I would then think about this conference and I would be horrified, and I would start to panic on my cushion in meditation. But then I would just say really kind things to myself. And as I said, not to drive the fear out, but just because I needed some love because I was such a mess, because I just couldn't psych out my panic, right? So, I was just feeling anxiety, loving myself, feeling panicked, loving myself, feeling fear, loving myself. And then when I got on stage, I felt the fear and the love came through. It was like a new voice that said, "Oh, may you be safe. May you be peaceful. May you be happy." And with that warmth, the anxiety disappears because, I'm sure you've heard "Love is the opposite of fear." It really is because when we can hold ourselves in a loving embrace in the midst of our suffering, it really does downregulate the arousal, the sympathetic stress response. It downregulates the stress response. So, this actually happened all internally without any intention at the time, because I had been building up this habit for a few months. And that was quite amazing. But I need to say that I don't want your listeners to think, oh, I just need to do this for four months, and then all my public speaking anxiety has gone or whatever I'm dealing with is gone because I also had what's called the "gift of desperation." Now I'm sure a lot of your listeners have that too, which is also known as a "moment of creative hopelessness." I was broken. Okay? I was an expert in anxiety disorders. I've been meditating for 30 years. I knew everything in the toolbox for anxiety and nothing worked. So basically, I had the gift of desperation. In other words, I couldn't figure this out. And that's when compassion is really most effective. Like, what can you do when there's nothing else you can do? Kimberley: I resonate with that so much. Christopher: For example, in medical care, compassion is usually part of palliative care when the doctors have given up on curing you. So then they just try to make you comfortable. But the irony is that in mental health, making yourself comfortable, giving yourself compassion is cure because it downregulates the nervous system. So, if you're afraid and you find a way to give yourself the kindness and the compassion you need, it creates an entirely different physiology, which is the opposite of fear and anxiety. So, the trick is how to do that. In my case, what enabled me to do it was that I was desperate. And in my desperation, it finally landed because I was actually simply being kind to myself because there was nothing else to do. Everything else had been tried and failed. I suspect there are a lot of people listening to this talk who know exactly what that means. In other words, you already have the gift of desperation. My suggestion is, that is a good thing. When you feel desperate like that, that's when you can really start to warm up your nervous system, warm up your heart. Again, not to fix anything, but simply because you are broken, broken in a good way, broken because you can't manipulate yourself into a different state of mind. So you have nothing to do, but love yourself, and that will make all the difference. Kimberley: Right. I resonate with this so much. I have a similar-- not a similar story, but I remember a therapist and I go to therapy. That's what I do. My clinician, my therapist was saying, "It doesn't sound like you're being that kind to yourself." I'm saying, "No, I am. I am being kind. I'm not saying anything critical." She's like, "But it's how you're saying it. Like that tone, it's aggressive. you're not saying anything so unkind, but it's so aggressive." And softening that tone – I had no other choice. I was so frustrated. Like, "What am I doing wrong? I'm not doing anything wrong." So, that was so powerful for me. Christopher: One of the sneaky aggressions, Kimberley, is, this is really sneaky aggression, especially for clinicians. And that is most of us have been sort of trained to try to fix things, fix things in ourselves or others. you're from Australia and there's a meditation teacher in Australia named Bob Sharples, who talks about the subtle aggression of self-improvement. Actually, in a subtle way, to think I'm anxious and I should no longer be anxious, and therefore I should do this, it seems as if it is compassionate, when actually the most compassionate thing to do is to stop trying to fix ourselves and to be really kind to ourselves because we are broken. That doesn't mean that you are going to be broken for the rest of your life. What it means is, this is the first opportunity you have to get fixed. That is to say, to get healed by the power of compassion. So, as Paul Gilbert says, there are three main subsystems in the autonomic nervous system. One is the care system, which we're trying to activate. The other is the threat system, which is associated with self-criticism. But there's also a kind of edginess or self-criticism in the drive system. And the drive system is "I'm going to fix this, then my life is going to be awesome." But if we are hooked by the drive system to try to fix ourselves, we are actually creating obstacles for healing. Kimberley: And I think that's so prevalent in this era of social media, and even my clients trying to get into colleges like, "You have to be going and do some much, and I'll have to be better," and all these things. I think that's so true of this era we're living in. Better, better, more, more. Christopher: Yeah, that's right. We're not very patient. In other words, this is a fast-paced society, particularly with electronics and the internet. But compassion is slow. Compassion is patient. If you think about how do you recognize compassion, there are a number of ways that we recognize compassion. One is with a soft gaze. One is with a soothing or supportive touch. One is with gentle vocalizations. But another way is with patients. When we are around somebody who is not trying to achieve anything, get anywhere, but it's just with us in an open-hearted way, we know that we're in the presence of compassion. But how often do we do that with ourselves? Very rarely. When it comes to ourselves, we are usually more impatient than we are with anybody else. And so therefore, we really need to back off. Learn to be with ourselves in a new way. give up the struggle just for a second and see what happens. Kimberley: Well, that's so interesting, because if you were to say like, compassion is slow, that is the opposite of anxiety, because anxiety comes with an urgency, right? Like, get away from it. We've got to fix it right away and remove it right away. And that is that sort of paradoxical thing of the answer isn't to run away fast and the answer isn't to push it away and just to slow down into it, right? Like you were saying, it's like the give up. It's like, let's just stay. Christopher: When we give up, we're actually not giving up. We're just giving up the struggle. Kimberley: Yeah. Laying down the sword. Christopher: We're not giving up. Say it again. Kimberley: We're laying down the sword. Christopher: We're laying down the sword, right? We're not giving up that we're going to have a happier, healthier life. It's quite the contrary. We're just doing it in a new way. We're giving up the struggle and we're learning to embrace who we are and what we're feeling in this moment. The great paradox is that then leads to cure. So, it's a paradoxical cure. Kimberley: It is. It really, really is. I love this. So, tell me, what are some of the roadblocks you see when it comes to people? I know I've done a lot of presentations with you. You do a lot of self-compassion meditations. What are some of the roadblocks you see people go through in trying to access self-compassion? Because for those of you who don't know, you have created this amazing program called Mindful Self-Compassion. Have you got any kind of reflections on what might be some of the roadblocks? Christopher: The roadblocks to self-compassion. Yeah. So, there are personal ones, there are more cultural ones. Well, the main roadblock is the term "self-compassion" because when people hear that, they think selfishness, narcissism, not good. Or compassion, they think, oh, soft, fuzzy, I got enough of that, I'm too compassionate already anyway, that sort of thing. So, the term itself is going to be a problem. And then there are other subproblems such as people associate self-compassion with self-pity, with lack of motivation, with self-indulgence, with, as I said, selfishness, weakness. And all these obstacles to self-compassion are actually myths. There are misconceptions because the research overwhelmingly shows that people who are more self-compassionate are actually more compassionate to others, less self-absorbed, more resilient when things go wrong in their lives, and they are more motivated, not less, more motivated to achieve their goals. They just do it in a different way. They don't do it with harsh criticism. They achieve their goals through self-encouragement and kindness. So, those are the obstacles. The research shows the opposite. But people also have individual obstacles, like personal obstacles based on their childhood. So, for example, if we were punished for crying, most males have been told that's unmanly. So, if I start to practice self-compassion, I might feel vulnerable inside. I might even touch some old wounds that happen. This is called backdraft that love reveals everything, unlike itself. People recognize that they might have shut down in order to survive. And then when they start to open up with self-compassion, they start to feel vulnerable, maybe some difficulties arise, and then they think, oh shit-- I'm sorry. Something's going wrong. And that then is an obstacle. But that's a personal obstacle because it's related to a person's personal, let's say childhood experience. So, when we practice self-compassion, we need to really understand the territory. We need to know how self-compassion works, what to do when-- so we have a saying: When we give ourselves unconditional love, we discover the conditions under which we were not loved. So, when difficult emotions arise, as they inevitably will, that's actually an opportunity for healing. But if we don't know that, that just means, "Oh, I'm not doing this right. Things are not going the way that they're supposed to go. I should stop." That's an obstacle. So, in this course, this eight-week Self-compassion Training course that Kristin Neff and I developed, now with the help of thousands of teachers around the world, this course actually guides people through the process, such that it is healing. In other words, we learn how to give ourselves compassion. We are open and kind to ourselves when the opposite arises, as it must in order to heal. And then we learn to meet everything that gets stirred up with compassion. We learn to meet that in a new way. In other words, in a compassionate way. And then as a result of that, we actually heal. In other words, we can even reparent ourselves with self-compassion, but we need to understand the territory. Sometimes it's really good to have a therapist to help you with that. Kimberley: Yes. I have taken-- just for the listeners, I've taken the eight-week course twice, maybe three times, I think. Twice, and then once I think the quick, fast one on the weekend, which I loved all of them. Let me take you back to something you mentioned before, because I want to make sure people are really clear. So, you'd mentioned the shame you experienced because of somebody else's way they've perceived you or that what they've told you or how they've communicated to you, but then there's the internal shame. Would you say that the compassion practice is the same for both situations? Christopher: Well, compassionate, in general, is a powerful resource for regulating our emotions, for coping, for emotional resilience. So, no matter what happens to us, if we know how to be compassionate to ourselves in the midst of that stress, it's helpful. But I found that there are many things that are helpful when we're under stress, like getting exercise. But when we're dealing with shame, then we need self-compassion more than ever because you're not going to deal with your shame just by, say running a marathon. That'll calm you down, but it won't touch your shame. So, in order to address shame directly, which has these characteristics of self-absorption and isolation, and self-criticism, we actually need to deliver a medicine, which is the opposite. And self-compassion is the opposite. So literally, Kristin Neff's three-part definition of self-compassion is self-kindness versus self-criticism, a sense of common humanity or connection versus isolation, and mindful awareness versus self-absorption or over-identification. So, what I experienced, example with my public speaking anxiety, is that I only discovered that I had a shame disorder after I had been giving myself compassion for four months, that in other words, the self-compassion enabled me to finally see what the problem was. It was like a resource or a strength. It was like a platform. It was like a firm foundation that I can actually see what the problem was. So, when we think about self-compassion as an antidote to shame, we really want to front-load the resource. We want to start getting good at self-compassion, and then we can turn around and touch the shame from a position of strength. And self-compassion targets shame because it's the opposite of shame. But just let me say that it's not only the opposite of shame. It has more than non-shame. It is kindness, which is different than non-self-criticism. It has a sense of connection, which is different than non-isolation. It has mindful awareness, loving awareness, which is different than just stopping to ruminate. So, the cool thing about self-compassion is it has all these positive qualities that actually create positive cycles in our lives. They warm up our experience. They make us happy, which makes other people happy, and it generates a lot of positivity. So, therefore, when we give ourselves self-compassion for shame, we're not just downregulating shame, but we're also building a resource, which actually creates – it's very clear in the research – happiness and life satisfaction. Kimberley: Yeah. And quality of life, right? Like connection. It is so true. If you talk about shame being about isolating, I think anxiety does that too. It makes you want to hide. But if you can be compassionate, you can stay present with your partner or your child or your best friend or whoever. I think then that is even more healing, right? It's healing upon healing, upon healing. Christopher: It's healing upon healing. That's a nice way of putting it. Kimberley: Yeah. So good. Is there something that we haven't-- I want to be respectful of your time. Is there something that you feel like we haven't addressed that you want to share on this topic? Christopher: We covered a lot of ground in this short time. And I guess the main point that we've already made, but maybe I can say it again because it's so critical, and that is, we have what's called the "central paradox of self-compassion." And it is that when we suffer, we practice self-compassion not to feel better, but because we feel bad. So, I said this a few different ways already, which I'm pleased about because it is the difference that makes a difference. When we give ourselves compassion for its own sake, it works like a charm. But when we do it as a kind of strategy, some slick strategy for fixing ourselves or how we feel, it really doesn't work. So, the metaphor is like, if you have a kid with the flu and your child is crying, "Oh, it hurts mommy. My head hurts. My tummy hurts," naturally, your heart will go out to the child and you're not thinking, oh, I'm going to be really nice to my kid so that my kid's flu will disappear tonight, because it's a five-day flu. You're just nice to your kid because you can feel the kid's pain, right? Similarly, can we do this for ourselves when we suffer, just like we have the flu? And mind you, we all have the flu. It's called human suffering and we all do it, and we're going to suffer until we die. So, this is like a lifetime flu that we all have. And so, what happens when we suffer? Can we be as kind to ourselves in the moment of suffering as we would toward our own child who is suffering? That's the challenge. When we can do that for its own sake, self-compassion can change your life. Kimberley: Yeah. Thank you. Oh my gosh, I love it so much. It's so powerful, and it's so crucial. I'm so grateful for you sharing all of that wisdom. Actually, we covered double what I was hoping to talk about today. So, I'm thrilled. Share with us where people can find out about you and all your resources. We'll make sure to have them in the show notes. Christopher: Yeah. So, we have an organization called the Center for Mindful Self-Compassion that basically is a clearinghouse for everything self-compassion-related training, and you can download audiotapes and videotapes of things. That website is CenterForMSC.org, and my website is ChrisGermer.com. Also, if people are interested, particularly in the research, you should go to Kristin Neff's website. She's really the-- I could say the main pioneer of self-compassion research and she is Self-Compassion.org. Her website is just amazing, and her work is amazing. And she just came out with a book called Fierce Compassion, which tries to correct our misunderstanding that compassion is always soft and tender. Sometimes it's fierce and it's tough. Sometimes we need to do really hard things in a kind way. And that book shows people how to do it. So, you can learn more about Kristin at her website as well. Kimberley: Yeah. She'll be on the show here in maybe, I'd say six weeks. Christopher: Okay, great. Kimberley: Yeah. Again, because she's been on before. It's so good. And you said there was a training for clinicians as well. Christopher: Oh yeah. So, we have a Self-Compassion in Psychotherapy Certificate Program, and this is a 10-- I'm sorry, a 30-week training with a lot of renowned people as faculty. Basically, it teaches how to integrate self-compassion into all aspects of psychotherapy, as well as into our lives personally. It's a 30-week training, with the first cohorts going to complete the training in the next few months. And there's a new training that's starting in October of this year. So, if you're a clinician and you're excited about self-compassion and you want to know how do I bring this into my clinical interventions, into therapy relationship, into my own personal life, and into therapeutic presence, that's the best place to learn it. you can learn about that from that website – CenterForMSC.org . Kimberley: Wonderful. Well, thank you. I'm so grateful. I have, like I said, such deep respect for you. I'm so grateful for the work. It's been crucial in the work that I've done as a clinician and for myself. So, just major props to you. Christopher: Thank you so much, Kimberley, and thank you for all the heartfelt and really effective work that you're doing – getting out insight into new approaches to old problems. Anxiety has been with us since the birth of humanity. Kimberley: It's true. It causes a lot of suffering. Christopher: So, we've got a lot to learn, and thank you for being in the center of that conversation. Kimberley: Thank you. ----- Please note that this podcast or any other resources from CBTschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting CBTschool.com . Important Links: https://chrisgermer.com/ https://centerformsc.org/advanced-skills/ Mindful Self-Compassion Workbook https://www.amazon.com/dp/1462526780/ref=cm_sw_em_r_mt_dp_3YD9C23Q1KQ56WDYCN3C Mindful Path of Self-Compassion https://www.amazon.com/gp/product/B005CWSC06/ref=dbs_a_def_rwt_bibl_vppi_i1

Aug 20, 2021

This is Your Anxiety Toolkit - Episode 198. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Okay, friends, how are you doing really? How are you doing? It's summertime, you guys. Oh my goodness. We're here. How did this happen? Just to let you know, I will be taking a break as I have done for the last several years over the summer. So I will probably take a few weeks off in July so I can have some time with my kids to really rest and repair and play and be human. It's such a weird year. And so as I'm recording this, it's not summer yet, but it's crazy to think that we've landed in summer already of 2021. Am I right? Holy smokes. Okay, before we get started, as I always say, please do go and leave a review. I will be giving away Beats headphones to one lucky winner when we get a thousand reviews. We're on our way, guys. So please do go and leave a review. I would so be grateful. It just really helps me strengthen the podcast, and it's one of my big goals for 2021, is just to really help people with this amazing platform. All right. So here we go. Today, I am talking about how I am protecting my daughter from an eating disorder. But what I'm really going to be talking about is how we, me and my husband, are protecting my daughter and my son from an eating disorder. The reason I preface that is because, number one, yes, while women are more likely to develop an eating disorder, there is an increase of prevalence of young men and young boys getting and experiencing an eating disorder. There are many different types of eating disorder. It doesn't have to be anorexia. They can be binge eating. There's also types of eating disorders, such as bigorexia, which is around developing muscle. There's orthorexia. There's so many kinds of, again, bulimia anorexia, of course, we've discussed. There's so many types and it's so important that we recognize that this is not just a problem for women and girls. So let's talk about it. How myself and my husband are protecting my daughter and my son from an eating disorder. So there are two main things I want to discuss today. Number one is how we talk and number two, how we model. And so I'm going to give you much more detail into how we are doing that and how we're choosing to do that and the struggles that we're having. I, myself, had an eating disorder. So I'm really, really protective of this topic with my children. It's something I really want to try and protect them from while I know that I can't entirely protect them. I can do a lot of education to give them everything they need to hopefully not have to go through what I have gone through and what so many people have gone through with eating disorders. So, first of all, let's talk about what we talk about. Let's talk about what we talk about, shall we? All right. So the first thing, and you guys have heard me say this probably before, the first thing we talk about is diet culture. This is where we identify how our society is teaching us to believe that we should be a certain way. Our bodies should be a certain way. Our skin should be a certain way. Our hair should be a certain way. We should look a certain way. And we want to be able to identify this so we can call the BS on it. So the reason that I call BS on it is, just because society tells us our body should be a certain way doesn't mean it's true. In fact, it's entirely BS. Your body, my body, my daughter's body, my son's body, and my husband's body – doesn't have to be any particular way. Society and diet culture is going to tell us that it should be thin. It's going to give us all of these messages. "We should be thin. We should be strong. We should be tall. We should be short. We should be eating this certain thing. This product will help us with our metabolism. This product is bad. These foods are good. These foods are bad." And there's so many messages that are faulty and proven to be wrong. So, so important. So we talk a lot about this with my children. When my daughter and I go shopping, which we haven't done in a long time, but when we see advertisements, when we watch TV shows, when we look in magazines or pitches of books in books, when we look at Barbie dolls, we talk about diet culture. I might say, "What about her body? Let's talk about Bobby." And we look at Bobby and I'll say, "What do you think about her body?" And she'll be like, "It's kind of weird. It looks kind of strange." And I'll say, "Yeah, why do you think that is?" And she says, "Well her waist is really small." And I'll have a conversation with her. We talked to her about, "Do you feel like you need that to be beautiful? No, no, you don't." How might we change this? And I might say to her, "You don't have to look anything like that. You know that your body is genetically set up to be exactly the way your body is and there's nothing you need to do any differently about that." So important. Same with my son. Look at the action figures. We might say, "Your body doesn't have to look like that." That's diet culture. You don't have to have a six-pack of abs. He's only six, but we're still already having these conversations. Now, what's interesting is my husband right now is reading the book to our children, and it was a book that he read when he was a young kid with his parents. It's interesting because there's all these references to fat, like fat this and fat boy and fat girl, and she was fat and so forth. We talk about the word "fat." We talk about, is that a good word or a bad word? No, it's just a word. It's a descriptive word. But would we use it to describe somebody else? No. We would use many other things to describe somebody than using that kind of word. Not that there's anything wrong with the word. It's just that we don't want to encourage them to define a person by their body. We try our hardest not to compliment our children's body. You might think that's crazy. Some people go, "Oh, no, no. My child won't have an eating disorder. I tell them how beautiful they are every day." I often will educate them and say, "That doesn't actually prevent anything. In fact, it just adds to that kid and that child thinking that the way they look is important. Because what if their body changes? Then they're going to be like, 'Oh no, mom's always complimenting me on my body, and now my body changed. So does that mean I'm bad?'" So we do our best not to compliment their body or anybody's body. I have worked really hard since my own recovery to never congratulate someone for losing weight, which is really hard. In fact, I've had one really difficult conversation with our friend where she was saying, "I really just want you to compliment me because I have lost a lot of weight." And I've said to her, "That doesn't line up with my values. I love you, but I never want to engage in something where you believe your worth is caught up in your body. I just can't do that. I'm sorry. But I love you and I love everything about you, every part of you, whether your body is in a large body, a small body, a tall body, a short body, whatever color skin. I love you." And we say the same to the kids. Now, of course, we also don't ridicule their bodies. We don't comment on their bodies, their ever-changing bodies, as they, my daughter moves into preadolescence. We're still in the talk section. We talk about what we do value. That person is very kind. He has kind eyes. She has a beautiful smile. She radiates love. She is a fun person. She's very intelligent. My five-year-old son says intelligent a lot. "He is very intelligent. I am very intelligent." Not that we want to overvalue that either. Because we want to really remind them that unconditionally, we will love them and that their worth is consistent. It doesn't matter what. It doesn't matter what. That they're worth and our love for them is consistent. And to be honest, I will say there is nothing more powerful than hearing that from a father, particularly if you're a young woman, a young child like my daughter. For my husband to say, "I love you, no matter what. Don't ever let a man judge you or comment on your body and you believe what they say, because you're more than a body." To teach our son that other girls and other boys are more than a body. To teach him that he's more than a body. So important. Now another thing we do is we praise all foods. We celebrate all foods. We are grateful for all foods. We do not have good and bad foods in our family. We don't talk about things being healthy and unhealthy. While we do very much value health, we really try to help the kids understand that they can listen to their body and our body. This is the kind of funny story, I'll tell you. My daughter is going to be 10 and she can outeat anybody. It's really quite phenomenal. She's always hungry. And my instinct is to go, "You've already eaten. Stop eating. You certainly cannot be hungry." I'm feeling full and she's eating double what I have. But I really catch how we talk to her about her food and we celebrate, "Good for you, honey. You're listening to your body." She'll often come to me and say, "Mom, I'm starving. What can I eat?" And we laugh. And she smiles. And I say, "Hun, what do you think I'm going to say?" And she rolls her eyes and she says, "You're going to say, 'You can eat whatever you want.'" Now, of course, we have some rules around this. We don't encourage and we don't allow the kids to eat a lot of snacks before a meal. We try to really have them understand the importance of waiting for their meal. But that's probably 45 minutes at the most. Often my daughter will have a full peanut butter and jelly sandwich 45 minutes before a meal and still eat her whole meal, and we praise her for that. My son is really, really picky around food. There's certain things he really, really likes. And interestingly, he has no interest in sweets. If he could choose between salty and a birthday cake, he would choose salty all the time. We encourage him to just listen to his body. I talk to them about me listening to my body. They'll be like, "Mom let's go have ice cream." And I'll usually sometimes not eat ice cream. That's not because I'm restricting. I might say, "No, I'm listening to my body. I don't really need ice cream right now." And then there's other days where I'm ordering three scoops of ice cream because I'm really hunkering down for some ice cream. So I try to also teach them that it's okay to listen to your body as does my husband. So these are all really, really important things we talk a lot about. And this is the last thing we talk about, which is health. What is health? Is health only eating sugar-free foods? Is health being thin? Is health being tall? No, none of those things. Is healthy eating only organic food? No, absolutely not. Health is having balance and taking away judgment. We have to remember here too, health is not just physical, it's mental. I know people who eat the most "clean diet" and they exercise, but they're not healthy because emotionally they've got a really unhealthy relationship with food and their body. They're hard on themselves. They beat themselves up. Maybe they binge. So this is the thing to remember. Your definition of health might not be what is the real definition of health. Now this is really true and I'm going to make sure I have some people on coming here once we get back after the summer on talking about health at every size. This is a crucial conversation we need to have. If you haven't read yet a book called Health at Every Size, I urge you to. It's so important to really understand the science behind that and understand the issues we have around how we have stigmatized people in bigger bodies as being unhealthy when we've actually got lots of science to prove that you can be really healthy in any size body, that health is not indicated by just your size. Okay. So now we move on to what we model. This is similar, but very important. So my husband and I have two completely different body sizes. Not that that's super important, but I feel it's important for our children to have those two examples and to have family members with different body sizes, where we celebrate every single body, and we do a lot of modeling around that. We do a lot of modeling, celebrating bodies – all the body sizes, shapes, skin colors, nationalities, sexualities. We try to model to our children and normalize differences instead of things being like, "This is good and this is bad." We also model, like I've mentioned to you, how we eat. We try not to judge each other for what we eat in front of each other. We try to really encourage by modeling like there's no time you should eat food. A lot of my patients will say like, "Oh, I had a bagel for breakfast so I can't have a bagel for snack." And we go, "No, you can eat a bagel for breakfast and for lunch if you want." My son loves more than anything to put cream cheese and sprinkles on his bagels in the morning. He loves really sprinkled-up bagels and we allow it. We figured it's no different than him putting jelly or jam on his bagel. And so we allow it, we allow him to enjoy his food. Given that he's a kid who doesn't like a lot of sweets, we're all for it. We also model by not saying negative things about our own body. My son is a personal story, but my son once came in and I was getting out of the shower and he said, "Mom, your belly's all jiggly," which is most moms' nightmare. You know what I said? I said, "Yeah, it is. Isn't it beautiful though, that I had two babies in that belly? Isn't that cool?" He might say, "Daddy's belly is big," or whatever he may say. And we'll go, "Yeah, isn't that wonderful? We have so much fun eating food and what a wonderful body. Isn't it so great that we have our bodies, that our bodies do all these things for us, like pump blood and breathe and digest food and run and hold our hearts and hold our brains and filter nutrients and things like that? Isn't that incredible?" We model body acceptance and body love. This has been really helpful for us, particularly because I know a lot of women and men who've developed eating disorders because their parents were on a diet all the time, that their parents model these strict diet culture rules, and good and bad rules, and all of this stuff that's so dangerous for young ears to hear. Now, we also model this or share one more personal story is, so much of eating disorders is around restriction. Over the last two years, my daughter has had some medical issues where she had to restrict several different food groups and this was really uncomfortable for me. I was very strong against it. I had said to her pediatrician, "I'm very uncomfortable with this. I do not like the idea of her restricting." And he really coached me through. "You have everything you need to help her protect against this becoming something eating disordered. And just because she needs to do this medically doesn't mean we have to make it about her body," which was really helpful for me to hear. And so, yes, she has had to restrict several really important food groups because of some stomach issues that she was having. And so it's been a really interesting thing for us to have these conversations around what is a diet and what does that mean and why would we go on a diet and what are some reasons that we probably would not encourage her to go on a diet around and so forth. And so, that has been really, really fascinating to watch her navigate that. There's been a couple of times where she said like, "Mommy, I know I'm supposed to check on the ingredient list for certain things." But she said, "That has made me really uncomfortable having to do that." And I so appreciated her talking to me about that. And so we came up with basically a strategy that she could know basically what is in certain different foods. And from there, she wouldn't have to look at the nutrient lists anymore, the ingredient lists. I was so happy that she felt comfortable saying, "This feels not right for me. This feels like it could become a problem." And so, that has been really, really huge. I think the only thing I would add from there is, for me as a therapist, but mostly a mom, I've had to really allow a lot of space for anxiety around this stuff because I never want my child to have to go through that. I have caught myself being hard on myself and feeling a sense of hyper responsibility, like it's your job, it's your job to protect her. I've had to really pull back on that as per my conversations with the pediatrician in terms of saying, "Kimberley, you can do what you can do, but you don't have control. It will be what it will be. You can model and you can talk and you can be the best you can be, but we also have to let go of control and just be uncertain." Like I'm always telling you guys, it's an uncertain thing. There's no promises that we can do the best that we can. If we make a mistake and we mess up, we apologize and we share and we talk about where that mistake in that era came from, where did we learn it, what triggered us in that moment. And so, that has been really, really important for me as well. So I hope that that's being helpful. Those are the main pieces that have helped us as a family to protect our daughter and our son from an eating disorder and body image issues. I do hope that even one point has helped you in navigating this. If you haven't, if you're not the parent of somebody, these are also messages and things that you'll have to do for yourself, to model to yourself, talk to yourself about. And if not, go and find an eating disorder specialist who can help challenge this and work through the beliefs you have around food and diet culture in your body, and that can be really, really, really helpful. Okay. I love you all. Have a wonderful, wonderful day. It is a beautiful day to do the really, really hard thing and you're doing it. I know you are. So, I will talk to you very, very soon. Have a wonderful, wonderful day. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

Aug 13, 2021

This is Your Anxiety Toolkit - Episode 197. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, you guys. So grateful to have this precious time with you. Thank you so much for coming and spending your very, very precious time with me. As we do this together, it's exciting, we're almost at 200 episodes. You guys, I cannot believe it. I am pretty, pretty proud of that, I'm not going to lie. Today's episode is with the amazing Jon Hershfield. He's been on the show multiple times and I have been really reflecting and thinking about how important it is for us to practice response prevention and how that is so, so important for everybody who has any type of anxiety, whether that be an anxiety disorder like OCD, social anxiety, specific phobia, generalized anxiety. Even for myself, I've been reflecting on any time I'm responding to fear and responding to discomfort. It's just a topic that I want to continue to address because I think from you guys, I just continue to see how much it's a struggle for you. As I thought about continuing education on tools you can use, I thought, who else can I have none other, but Jon Hershfield to talk about using mindfulness to manage compulsions. Now we talk about compulsions like mental compulsions and rumination. We talk about reassurance-seeking, avoidance, any kind of physical compulsion. We also talk about how to practice mindfulness so that it doesn't become a compulsion. And so I'm just so grateful to have John give us his very valuable time and to talk with you guys about these amazing concepts. I'm not going to spend too much more time doing the introduction. You guys know how amazing Jon Hershfield is. He has some amazing books. He has The Mindfulness Workbook for OCD , and he has Everyday Mindfulness that he co-authored with Shala Nicely, and The Teen OCD Workbook , and Harm OCD book. He's just written amazing books. So please do go out and support him. He does share all that information at the end of the show, and I can't wait for you guys to listen. In the meantime, please do go and leave a review. It helps us to reach more people. I'm going to be quiet now and let you listen to Jon's wisdom. Have a wonderful day. ----- Kimberley: All right, welcome. I am so happy to have the amazing Jon Hershfield with us again today. Jon: Thanks for having me. You make me sound like Spiderman of the OCD world. Kimberley: You are the Spiderman of the OCD world. I love it. Jon: What does that mean? Kimberley: Yeah, it's true. Well, that's a good thing. I know my son is probably jumping up and down at the idea of me meeting the Spiderman of something. Thank you for coming on. I really wanted to invite you on, of course, because I love the work that you're doing regarding mindfulness in OCD. I really wanted to talk about how we can use mindfulness, particularly to address compulsion, because a big part of Exposure and Response Prevention is the response prevention piece. I would really love to pick your mind on how you implement mindfulness as a part of that and also address some of the misunderstandings that happen regarding mindfulness. So, let me first ask you, just for those who don't know or new to the show, how would you give a definition? How would you explain mindfulness, particularly in the respect of treatment? Jon: It's interesting because we all make this same grammatical error. I do it too. We say we use mindfulness as if mindfulness was an act or an action or a thing that you use as opposed to a perspective that you take. So I'm thinking about what mindfulness means. Usually, the definition we hear is "Paying attention to the present moment as it is without judgment and without the desire to change it." And that's a great definition. It's escaping me at the moment who actually coined that exact language, but I think it applies to most mindfulness concepts. But I don't like that it starts with the word "paying" because it still implies that you're doing something. I think mindfulness is actually the perspective that you have when you're paying attention to the present moment. If you want to play around with the words, it's really noticing the fullness of the mind – mindfulness, right? It's a position that you take as opposed to a thing that you do. Right now, I'm sitting here in my desk chair. I'm aware of the sensation of my body in the chair, hearing my voice in the headphones and I have coffee and tasting that coffee. These are all things that I'm noticing and I'm being mindful of. The other part of mindfulness that I think is important to understand is that, in a state of mindfulness, you're best able to observe the difference between an experience – I just listed for you a bunch of experiences – and a story. A story is a narrative. It's the meaning and the webs that we weave around those experiences. So it's me thinking I'd had too much coffee today, right? That's a story about the taste of coffee in my mouth right now and its significance, but they're two separate things. When we're treating something like OCD, which is very much about being pulled away by your mind into these narratives, these fear-based narratives – to be able to drop out of the narrative and into the experience would be to take a mindful perspective, or in colloquial terms "to use mindfulness." But I think a lot of times when we say "using mindfulness," we associate that with stopping what we're doing and focusing on the breath, or pulling out an app and doing a meditation, or trying to execute change in our environment by being mindful. When in fact, mindfulness is very much the opposite of that. It's not about executing change. It's actually about stepping back and seeing the way things really are. Kimberley: Right. I love this. So would you say in this perspective that mindfulness is not adding something on, it's just dropping down into what was already there? Jon: Yes. I would agree with that. Kimberley: I like that. So how might we use this, particularly in terms of managing anxiety or uncertainty or any other discomfort? Can you give me a walk-through of what that might sound like or look like for somebody who is practicing mindfulness? Jon: Well, one of the things you might think about, when somebody feels triggered, something happens. You've touched something you think is contaminated or you've become aware of an unwanted, intrusive thought, a harming thought, or something like that. Then you have an experience in the brain and in the body that alerts you to the fact that you're under attack, that you're distressed, something is wrong and it needs to be fixed. What most people do is they immediately go into the story of, "This is bad. I'm triggered. I need to get away from this trigger. How do I make this feeling go away? Because it's unpleasant." Of course, it's unpleasant because it's your brain's way of trying to help you jump into action to get away from the things that could harm you. So it's natural that we want to get rid of this feeling. And then we do these things called compulsions that reliably, in the short term, get rid of these feelings. If you know anything about OCD as you do, it's like you get stuck in that loop. The more you compulse, the more you really feel the responsibility towards your obsessions as they arise. In that space, between the trigger and the compulsion, there's an experience you're having. A person who has been practicing mindfulness or who is mindfully aware can show up to that experience in the same way they might show up to other experiences, again, without having to make it go away. So you render the compulsion less important because you're willing to be in the presence of that triggering experience. If you were to take this to the mat and think about, "Well, what happens when you're meditating and you get an itch?" what is the instruction? It's not, "Well, just scratch it so you can be more comfortable." It's usually, "Okay, well, notice what itching is like. Notice what it's like to be sitting, which is what you're doing, and then have your attention pulled away from the sitting to the sensation of itching, to be able to say, 'Oh, that's itching.'" Now at some point, we all break and we start scratching ourselves all over it because it's too much, but that's fine. But that's not the first instruction. The first instruction is simply notice itching. And then if you're capable of letting go of that and going back to what you were doing before you got distracted by the itch, you'd go back to your breath or whatever the anchor of your meditation might've been. It's the same thing in real life. You're minding your own business. You're trying to read a book and then you have an intrusive thought that something terrible is going to happen. And then you notice that experience of this mental itching and you're, "Okay, that's happening." And then you have a choice. You can drop down out of that back into your book, or you can dwell on it, ruminate on it, try to figure it out, try to figure out a way to make it go away, and then give yourself permission to go back to your book. Kimberley: So, we call it in my practice, my staff have called it "itch surfing." Jon: Itch surfing. Yeah. Kimberley: I always laugh when I say "itch surfing." So, let's say you have the presence of a thought that's really concerning, right? It's triggering. And you're trying to be mindful, but you're also not trying to step across the line to where you are ruminating or being compulsive related to that. How might someone differentiate between the two? Jon: So there's a couple of things to consider here. One is that a lot of people will say, mindfulness is about watching your thoughts come and go. There's a good reason why we use that metaphor, that idea of sitting at the bank of the stream and watching the leaves go by. But it's not really accurate in the sense that it's more about just noticing thoughts coming and going. Watching thoughts coming and going implies that you're supposed to sit there and stare at them and give them special attention. You're supposed to remember, right? It's a perspective. It's not an act. You're supposed to remember like, "Oh yeah, it was a thought coming and going. Okay, that's cool." And then let go of it. Ruminating is when you're digging up that thought for the purpose of trying to figure it out to digest it. You're trying to act on the thought and get certainty about it. It's a very active thing you're doing when you're ruminating. To be mindful would really be the opposite of that. It would be to notice that you're ruminating and stop. Because the whole point, if you're being mindful, it's not that you're executing change on your environment, but you're simply noticing what's coming up. So it was really impossible to be mindful and ruminate at the same time because that would be like being mindful while trying to figure out some problem. So the instruction would be to notice that urge to ruminate, to notice what's coming up for you in your body, that experience of, "I really want to figure this out," and then to allow that experience to be there, and again, drop back down into your anchor. In real life, it's whatever you were doing before you got distracted. In meditation, it's whatever your anchor is – the breath, the feeling of your body in the seat. Kimberley: So it'd be like using the metaphor of, if you're sitting at the edge of the stream and you're just watching the leaves come and go, that would be mindfulness. But ruminating or being hyper-aware would be like watching the leaf after it's way, way, way, way down the river, but you're still giving that attention and missing what's right in front of you? Jon: Yeah. It's easy to make that mistake because you could feel like you're being mindful. You could say like, "Well, I'm just watching this leaf and seeing how far it goes." But in fact, when you're doing that, you're missing everything that's happening in the present moment, all those other leaves that are going by. A lot of times, people think of themselves as being very negative because they get distracted by negative thoughts, and the thought comes down the stream and they follow it. And while they're falling, those negative thoughts, all sorts of other nice things are happening – the smell of their breakfast or the warmth of the sun or whatever it might be. But they're not noticing that stuff because they're immersed in tracking that negative experience that they had. They think of their lives as being negative instead of thinking of their lives as just being whatever it happens to be in any given moment. Kimberley: Right. Talk about, if you will, hyper-awareness, because I think sometimes people think they're being mindful, and I think it's going to be very similar maybe in your answer, but I just want to be really clear for people who I've heard struggle with. They're trying to be mindful, but it becomes hyper-awareness. Do you have any thoughts on that? Jon: A lot of this, I think, comes down again to language. Most of us are trained to say things like "Sit with uncertainty," which sounds like a good idea, but the implication for some is that you're literally sitting and there's literally uncertainty in front of you. It's like sitting on your head and you're immersed in it and you're dwelling on it. So it gets translated as "Dwell on uncertainty," and feel bad as long as you can feel bad. Actually, I interviewed Jon Abramowitz who some of you may know in a lecture series here at Sheppard Pratt not too long ago. He said he likes to say, "Act with uncertainty instead." I really like that because to me, that is still mindfulness. You're doing something, you notice you became distracted, cool. That's what that's like. Now I'm going to go back to what I was doing before I got distracted. I'm going to act with the uncertainty instead of sitting, letting the uncertainty sit on my head. I think it's such an important distinction because to be mindful of your thought process is to be aware of it. But it's not the same thing as to be trying to figure it out or be certain about it. That would be the opposite of mindfulness. And so the whole instruction, if you've had a lot of experience meditating, it might sound something like you wander away from your anchor and you start trying to figure out what's wrong with your life. And then you go, "Oh yeah, thinking." And then you go back to your anchor. No meditation teacher is going to tell you like, "Well, just notice that you're trying to figure it out and keep trying to figure it out and try to get to some sort of outcome." That really would go against the larger project. Kimberley: Yeah. I mean, for me, if I were to explain it, if I were out and about, and let's say another emotion showed up, like shame or guilt or something, my practice is just to go, "Oh, hi, Shame." I think actually in the last episode, you were here talking about teens and you were like, "That's cool, bruh," or whatever it was, but that's observing it and allowing it to be there. But then there's a redirect to the present. Would you agree that's a method that you use? I mean, again, we're saying it's not a doing, but talk to me about whether that's something that you would apply to. Jon: I would absolutely apply that. I mean, at the end of the day, we're coming up with fancier and fancier ways of politely and compassionately saying, "Let it go." We might have all the different ways of saying "It's okay to let it go," where we understand that it's very painful to have these experiences and that makes it difficult to let it go. We don't mean let it go, like, "Oh, you're being silly." I mean literally, it arrived and you allowed that, and now it's leaving and you can allow that to let it go. To become aware that you have an urge to ruminate or an urge to do some other compulsion and to let that urge be a thing, don't sit there and stare at the urge and wait for it to go away. just be like, "Oh, that's happening." Just like shame arises or guilt arises. And then just gently note it and allow it to be, and you don't have to do anything. It's really a beautiful thing. The shame and the guilt and the urge to ruminate and the urge to wash, it'll go away in its own time. You don't have to be actively involved in it. Kimberley: Right. It's like mindfulness underneath there. A major component is non-attachment, to not be attached to it or the story we tell about it or what it means and all the things. Jon: I mean, if you look at that and the concept of diffusion, they have specific skills for trying to make that happen. I think people can argue over like, "Well, what are the mechanics of building those skills? And could there be some compulsivity involved in that?" I mean, I think there's some people that certainly could. If you're going around saying, "It's just the thought, it's just the thought, it's just the thought," that's not exactly what we're getting at when we talk about diffusion. But the end game is diffusion, it's being able to say, "I'm having a thought that..." What we want is to be able to do that without having to say it, without having to remind ourselves. But instead, simply have the experience that the thought arises much the same way the credits in a movie arise on a screen. Okay, yeah, that is the thought. And then you get to decide, "Do I want to engage with this or let it go?" If it's an obsessive thought that you've been grappling with, that you've decided is your OCD because you keep trying to get certainty about it, well then the instruction is going to be to drop it, not to play with it. Kimberley: Right. Yeah. I think that this was a lesson for me early in my mindfulness game. Mindfulness is not just that heady, heady meaning like only a cognitive skill. It's like you talk about dropping down, and it's a behavioral skill as well. It's not just sitting still and thinking, thinking, thinking, thinking your way out of discomfort. It's also a doing. It's a body thing as well, instead of it just being heady. I think that's where we get into trouble, right? We start to try to think our way out of problems or our way out of discomfort. Jon: Look at checking OCD, for example, like OCD where there's a lot of checking compulsions. What happens is there's this experience of not being complete, something missing or something being lost. And rather than own that experience and be able to say, "That's something that just came up for me and I'm willing to allow that," the instinct is to get rid of that experience by engaging in the checking compulsion. So, mindfulness plays an important role in being able to say, "I'm aware of this urge to check, and that's fine. I have all kinds of urges throughout the day. I don't have to give in to this urge." You don't have to do anything about it. Like you were saying, that's an experience you have in the body, like a sense that the body is craving a change and your willingness to allow that craving. Again, not to sit there and stare at it and wait for it to go away, but just simply just know that it is there and then go onto the next thing. Kimberley: Right. I think that this is true in so many compulsions. Would you use the same skill? Would you use the same concepts regarding reassurance-seeking compulsions? Jon: Yeah. Well, reassurance-seeking is really just another form of checking, isn't it? It's like you have a sense that you know something, just like you have a sense that your door is locked when you go back to make sure. In the case of reassurance-seeking, you're going to a person or the internet to try to make sure. But again, it's that experience of dis-ease, right? Not feeling ease with your experience and wanting to change. Instead of resisting that by doing compulsions, you're saying, "I'll allow it." I've been using this coping skill with the client. I might have mentioned that they prefer "allow" rather than "accept" because accept felt, I don't know, it felt different to them. We can use whatever language you want, but I liked it. I've noticed that as a coping statement. If something comes up, like, "I want to change it," and they're like, "Nope, I'll allow it." And then now you're free. Kimberley: Open the gates to it. Jon: Yeah. Kimberley: Right. I like that a lot. The same goes for avoidance, right? Do you want to share how you might drop into mindfulness when it comes to avoiding, whether you're about to avoid or you're already in avoidance? What would your thoughts be there? Jon: Well, it's like observing your inner magnet, right? Something is pulling you in a direction. It might be pulling you away from something or pulling you towards it. And again, what does that feel like for you? What does that experience in the body? And rather than telling yourself "Accept it, accept it, I got to accept it, and push, push, push, push, push," can you just notice where the resistance is? Can you let go of that, that part of you that's resisting? you want to go to this party, but it's overstimulating and you might say something embarrassing and there's something there that might be triggering for you or something like that. But you want to go. As you're approaching it, do you notice that resistance? Do you notice that push-pull in your body? And again, can you allow it? Can you say, "Worth it, investment return, worth it." Very quickly, not spending a lot of time on it. Again, I think cognitive therapy gets a bad rap a little bit in the OCD world because it can so easily turn into mental rituals, trying to assess the probabilities and things like that. But just a pinch, like a pinch of salt, a pinch of cognitive therapy where you're able to say, "Come on now, this is a black and white thinking. I can handle this." If you're allowed to do that. Kimberley: It's funny that you say that because I was actually just about to ask you, like, go back to your story. Remember at the beginning, you were talking about the stories we tell ourselves. And I think in avoidance, there are so many stories that take us away from mindfulness. So I was actually going to ask you. Do you want to share how you would maybe implement a cognitive skill there? Jon: So, if you're being mindful, it means that you're aware that you're thinking. And if you can be aware that you're thinking, you can also be aware of the tone of thinking. This is especially useful if you're trying to quickly assess. Are you ruminating? Are you engaged in mental rehearsal? Are you thought-neutralizing? What is the mental behavior? If you're noticing the way that you're thinking and that tone, you might be able to pick up historically if that tone has been helpful or not, or if it usually ends in you feeling like you have to do compulsions. Take catastrophizing, for example. You're saying, "Something in the future is definitely going to go badly and I'm not going to be able to handle it." Now, if you're aware and you're mindful, you know you're thinking, and then you know that that's what you're thinking, and you know that that's catastrophizing, you can simply say, "Yeah, that's catastrophizing. I don't need to do that right now." Very simple. "I can't predict the future." You don't have to go into "Everything will be fine," or "The probability is that this is going to go my way." Again, we want to spend as little time there as possible because we don't want to get wrapped up in arguing with the OCD, but to just call it out and say like, "I can't predict the future. I'm going to just go with this and see what happens." And then when you make that choice, notice what that feels like. Can you allow that or not? And if you can't, that's okay. You can go find something else that you can allow. Kimberley: Right. I will always remember many, many years ago, probably even when we worked together, a client of mine, and they gave me permission to tell this story, but I won't, of course, disclose any information. But they always said they can feel the shift in their body. And that was them being mindful. They said as if they were holding onto the sides of their chair. So even though they weren't sitting in a chair, they could feel this shift in their body of clenching. You can't see me on the video. You can see me on the video, but listeners can't. But just this wringing of the hands or clinging of the hands, and that her being able to just identify that slight shift in her body was enough to be able to shift out of that avoidance or resistance. I think just being aware and mindful of that, I think, is a big piece of the pie. Jon: So, it's knowing the quality and the tone and the texture of your internal experience. That's essential for being able to pick out and resist mental compulsions. Ruminating is not just thinking about something because you like to think about it. Ruminating is very much like, there's a puzzle and you've put all the pieces together but one, and now you can't find that one piece that it's somewhere. Maybe it's on the floor, it's under your desk. You know what that feeling is like. It's so intense. And that mental quality is what's going on with the person who's ruminating. And that's what they have to let go of, or be able to experience to let go of the ruminating. If you can't truly appreciate the tone and texture of your mind that "Sometimes when I'm thinking this way, it feels like this, sometimes when I'm thinking this way, it feels like that," it's just very difficult to trust yourself enough to call out the mental compulsion as they happen. Kimberley: Yeah. I love this so much. I think it's so important that we do address it. So, in all, I know there has-- we have addressed this, but I want to make sure we're really clear. Do you believe that someone can mindfully ruminate? Jon: I think it's an oxymoron because to be mindful is to remember that everything going on inside is an object of attention, and to ruminate is to really engage in a changed behavior. So it's really the opposite of mindfulness. There are types of meditations like traditional meditation. You have an anchor. You notice when you're not paying attention to the anchor, you return your attention. Then there's other types of meditations that might involve free-floating, like free-associating. Notice that this thought then connected to that thought, then connected to that thought. That is a kind of meditation. And you could argue that there's a kind of mindful awareness of where things are going when you're doing that. I still wouldn't call that ruminating though, because ruminating is done with purpose. It's done with a specific intention. It's not just watching where your thoughts land. Now, if you have OCD and you're learning to meditate, I certainly wouldn't recommend you do the type of meditation where you just watch your thoughts bounce around each other. But if you're a more experienced meditator and you want to do that free-associating of watching each thought arise and fall and rise and fall and connect to other thoughts and feelings, that can be fun. But it's not ruminating. To ruminate would be to intentionally try to figure out or try to get certain about your obsessive content. And I don't think that there's any mindful way to do that because it is literally the antithesis of mindfulness, in my opinion. Kimberley: Right. No, and that's how I was trained on it as well. I think the thing that I often will say to clients is, anything can become compulsive. Treatment can become compulsive. If you were to technically look at the term, engaging in compulsive treatment isn't actual treatment because it's going in the direction of doing compulsions, which is not the technical term for treatment. Jon: It's tricky with exposures. For example, I encounter people all the time who are doing checking compulsions but calling them exposures. "I have a fear of something. So I'm going to go over and pretend to do that thing and expose myself to that fear by being in this scary situation. And then it's going to go away and then I'll know that I'm not going to do that thing." Well, that wasn't an exposure. It might've been hard, but it really wasn't ERP. I usually tell people not to do ERP when they want to. That's usually suspicious of that. And also to consider what the point of it is. Like, if your OCD is getting between you and some valued behavior, that's a good reason to go do that ERP. But if it's not, and it just exists in your head, you don't have to go ahead and be ready to go find any ERP to do. You're allowed to just live your life. That's allowed. Kimberley: Right. Jon: Yeah. I think that the other thing that happens with rumination that I think is very confusing and hard for people to appreciate is that, though, I wouldn't say you can mindfully ruminate. You can certainly be lost in thought and you can certainly ruminate without full awareness of what you're doing, because a lot of it is habit, right? Rumination, some compulsions, they can become habitual, but most of them are pretty easy to tease apart from habits. But mental behavior is a little bit trickier, I think. In the same way that a person who's-- let's say they have difficulty with biting their nails, and they always bite their nails when in front of the computer. The computer becomes the cue to bite their nails. The hands go up to their face. They start chewing on their nails. They're not necessarily thinking, "Oh, I'm going to bite my nails now." It's just happening. And then they might become aware of it. And if they're working on it, then they might use a habit blocker or some other strategy that they might remember to be mindful of the urge to bite it and come up with another strategy. The same thing happens in the mind where if you're someone who's used to engaging in compulsive rumination in different contexts of your life, there are going to be things that actually cue you to do it without you paying attention. You might not notice that, but it's like, "Oh, every time I'm in this chair, I start to ruminate." The goal here in terms of improving your mental health situation would be to take ownership of the moment that you become aware of what you're doing. Not to beat yourself up for ruminating, because again, your mind was like, "Oh, are we sitting in that chair? Okay, sure. Let's bring up that topic and start reviewing it." And you can't take responsibility for something you can't control. You might argue, "Okay, well, that's not really rumination because you're not the one trying to control it," but it has all the same words. You're just lost in this thought of like, "Well, I know this thought must not be true because of this and that, plus my therapist said this and I read in a book, blah, blah, blah, blah." You don't know that you've left the building. You still think you're sitting in the chair. But then, boom, you become aware. You suddenly remember, "Wait a minute, I'm a guy sitting in a chair, having a thought, and wait, I'm trying to figure out if my obsessions are true. Nope. Not going to do that. That's rumination. Okay, good. Where was I?" Let it go. But I think people can get very self-critical, really hard on themselves, and say, "I can't stop thinking, I can't stop ruminating." In part, some of that is then taking responsibility for something that's-- it's just habit. It's just the brain has been trained to just start revving up the engine. That's all right. You'll catch it earlier and earlier and earlier if you practice. Kimberley: Right. Okay. Is there anything else that you feel we haven't covered in this area? I mean, of course, we haven't covered everything, but is there anything that you really want to drive home here in this conversation? Jon: Well, I guess one thing that's been on my mind is, we talk a lot about how thoughts aren't the problem, right? If you're being mindful, thought as a thought is a thought. And if you have mastery over your OCD, whatever, a thought about what day it is or a thought about hurting your baby, they're just thoughts. It's no big deal. And to some extent, that's true. We don't treat OCD by treating what thoughts people have. We address how they're relating to those thoughts and what behaviors they're choosing in response to that experience. But in the interest of remembering self-compassion too, I think it's important to recognize that it may also be the case that people with OCD are more predisposed to the average person to receive certain types of thoughts in a certain way. So even though those thoughts are normal events, it is normal for you to have thoughts about all of the potentials in human existence, all of the different things. We can kill and have sex with all of these things. It's totally normal to have thoughts about them. But it might also be that when you have that thought, it hits you in a way that immediately generates an urge or a moral responsibility to address it. And yes, mindfulness can help because it can help. You both recognize the arising of the thought as an object of consciousness and the arising of that desire to do something about it as an object of consciousness. But it's also worth noting that it's just hard to have OCD sometimes. And every once in a while, you're just going to get sucker-punched by it. And that's not because you've done something wrong, it's because your brain is conditioned or wired to receive some thoughts in that way. And that can be something that you develop mastery over. But I think when we take all of the emphasis on behavior and none of the emphasis on perspective or predisposition, some people feel like they're not being heard. Kimberley: Yeah. Thank you for saying that. I think that that's been largely the feedback I have gotten as well. If people are struggling and they don't want to struggle, and they're trying to navigate this thing, that feels like an absolutely crazy puzzle that, like you said, they don't even have all the pieces. They don't even have half the pieces yet. So I totally really loved that you said that. I love the idea of compassionate responsibility, which is, we can take responsibility for our experience with the absence of self-criticism. I think we sometimes think that owning this and experiencing this has to mean you have to beat yourself up and that it has to be like "You should've done better" kind of thing. But I do not like that. Jon: Well, you've recently written a book on the subject, and I could go on and on about self-compassion. We could do a whole other episode on it. But I do want to end on this note, which is, a lot of what mindfulness means is simply being honest, and we often lie to ourselves about our experiences. We say, "I should have known better," but when you look at it, there's no way to have known better, that everything you've done is preceded by a thought or an urge or an emotion and we can track this back very, very far. I'm not making the case for no free will or not taking responsibility for anything. I'm just saying self-criticism is inherently dishonest. I say, "I'm a bad person." That's a story. That's not an objective fact. I say, "I feel terrible." That's an experience. That's honest and that's also mindful. Kimberley: Right. I love it. Thank you so much. I'm so grateful. I wanted to navigate all this, but I didn't want to do it on my own. So, thank you for coming on and helping me because you're just so good at explaining this stuff, and I really appreciate the way that you conceptualize this. So thank you. Jon: Well, I appreciate you inviting me. I always love hanging out. Kimberley: Yeah. Are there any projects or things you've got going on that you want to share with us? Jon: Well, right now, we're working really hard at The Center for OCD and Anxiety at Sheppard Pratt. We have some new team members and so we're helping a lot of people that way. Not too long ago, we launched the residential program, the OCD program at the retreat here at Sheppard. We've had a few people come in and out of that program. It's really exciting because it's just a different way of working, working as a team on one or two cases at a time and seeing them every day. That dynamic is new and exciting for us. And then book-wise, the OCD Workbook for Teens is out there. The second edition of Mindfulness Workbook for OCD is out there. I just started working on a new one that I'm co-writing with a friend on how to combine ERP and DBT. Kimberley: That's fantastic. Jon: Yeah. So, dealing with relentless thoughts and painful emotions. Kimberley: Nice. That would be so important. Jon: Yeah, I hope so. Kimberley: Oh, without a doubt, DBT is such an important piece of the work, particularly when those emotions are really strong. So that's super exciting. We'll make sure all of those links to that are in the podcast notes so people can check that. Thank you again. Jon: Thank you. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .

Aug 6, 2021

This is Your Anxiety Toolkit - Episode 196. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, you guys. We have had a break. We are back. I'm actually recording this before I was back, so I don't even really know how I feel once this episode will be out, but nonetheless, I have been holding off and wanting to do this episode as the welcome back episode for the new season of Your Anxiety Toolkit. Today we have with us, my Assistant, my Executive Assistant, one of the most important people behind the scenes at CBT School and in my private practice. She is my intake coordinator. She is the doer of all things. She was originally hired as my Chief Copywriter. She does a lot of work behind the scenes for me. Her name is Elle Warren. Her and I have been working together for some time now. It has been such a pleasure to get to know her. She today is going to share with you, just so you know, who it is behind the scenes if you're ever in contact with us or you're reading out Instagram posts or a newsletter or emails. She's doing a lot of this stuff for me and we're working together very closely. I wanted you to feel like you knew her, just like you know me. She also comes with a beautiful recovery story where she shares her experience with mental health and OCD and health anxiety, and grief, and post-traumatic stress disorder and experiencing, and really coming to find a place of peace with her sexual orientation. It is a beautiful, beautiful episode. I'm so, so excited to share it with you. Again, I want you to feel like you know us. I want you to feel like you trust us and you know who's behind the scenes, and that's why this was so important to me. So, I hope you do enjoy the show. Elle really does share her story so vulnerably. If you do notice some background noises, Elle was in a really rural location, a lot of background noise. So, bear with us there. We were doing the best we can. I wanted to make sure we had this episode recorded before we left, so please bear with me. The content is still fabulous. I hope that isn't too difficult on your listening. In addition, welcome back. So thrilled to be back. I've been trying to do episodes through the school year and then take some time off for the summer. This season, we have some big plans, some amazing guests. I am really dialed in with specifically what I want to address this season. So, get excited about that. I hope you're well. I hope you're being kind to yourself and you had a lovely summer and you had some time to rest and recover. I will share here very soon about our trip and what happened and what I learnt and what I experienced. I always like to refer to a couple of reflections later on, but first, I hope you enjoy this episode with Elle. ----- Kimberley: All right. Welcome, everybody. This is a really wonderful start to another season of the podcast because I have here with me one of my core team members, Elle Warren. Thanks so much for coming on, Elle. Elle: I'm so excited to be here. Thank you for having me. Kimberley: All right. Let me share. I know everyone's listened to the intro, but let's just talk about how important you are as a part of helping me. I'm so grateful for all the work that you do to help me, so thank you. Elle: Yes. I love it. Kimberley: Yeah. The reason that you're so special is because you're so special. But in addition to being so special, you're so wonderful as a part of this team because you get it. You get what we're talking about, and that's why I'm so grateful to have you on our team. I'd love to spend some time you sharing that story if you're comfortable and telling us a little bit about your background. Do you want to give us an intro to your story? Elle: Sure. Yeah. It is a long and winding journey, but I will try my best. I have had OCD for as long as I can remember, but I did not know that it was OCD until about two years ago. I was only actually diagnosed in February of 2020, so right before the pandemic, but I had been learning a lot on my own before that and came to that conclusion. Big themes for me growing up were sexual orientation, health anxiety, safety things. I remember I would always ask my mom for reassurance all the time. And then my mom passed away a little over three years ago now when I was 20, and that was the catalyst for my mental health feeling more unmanageable. I started having panic attacks. I was later much more recently diagnosed with PTSD from her illness and death and all of that as well. At the time, I just thought that my brain was broken, that I was broken. I can see now that it was just the intersections of OCD and PTSD and grief that is a pretty nodded up ball of things. So, that's an overview. Kimberley: When did you notice these symptoms first start? Was it in childhood, you said? Elle: Yeah. I can definitely look back and see it in childhood. I remember one time when I was little, I don't know, I was probably five or six, and there was a storm going on outside and I was so convinced that a tree was going to fall on our house. I remember I just kept asking my mom, "The tree was going to fall on our house." That's one example. Kimberley: Did your mom suspect anything? I mean, was that something that was in your family, or was that just like Elle being Elle? Elle: I think no one really talked about mental health in my family. I know now that there is a history of mental illness, at least on one side, maybe on both, but it wasn't talked about at the time. Kimberley: Isn't it crazy when you find out, after the fact that you have this whole long line of genetics? It's like, "Why didn't I get told this information?" Elle: Yeah, exactly. Right. It's like, okay, there were definitely some signs that could have been. I mean, I don't blame my parents. They were only doing what they knew and what they were taught, but it would have been nice if those things were acknowledged and then noticed earlier on and if treatment was offered earlier on. Kimberley: Right. Sometimes it's that our parents didn't even know they had stuff. Often not even a parenting blunder. It's like they had no idea the words to use to describe things either, right? Elle: Right. Exactly. Kimberley: Yeah. Do you want to share that about your themes? For those who are listening, we will share at the end that you've written some amazing blogs for us and we will make sure we have those in the show notes, but do you want to share about the specific themes that you've struggled with? Elle: Yeah. I think the most significant one, like I said, was the sexual orientation one. That was definitely the one that I can remember taking up the most time and causing me the most distress. One day when I was probably 12 or 13, I was in middle school and I remember I was sitting on the sidelines at cheerleading practice and I had this memory come back to me of this girl in my neighborhood that when we were little, we used to kiss sometimes, which is a very innocent thing. We were four years old. But I agonized over that and wanted to know what it meant and be certain of what it meant. I grew up Catholic and I grew up in a relatively more conservative area, so to me, the idea that I could be anything besides straight was just unthinkable. I think I said this in my blog post about it, but almost equivalent to remembering I had killed someone or something super dramatic like that. Kimberley: And that was because of what you'd been taught? Elle: Yes. Really from the ages of 13 to 20, 21, that was a really big thing. It would come in and out, like I'd let it go for a little while, and then it would come back in full force. I would be imagining scenarios in my head all the time and trying to predict how I would feel in them. I would look at people when I was out and ask myself if I was attracted to them and all of that. Now, I identify as bisexual. I think that adds to it as well because bisexuality is often invalidated and there's the pressure to pick a side and all of that. I didn't really know. I didn't know much about my bisexuality. I didn't know anyone that was openly bisexual. I didn't see people on TV that were bisexual. I think it was not only hard for me to accept that I could not be straight, but it also didn't really feel like a possibility that I could be open to more than one gender. Kimberley: What was that transition like? It sounds like from what you've told us, there's this absolute struggle with this idea at the start and it being a lot of uncertainty. I think you're mentioning you have a lot of rumination around that. How did you get to the place where you are now? Elle: After my mom died, about a year after, I ended up moving from Michigan to Denver. Denver is what I would call a fairly liberal city. I knew a lot of people that were open with their sexuality and I wasn't around the people that have known me my whole life, because it's a lot harder to go against the expectations of people who have known your whole life. It's different when you can create the self that you feel like you are when you can start with that. I think I felt like I had the freedom to explore who I really was. I knew I had people that I could identify with. Also, I think the experience of losing my mother, who was the absolute, closest person in my life, I think it just made me less afraid, in general, because, it sounds cliché, but it was like, you're hit with the fact that time is limited, and you don't want to waste it. You don't want to waste it by being unhappy or hiding parts of yourself. I think in general, it just made me a lot less afraid and less timid because I realized that if there's so much out of my control, I'm definitely not going to waste time not being who I am. Kimberley: You move from a place of being uncertain to just fully accepting radically who you were and just waited to land wherever you landed. Is that how the shift was? Elle: Yeah, pretty much. I don't know. I remember I was laying in bed one day trying to go to sleep and it just went off like a light bulb in my head. I was like, "Oh, I'm--" other times, pansexual has felt more, right? Truthfully, I don't get too caught up in a specific label, but at the time I was like, "Yeah, I'm not straight." It just went off like a light bulb. I think maybe the groundwork for that was laid by the radical acceptance that I had cultivated for my mental health, because like I said, after losing my mom, my brain and my nervous system really went into overdrive and my mental health was really, really, really a struggle. But at that point, I had cultivated a lot of acceptance and self-love for that. And so, I think maybe that foundation was laid there and then paved the way for me to also accept my sexuality. I think I just realized that it actually doesn't matter that much. These days, I embrace the uncertainty. Like I said, I don't care that much about the label. If bisexual feels right now, cool. If lesbian feels right one day, cool. I more so just have the attitude of like, I'm going to date who I want to date and listen to my heart. The certainty doesn't actually matter. Kimberley: Yeah. It's such a cool concept too. I think a lot of the interviews I've heard around sexual orientation is like, "Oh, I had all this uncertainty and I did the treatment and none of my fears came true or whatever." You know what I mean? Elle: Yeah. Kimberley: I love that you're really walking the walk because you had fear and uncertainty and you just continued to be uncertain. It's not like you have some resolution at the enemy. There was. But I love that you're just in a place of just being at it. It is what it is. I feel like that's a story that's missing when it comes to sexual orientation OCD. Elle: Right. I think that's a really good point because it's true. The uncertainty didn't go away. My attitude on the uncertainty just changed. I think you're getting over the hump of shame that comes along with non-heterosexuality is a big part of that too, because I've seen on social media, I feel like a lot of people, it really scares them that someone else who had sexual orientation OCD actually turned out to be not straight. I think that that's scary for a lot of people. That's a whole other thing. That's not just OCD, that's the shame that many of us have grown up associating with non-heterosexuality. Kimberley: Right. That internalized stigma that is placed on us. Elle: Right. Kimberley: I really love when you wrote that article and we will share it again, and you share a lot of this story. I really do love it because I really worry sometimes when I see Instagram posts and things of like, "Everything I've ever worried about never came true." You know what I mean? I see that's true for a lot of people, but it is a form of reassurance almost of like, "Don't worry, your fear is just a thought." I think this is an opportunity to fully embrace these concepts. The thing I love about what you're talking about the most, and I don't hear enough people talking about it, is it's coming from a place of just genuine love. Not from a place of like, "Well, my therapist told I have to radically accept it." You know what I mean? Elle: Yeah. Right. Kimberley: Yeah. Thank you for sharing that. I've just loved that story so much, even though I hate that you have gone through a difficult time. You talked about your moms and the grief around that, you talked about how her loss helped you move into radical acceptance, but how else did that impact you and your recovery or your struggles? Elle: In so many ways. The person that I was before and the person that I am now are two very, very different people. I think the biggest thing is like, my mom and I were very close. I'm the youngest of four kids and I'm the youngest by a lot. So, I definitely got my parents, especially my mom, all to myself a lot. I was very emotionally dependent on her. She was a huge source of love and the most loving mom that I could have asked for. That said, I hadn't really learned how to mother myself, how to be my own source of love and affirmation, and all of that. That's terrifying to just be dropped into. I think the ideal situation, if we all got to have ideal situations, would be that we gradually get to that point. We grow into adulthood while we still have that support, which is the same, my dad is supportive but in a very different way. I felt like there was no one there to hold me up or to witness me. I just felt very alone. She was, I think, the person that I was the most vulnerable with. So, not having that just was really scary. I didn't know how to cultivate that in myself for a long time. I do now, which is a really good thing. Kimberley: How did you learn that? I feel like I don't know how to do that really, really perfectly. You know what I'm saying? I think there should be a course in middle school that teaches you how to do that. Elle: Yeah. There should be. I think part of it is like, what I learned from her in terms of how she cared for me, I think that I tried to replicate that for myself. There's a lot of trial and error and it was a lot of not wanting to do it, but I'm making myself do it just in terms of making myself meals, getting out, and going for a walk. Very basic things. Because when you're in the thick of something like that, the basic things are still hard things. I think it came from this almost outside source of love that I have for myself and the life that I know that I want for myself. It was like, I knew that I deserved that and I knew that I could get there someday again. This is a cliché metaphor, but I felt like I just needed to climb this mountain. I felt like I just needed to keep taking steps. And then maybe eventually, I would be able to see out over the top. I do have other familial support as well. I have siblings and my father. In terms of some other ways, it's affected me. It definitely did not help my health anxiety because throughout the time that she was sick, there just were a lot of fluke things that happened, a lot of things where doctors would be like, "Huh, we've never seen that before," things like that. So, that has been an increased challenge. Kimberley: Are you still working through that? I mean, that has to be really scary because that's what the voice of OCD says, right? Like, "This one symptom is one of the symptoms that's going to kill you," kind of thing. Given that that was your experience, how are you managing that? Elle: It's definitely gotten better over the years. Something that I still struggle with, it's-- I dunno. I'm a lot better at recognizing when I'm in an OCD spiral. I can usually, most of the time, be an observer of it and notice what's happening. I also did choose to go on medication just earlier this year. For me, that has been really helpful. Kimberley: And that helps with the health anxiety or for the grief or for a combo of all? Elle: It's helped in a lot of different ways. Honestly, it's helped with the PTSD symptoms a lot and it's helped with OCD symptoms. It's helped with depression symptoms. I mean, it can be hard to pick out which is which because they all feed off of each other. I feel like even if it's really just helping with one of those things, it helps all the other areas too. But just in general, it's been a game-changer. Kimberley: What degree did you have to practice exposure and response prevention for all of these symptoms? Was that a part of your work? How did you navigate all of that? Did you do it on your own? Did you have a therapist? Elle: I have only practiced ERP on my own. I have a therapist that I was working with for quite a while. I think I was seeing her regularly for probably two years. I found out, this was only maybe six months ago, just through us talking, I learned that she didn't understand OCD really at all. So, I don't see her anymore. I just try to do ERP on my own every day, and that has worked for me so far, honestly. I would like to work with an ERP-trained therapist at some point, but right now, that still has made a huge difference. Kimberley: Right. How was it to do it on your own? I mean, a lot of people, this is a common question I get – "Do I need to have an ERP therapist?" Of course, with CBT School, we have the course. We have ERP School. "Is that enough? Or could I do a workbook or could I just go off of what I've seen people do on social media?" How did you bring yourself to do that? Is it just by your own education? How did you learn? Elle: I feel like I started doing it really before I even knew what it was called, before I even knew that it was like a thing because again, I just kept going back to the vision that I had of myself and who I wanted to be, who I knew I could be, my love for myself. But I think that that can sound really romanticized like, "Oh yeah, I just did it on my own, and I'm pulling myself up by my bootstraps." But it was hard. In retrospect, I probably should've asked for more help than I did. I mean, I don't fault myself for any of this because you can't know what you don't know, right? But I wish I would have been more honest with the people in my life about how poorly I was really feeling. I'm proud of all of those exposures that I did every day. Sometimes it feels and felt literally like you're walking into the jaws of a shark and you don't know whether or not you're going to come out. It really does feel like that. That's not easy. I think having someone to support you through that and walk you through that is probably really helpful. Kimberley: Right. It sounds to me like you use naturally a lot of, and I could be wrong here, tell me if I'm wrong, but a lot of what we would call acceptance and commitment therapy tools, like your values really left you, led you down the road you wanted to be at like, "What do I want with my life?" Sometimes that voice and that question, remember, we talked about asking good questions. That's a really good question like, "What do I want for my life?" I think that can sometimes lead us in that direction. Would you agree with that? Elle: Yeah, I would. I think that that is what was carrying me through a lot of the time. Kimberley: Right. I have one more question if you're willing to share. What was it like for you to have PTSD? A lot of people I know have either been misdiagnosed with PTSD and then find out they have OCD or they find out they have both. What did that look like for you? Elle: For me, it was a lot of not being able to focus, not being able to be present. I felt really depersonalized and/or derealized much of the time. The panic attacks again, like I said, and the memories always felt very close. They didn't feel like things that happened a while ago. They felt like things that just happened. Honestly, that's been a big difference that I've noticed with the medication is that I can say they feel they were things that happened a long time ago. It's still painful, yes, blah, blah, blah. But it happened a long time ago. The way that I would describe it at the time, I remember thinking about this metaphor, it felt like my brain was just this mass of cross wires that were sparking, and again, it felt broken. Kimberley: Yeah. That's a really interesting metaphor. I think a lot of people would really resonate with that. Memories, cross wire, everything's misconnected, and so forth. Elle: Right. Because it changes the chemistry of your brain. Kimberley: Right. Yeah. Thank you for sharing that. It's something we don't talk about a lot. It's something that I'm actually in the process of being trained on more extensively because I think a lot of people do have PTSD and it has been misdiagnosed or underdiagnosed. I'm so grateful that you're sharing about that. Thank you. I know it's not easy to share that stuff. Elle: No. I'm honestly really grateful to be able to because I think younger me would have appreciated hearing something like this a lot. Kimberley: Well, before we finish up, I have a couple of questions, not related to your mental health, but just more related to you and I because I love what you're sharing here. I'm so grateful you shared this information because I think there's a story here that I think a lot of people may resonate with or be appreciative of to see that you're on the side where you're at right now. It's very cool. What is it like to work for a CBT School? Go ahead. I didn't tell you I was going to ask you this question. You can be as honest as you want. What is it like for you to work in the work that we do? And again, you don't have to make it sound good. Elle: I'll tell the truth. I appreciate being able to share information that, again, I would have needed or has been helpful for me along this journey. Also, they're good reminders for me. If I'm writing something about self-care or whatever, then I'm like, "Okay, it's a good reminder. Okay, I need to practice what I preach." They're good check-ins. Also, doing it on social media platforms is just a really powerful reminder that, "Oh yeah, it wasn't just me. This isn't just me. Lots of people feel this way, and they also have worried that it was just them." That's really connective. Obviously, you relate to this – I need to be fulfilled by my work and I need to feel like it's purposeful and I need to feel like it's connective, and it is those things. Kimberley: Am I just the biggest pain in the butt boss you've ever had? You can be totally honest. I am totally a pain in the butt boss. I know I am. Elle: No. I do tell people how much I like working for you. You have been definitely, I would say, the most understanding and flexible boss that I've had. Kimberley: I think that's because I was going to say, nearly every staff meeting, we made it almost this time. I think every single time I go, "You're going to have to bear with me. I'm all over the place today," I have to apologize for how messed up everything is. I'm like, "You're going to have to forgive me. I have no idea what I'm doing." Elle: Right. It's like we've said in posts before, like being imperfect, it gives other people permission to be imperfect. Kimberley: Right. I agree. Thank you. When I asked this, I was like, I wouldn't doubt if she was like, "Oh boy, I feel uncomfortable, I don't want to tell you the truth." For those who don't know, Elle and I meet, and we go through probably 40 things we have to get through. We have this whole list of social media or newsletters and podcasts and SEO and websites and all these things. I think every time I started going, "I really have no idea--" I will add, which I think is hilarious, is that Elle went on a vacation recently and asked me to do some of her jobs. I actually had no idea how to do that. I literally had no idea how to do the jobs that you do for me. Thank you so much for being my friend and helping me in those moments. Elle: Yes, absolutely. Kimberley: Right. I'm like, "I have no idea how to call my own clients," or "I have no idea how to write my own email here, help me." I'm so grateful for the work that you do. I think that you have a voice. Again, you actually came on to CBT School as the copywriter, as our Chief Copywriter, and your voice is so exactly the voice we need. Your compassion and your experience and your kindness – it's wonderful. Elle: That's awesome. I'm so grateful that we have found each other. Kimberley: Yeah, me too. I'm so, so grateful. Before we finish up, tell us where people can find out about you or get your information. Besides the work we do here, where can they get your personal stuff? Elle: Yes. You can find me @griefgurlwithocd on Instagram. I spelled girl G-U-R-L, and everything else is spelled normal. I'm not super active on it, but I do love getting messages from people. Feel free to reach out there. Kimberley: Thank you. All right. Everyone, I'll link the blog that you wrote about sexual orientation OCD. They can read that too. Thank you so much for coming on. Elle: All right. Thank you. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting cbtschool.com .

Jun 25, 2021

This is Your Anxiety Toolkit - Episode 195. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Kimberley: Hello there. I have with me a very special friend who is going to talk about something so important. So, so important. I am so excited to have with us Shala Nicely. Oh my goodness, thank you for coming back onto the show. Shala: Thank you so much for having me. I love being here. Kimberley: Oh my goodness. Okay. So, probably the reason that I have been so adamant about getting you onto this episode is this topic that we are going to talk about is probably one of the topics that comes up the most with my patients and clients that nobody is talking about. Shala: Yes. Kimberley: Nobody. And I am seeing it more and more and more and more and more, which is why I wanted to have you on. So, thank you. Shala: Yeah. Kimberley: Thank you. Okay. So, you wrote a blog about depression as a compulsion. Can you tell us what does that mean? Shala: Yes. I'll start off by saying that this is one of the many subtleties of OCD. Sometimes OCD takes a long time to figure out. I spent years becoming a therapist. I spent years thinking about my own experience and when I was writing my memoir Is Fred in the Refrigerator?. It wasn't until after Fred was published, that I figured out this particular compulsion that I had been doing. By identifying it, it's been able to help me make a huge difference in my recovery, and that's why I wanted to share it and write the blog. Kimberley: Right. It's so important. I mean, I can't tell you, I've been practicing for many, many years and I only came across this in the last year or two. But the more I get to know it and the more I understand it, I'm just like, I feel like I see it in almost all the cases in some way. So, go ahead. Tell us what it is. Tell us what it looks like. Shala: So, I'll give you an example that I used in Fred, which is, when I was in my twenties, I was convinced I'd given myself HIV aids because I had gotten cut with a broken beer bottle at a party and I had spent all this time in my head arguing with OCD about whether or not that you can transmit HIV aids through that. It went on for months and months and months. While I was doing all this ritualizing in my head, trying to figure this out and prove to myself I didn't have this disease, which this was years and years and years ago, the treatments for HIV aids are much better now, they weren't. This was 25 years ago. I know people with OCD are still frightened of it. I was really frightened of it back then because there weren't very many treatments for it. And so I would spend all day long thinking about how I had given myself a fatal disease and how I was going to die. And then I started acting as though I had a fatal disease that there weren't good treatments for and I was going to get it and die. So I would go into situations and put on a happy face and smile, but in my head, I was thinking, "Oh, this is the last time I'm going to be doing this. Oh, this is so sad. Just wait until people find out what is really going on with me." So I would focus in those situations on how awful this was and how depressed I was and how this was going to be the last time I was going to do it. So, I was actually acting as though what OCD was telling me, which is that I'd given myself fatal disease, was true. And the depression that came from that became the compulsion because I took that emotion and I acted on that emotion. So I started acting depressed, making depressed choices, living in a depressed lifestyle, having a depressed attitude as I went out into the world because I had given in completely to what OCD was saying. When I realized that, again, this was after I'd written the story, after it had been published, and I started seeing this in my clients. I started recognizing I still did some of this. I'm like, "Wait a minute, it's the depression itself, which was really propping all this up." It's really a very subtle form of compulsion that if you don't recognize it can sabotage your ERP work. Kimberley: Yeah. I would admit as a young intern of treating OCD, I think if I saw this, I would have stopped ERP and focused on depression and really worked on that, which is not a bad solution, but without really recognizing it under the lens of OCD, right? So, I would have seen it as separate. I love it. Let me explain how I've seen it a lot. Once I've shown them your article, patients and clients have said, "I recognize in the moment that I'm having uncertainty. I try doing a compulsion to make the uncertainty go away and that doesn't work. So, going into depression is our easy way to just exit out of uncertainty. It's the worst-case scenario. That's where I'm going to hang out." That has been so helpful for people to be able to recognize that. It's a response to not wanting to be uncertain. Shala: And I think it's important to differentiate between depression that comes secondary to having a diagnosis of OCD from this, because a majority of people with OCD will end up with some form of depression at some point, because it's just so debilitating. It's the 10th most debilitating condition in the world. So people will end up depressed just because of how exhausting it is to manage this monster in your head all day long. But that's very different than being depressed because you've decided to believe that the OCD is true because you cannot figure it out otherwise. And OCD just wants certainty. It doesn't care what kind of certainty it gets. If it can't get certainty, for instance, that I don't have HIV aids, it's just going to go the other way and say, "Well, I'm going to get certainty that she does have it," and then go from there and then becoming depressed as a result of that obsession. So, I think that's really important for people to understand. You can have both going on at the same time too, which makes this even more tricky. Kimberley: Yeah. Even more tricky, but even great to know that we can differentiate the two now, because we'll talk later about how to manage that. Now, this is where I want to look at insight because, in your blog, you talk about insight. I think that's an important piece of this, right? Because when you first have the onset of OCD, you might recognize that this is like ego, what we would call egodystonic, like this stuff. "I know it's not true, but I keep fearing it's true." Can you share how insight impacts this specific situation? Shala: Yes. In fact, it was Jon Hershfield who introduced the two of us years ago, who helped me put this insight about insight together, because I was talking with him about this depression is a compulsion. What he pointed out is that typically, when an OCD obsession starts, you're doing compulsions to try to prove that it's false. If you can't get that to work, which of course you can't because there's no way to prove all this stuff that I see he's worried about, then sometimes you can start going the opposite way and trying to prove that it's true. Really that's the difference between insight. When you're trying to prove that it's false, then you know that what OCD is saying in some part of you is nonsense. "I don't have HIV aids, come on." Not like in a reassuring way, just there's a part of you that still recognizes, "Yeah, this is super scary, but this is OCD reacting to an intrusive thought. This isn't actually a real problem." So, you've got that insight there. You're still stuck, but you got insight. When you start trying to prove it's right, that's when you've lost insight. When you really give in to everything that OCD is saying, really hook, line, and sinker, and you don't have any insight anymore. That's really when this depression as a compulsion becomes a big problem. The longer that a particular obsession is maintained by doing compulsions, the more likely you are to lose insight, the longer it's been going on. Kimberley: And this is where it's hard, isn't it? Because we know the whole story of when you stare at something for too long, it starts to look weird and distorted. I think that's very much true here. I think it's true of depression in general and in this subtle compulsion. When we look at things as negative, we notice more and more things that are negative. Is that what you feel to be true here? Or is it just the same story that you hear over and over? Share with me how that might sound in your head. Shala: I think it starts to sound like a soundtrack for my life because most of my rituals became internal. And the way I see mental rituals, it's physical rituals taken inside. So you can't do things physically because you don't want people to see or whatever. So you start pulling it inside. The more that I would do that, the more I would argue with OCD, of course, the more I'm strengthening in it. So the more I hear it and the more I argue, it just expands to fill every waking moment. It really becomes a soundtrack playing 24 hours a day because I was doing those mental rituals. And then the longer that that went on, the more likely I was to start becoming depressed because I was losing insight, which then also further reinforces this cycle. Kimberley: So interesting and so helpful. One thing that you talk about is emotions as a ritual. Can you share how this may play out with other emotions such as – you've written guilt and shame, regret and grief? Shala: Yes. So what I'm going to do to describe this is I'm going to take you through the OCD cycle in some anatomical details, so to speak, so we can piece together how this is all happening. So you have an intrusive thought. That is not OCD because everybody has intrusive thoughts. The OCD is the next stage where OCD reacts to the intrusive thought – "Why did I have this? What does this mean? Am I going to do it? Am I going to make it come true because I have the thought?" That reaction, that's the OCD. Of course, that makes you feel anxious. And then if you haven't had treatment, you typically do some form of compulsion, something to try to get certainty about what the OCD is bothering you about, because this is all based on an intolerance of uncertainty. And OCD just picks content that you care about and puts uncertainty about it in your mind and then gets you stuck in that cycle. When you do a compulsion, it tells your brain that this is a dangerous thought, "This intrusive thought I had is dangerous," and you need to keep doing something about it. These steps just repeat on an endless loop. And then what happens is that when it repeats on the loop long enough, the acceptance of the scary thoughts that OCD is presenting causes you to experience the emotions that you would feel if those stories were true. Those emotions tend to be things like depression, as we've talked about, guilt, regret, shame, grief, and others. And then in classic cognitive behavioral therapy perspective where our emotions and our thoughts and our actions all come together in this triangle, the emotions then dictate how we act, so we begin to act depressed or guilty or regretful or shamed or grief-stricken. Those emotions can then become compulsions because they're driven specifically by believing the content of the OCD, by acting like what OCD is saying is true. That's the definition of doing compulsions. So that's how emotions can become part of the compulsion cycle because you start acting as though they're true. Kimberley: Right. This is so true and this is where I see it play out a lot, is when people have an intrusive thought that they've done something wrong, and then they feel... Because they start to believe it, they go into regret and then they go into confessing, right? Then they'll go into like, "Well, I have to confess it because I've done something wrong," instead of that they had a thought that they did something wrong. Or that they feel such deep guilt that they're saying things like, "I'm a terrible person. I'm terrible. And I'm so guilty. What kind of human am I?" because of a thought like you've just described, how then that plays out and keeps playing out over and over again. Let's play out because we haven't really talked about this, but what would the action be as a result to regret? It would be reassurance seeking or confessing. What else would you say? Shala: Maybe going back in your mind and trying to undo it and, "Gosh, what would it be like if it had only gone like this?" Almost like a wishing compulsion that I think [14:22 inaudible] talks about in his book. All sorts of things like that. Kimberley: What about guilt? Similar, but what about guilt? Shala: I think with guilt, it's a lot of self-punishment as a ritual. "I'm bad. I did something bad." With guilt and shame, guilt is, "I did something bad," shame is, "I am bad." I think in this case, those can get conflated together and people just start punishing themselves. "Well, I don't deserve this because I did this bad thing," or "I am this bad person." They start being very uncompassionate with themselves and treating themselves like they're this horrible human being. Kimberley: Right. And that's a big part of how I see it play out is that the self-punishment is pleasure withholding, like you don't deserve the nice-- it could be as subtle as you can't have the nice brand of crushed tomatoes. You have to have the crappy brand because you don't deserve good things or you don't deserve the nice sheets or so forth. And that will make you feel-- when there's no pleasure in your life, you get depressed, right? I think that's a very subtle way that OCD plays out. I've heard lots of people will say, or the flip side is they'll say something like, "Oh, because I have harm thoughts about my child, I have to buy them the best diapers," which is treating yourself as if you've done something wrong. Shala: Yes. You're making up. Kimberley: You're making up for something that you had a thought about, right? Shala: Yeah. Kimberley: Right. It's so subtle. What about grief? Can you kind of give an example of that? Shala: I think with grief, it's pre-planning things. So, for instance, I'm not kidding you, I've pre-planned my funeral in my head – "Well, this is what it's going to be like. It's going to be so sad and I wonder if this will happen and that will happen," as though it's an event two weeks from now on my calendar, Shala's funeral. So I think it's almost like you act like the loss has occurred already and you begin to start going through the grieving process. People with OCD tend to be really empathic people, so it's really easy to go there. It's easy to put yourself in that, "Oh, so-and-so has died. This horrible thing has happened. Let me go ahead and get into that grief state," because we're just good at being able to put ourselves in other people's shoes to imagine what something would feel like, and to feel it as though it were happening. Kimberley: It's so good. All right. So-- Shala: Can I say one more thing? Kimberley: Of course. Shala: Sometimes I think of these as fake emotion. They're not, right? But they're OCD-induced emotions. Kimberley: They're manufactured. Shala: They're manufactured. They don't actually fit the truth of the situation. I'm not saying they're fake like, gosh, the shame you're feeling or the guilt you're feeling isn't real. Certainly it's a real emotion, but I think it is induced completely by the OCD, as opposed to being induced by a situation that has happened in life. Kimberley: I agree. And that's where that insight is really important, right? Is to be able to catch that. I fully agree with you. I'm so glad that you recognize that because people will say it feels real, right? It feels real. And then I'll always follow up with like, "But it's not a fact." But still, it's important to have that conversation. Now, I want to just jump in here. Before we talk about how to break this cycle, how might this play out with just Right OCD? Shala: I can give you an example from yesterday about this. Kimberley: All right. Shala: I decided I was going to get these floating shelves and hang them on the wall. It requires using a drill and all sorts of things, which I can do, but I'm not very good at it. I also, I guess, was sort of distracted and I'd had problems with one of them and with the drill, as I went downstairs to do the other one. I put the shelf a couple of inches too high because I used the wrong mark on the wall, probably because I was exhausted from having drilled drywall over the place and making a huge mess upstairs. Once I got the shelf installed, I'm like, "Oh, what's that little mark on the wall? Oh, that was where it was supposed to be, a couple of inches higher." I am not redoing it because it made a huge mess in the wall and it's going to have to stay there. My OCD put this little feeling in my stomach. "That's just too high. It's wrong. It's horrible." I could feel it. Like, I feel it right in my solar plexus, this little tightening, like, "Oh, we can't stand this." What I decided to do, because I am not moving that, I just say, "OCD, this is great. I am so glad that shelf is at that level. I'm glad, number one, because it's upsetting you. But number two, it actually probably is a good level because I have a big dog who likes to bounce around on the couch. This is above the couch. If it's actually too low, he's probably going to knock his head on it and knock it over. We're just going to live with it. There are some good things about it being at this level, just like there's some good things about it being at another level. I'm just going to smile and be happy every time I see that shelf." So, when I see the shelf now, I really try to have good, positive, happy emotions about the shelf being at that level and tell myself, "We're not changing it. OCD, if you don't like it, fabulous." Kimberley: Right. But originally, was it that you would slip into a depression as a compulsion? Shala: Yes. So, what happens with Just Right OCD that can have this same thing go on is we look at the shelf every day and go, "Oh, it's ruined the house. The house is not perfect because the shelf is in the wrong place. If we could just move the shelf down." And then you envision moving it down, but then you think, "Oh my gosh, it's going to open up more holes in the drywall, and then I'll have to fix that. I can't do that. If I'd only been paying more attention." Everybody can't see this because they're not watching the video of this, but if you can see my posture, it's like-- Kimberley: It is. You're getting low. Shala: Like, "I screwed up and now it's bad and I'm depressed." And then every time you look at it, you have those regretful thoughts and you think about, "Gosh, how I'd like to change that." And that causes more regret. And then that fuels the whole emotions as a compulsion cycle. Kimberley: Which is interesting. I think this is true for any subtype. And you may correct me on this. The thought that I hear the most is, "This is going to bother me forever." That's where I feel like the depression as the compulsion set seen as like, "You'll never have happiness again. This is going to be the worst." And then you go actually, like you sunk down into that. You sunk in and you stayed into that kind of mindset. Is that an example you would give as well? Shala: Yeah. I think with any Just Right OCD, it's this feeling that life is somehow ruined because this thing is wrong. Ruined means forever. It's all blurry, black and white like you were saying. So it feels not only unfixable, but unbearable, and then giving into that and then acting as though this unbearable thing has happened, then becomes the emotions as a compulsion. I think this is probably pretty common within the whole Just Right OCD thing, is having so much regret that it's not right, then act as though that regret were true. Kimberley: Right. Well, okay. So, that's the perfect segue, is how do we break this cycle? How do we intervene? Where do we intervene in the cycle? Shala: The way that we intervene in this cycle, through exposure and response prevention obviously, is doing the acting as though the content that OCD is threatening you about or bothering you about is irrelevant. Let me start out by first saying how people tend to make mistakes doing this because I think this is important. So, as we know with exposure and response prevention, we're exposing ourselves to the uncertainty of the obsession while not doing compulsions. If you have emotions as a compulsion, depression as a compulsion, you can do an exposure. Think you're not doing compulsions because you're using scripting to get out of your head. You're not asking for reassurance. You're not doing your physical compulsions. But you're still bummed out, regretful, ashamed. So you're doing it while in your head, really spending a lot of time in that emotion. So you're really doing exposure without response prevention. You're doing some response prevention, but you're not doing enough response prevention. So the exposures don't work very well. People can get stuck in this cycle where they're doing ERP over and over and over again and they think that they're getting rid of all these components and they're not getting better. It's probably because something like this is going on in the background where they're still, at some level, believing this and acting as though it were true. So, that's where people make mistakes. What we really need to do here is find that little bit of joy because it's there. It's probably been so covered up by the OCD, the depression, whatever other negative emotions you're experiencing, that you don't think it's there, but it is there. You can take yourself back to when you were really happy about whatever it is, like, say that you think you're going to harm your children. And you can remember times that you were with your kids where this wasn't bothering you. So, you take yourself back to that and you think, "How was I acting? What was I doing? How was I feeling?" You find that and you go do those activities and you focus on that joy. So, when the OCD says, "Oh no, we can't, we can't. You're irresponsible. We were going to kill them. We're going to harm them. We have to focus on how bad we are," you're like, "Nope, I'm going to focus on how much fun my kid is having in the pool. Isn't this great? It's a sunny day. Really enjoying it. It feels so nice to be out here. Look how happy my kids are." You just find all of the joy you can and you focus on the joy. What we're trying to do here is act as though the content is irrelevant. So, if you're acting like it's relevant, you're standing in the pool with your kids going, "Oh my gosh, this is terrible. I'm going to kill them. They're happy now. But just wait until I kill them and their mother finds out or whatever, that it was me." Or you can be in the pool like, "This is great. I love spending time with my kids. This is awesome. Look how much fun they're having. They're doing so well with their swimming. They're having a great time. They could probably stay in here until they turn blue. This is great." You're acting like all that stuff in your head about the fact that you might harm them doesn't matter. And that's the essence of good exposure. It really takes this finding joy because you want to do the opposite of what OCD is saying. OCD says you should act depressed, regretful, ashamed. So you say, "I'm going to do the opposite of that. I'm going to act happy, jubilant, carefree." And that's how we do these exposures. It's not easy, but if you get good at it, it can be really revolutionary in terms of your recovery. Kimberley: I love this. So, I'm thinking of one particular person right now, and it's a follower actually. What would you say, because I love everything you're saying. What would you say to the person who then may start to do that as a compulsion too? Shala: Yes. I think that OCD can turn anything into compulsion. Kimberley: It's so skilled. There's such skill. So Shala: Yeah. I think that that is a potentiality for anything that we do with ERP. We are not doing this to make your anxiety go away. In fact, you're going to be more anxious while you're trying to find this joy because you don't deserve to be joyful. It is not responsible to be joyful. It is tempting fate to be joyful. So you're going to be-- Kimberley: Irresponsible is the word. Shala: Yeah. You're going to be having maybe 5% joy and 95% anxiety if you're doing this right. If you make this compulsive, you're doing it to reduce anxiety. I'm so glad you brought that up. That is what we're looking for here, is this is going to make you more anxious. And the more that you do it and really find the joy and act like you're having fun anyway, eventually, the anxiety will subside. Who knows when? It may take hours, days, weeks, months, whatever. But that is not the goal. The goal is to be in the situation while being anxious. And the more anxiety, the better, right? Because that means you're giving your brain a good learning experience. That means that you're doing things that help you tame OCD and reclaim your life. Kimberley: Right. Thank you so much for sharing that because that's such a crucial piece – to be able to integrate joy and anxiety in the very same moment. If you could do that, you're winning, right? You've won, because OCD wants you to integrate anxiety and depression at the same time. So, I love that that is the way to give OCD birth ultimately, is to show that you can do that. I love it. So, let's talk about one more thing. I want to be respectful of your time. Someone has had OCD for a long time, obviously, because this has gotten so stuck. They're having a lot of this depression as a compulsion. We're asking them to find things that used to bring them joy or look back to a time where they could integrate anxiety and joy at the same time. What are your thoughts around "Fake it till you make it"? Is that an approach that you would consider? I know you've talked about other ways. Would you like to share your thoughts on it? Shala: Yeah. I mean, there's nothing inherently wrong with the "Fake it till you make it" stand, except for if you're saying you're faking it, you're saying that there is no happiness there. And that's almost giving in to the OCD once again. So, what I like is a different way of phrasing it, which comes from a woman named Heather Hansen who wrote a great book called The Elegant Warrior. We've both been on her podcast. What she says is, "Show it till you grow it." I love that because that acknowledges that the positive emotions are there. The OCD is sitting on them and squishing them and you can't feel them, but they are there. That also reinforces this notion that the OCD, this is a bunch of content it's making up. It doesn't feel like that, but these are things that it has imposed upon your life to make you worry about them. But you've got this great life that sort of smushed down underneath it. And you just need to find a little bit of what that great life used to be and find that and grow that. It's almost like if you think of a black canvas and then there's a little pinprick of light, sunlight and it comes through as like a ray. And then the ray comes through and it starts to makes the black cloth start to have the hole, get bigger and the sunlight gets bigger. And then the sunlight comes through and eliminates everything. That's what we're talking about here. It's just a pinprick. It's a tiny bit, but it's really there. If you say you fake it till you make it, you're not giving yourself the empowerment you deserve, that it is in you. It is there. You just don't feel it because of the OCD. Kimberley: Right. It is. It's like a muscle that you grow. I agree with that. I think that that is exactly perfect for it because, like anything, if you're trying to get 100% joy, you won't get any joy. But if you give yourself permission-- because we can get perfectionistic about this and be like, "Well, no, this used to bring me so much joy." So I think you're right. It's just little baby steps and little baby pinpricks is the way. Shala: I'm so glad you brought that up because like all of us with OCD can make things compulsive. We can also try to do our therapy perfectly and try to do these exercises and go out and be like, "But I wasn't totally happy. I did have some intrusive thoughts. I did feel some depression." Yes, of course. You're going to. So, I think recognizing this is a process and what we're trying to do is find the 1%, the 0.05%, the 3%, the 15%, whatever it is of joy and focus on that. Yeah, you're going to have those depressed feelings. They've been there for a while. By the time you have depression or other emotions as a compulsion, it's probably been there a while. So, this process of ERP is also going to take a while and it's challenging and it's hard. So, you're not going to go out and do this perfectly. You're not going to go have some awesome experience with your kid. You're going to be acting as though you're having an awesome time. You're going to be trying to focus on that in your head. But the vestiges of the OCD and those other emotions are going to be there. Let it be there. We're not with this trying to shove those away necessarily and not feel them. What we're trying to do is focus on the ones that actually match the ERP, which is, if I'm going to go focus on being with my kids and having fun, that's what I'm going to focus on. Not this other stuff that's going on over there. But give yourself permission to have this be a messy process because it is and do it imperfectly because you're going to, because everybody does. It's going to take a while, because it took a while for all of us with this to get there. It's going to take a while to unravel it. And then even after you unravel it, it can still come back. I still have to watch for this one. If I get triggered with something that is a really high-level item for my OCD, I have to work on this sometimes too, because it's easy for me to sink back down to this because I did it for so many years. Kimberley: Which I'm so grateful that you share that because I think that for those-- and I want to make sure I just did it before we finish up and I want to hear about what you're up to these days is, the treatment for this is actually similar to the treatment of just depression too. You're working double shifts here, but in a good way. You're working on two things using the same tool. So, do you have any feedback on that? Shala: Yeah, that's a really good point. I hadn't thought about it like that before, but it's very much a behavioral activation approach. Behavioral activation is used in the treatment of depression to help people start to put activities back in their lives that gave them pleasure and that gave them some feelings of mastery. And that's what we're trying to do with the added component of "And let's focus on that pleasure. Let's focus on that feeling of mastery. Those other feelings are going to be there, but let's focus on the way life used to be before the depression came in." So, yeah, it is a very behavioral activation type approach here. Kimberley: Oh my gosh. I love it so much. It's so good. I feel like everyone needs to be trained in this specific area because it's such an important area that gets missed and missed and missed and missed. So, you're like brilliant, brilliant in my mind, as you already know. Shala: Well, thank you very much. Kimberley: Okay. Is there anything you want to add before you tell us the way we can find out about you? Shala: I don't think so. I think we've covered everything. Kimberley: Okay. Tell us where people can hear about you, your blog, and all the amazing things you're doing. Shala: They can go to shalanicely.com. On that website, you can sign up for my newsletter, which is called Shoulders Back!: Tips and resources for taming OCD. I send it out every couple of weeks and it has some sort of new resource I've created or been a part of every time I send it out, free resources to help people learn how to effectively tame OCD and reclaim their lives. So, that is where you can go. If you want to read more about this, this particular blog is on my Psychology Today blog. It's called The Subtle OCD Compulsion that you might not know you're doing. Again, you can go on my website and it'll link back to all the Psychology Today blogs as well. Kimberley: What about your book? Shala: Yes. So, both books, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life and Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully, which I co-wrote with Jon Hershfield. You can learn more about those on my website or on Amazon or anywhere that you buy books. They're both available on audiobooks as well. Kimberley: Right. Let me do a plug for your book because I have had so many of my patients say it's the first time they wanted to hand their book to everybody because it was exactly how it felt for them. I have so many clients who bought a copy for themselves and a copy for their parents because their parents were like, "Oh, this is what it's like to be you. Now, I finally get it." So, I'm so grateful you did that beautiful book. Shala: Well, thank you. That's the whole reason I wrote Is Fred in the Refrigerator? because I wanted people to understand how it feels to have OCD. If you have OCD, I wanted you to understand that you're not alone and that there is hope that you can get better. You can tame OCD and you can reclaim your life. Kimberley: Right. Oh my God, thank you so much for being on today. Shala: Thank you so much for having me. It was fun. Kimberley: Such important information. I can't say it enough. So, so important that we're addressing this more. I think that this can open it up to everybody having a better understanding. Shala: Thank you again. Website: shalanicely.com Is Fred In the Refrigerator: https://www.amazon.com Everyday Mindfulness for OCD: https://www.amazon.com Psychology Today blog ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .

Jun 18, 2021

This is Your Anxiety Toolkit - Episode 194. In today's episode, I had the most amazing conversation with Hayden Dawes. Now, Hayden Dawes is a therapist, a PhD student. He is what he calls an "aspiring compassion warrior" – we talk about in the interview what that means. Hayden is just doing some really cool work. As I share, and we go into detail in this episode, he's really brought out some stuff for me as I've watched him and learned from him. It's been incredible to see this journey that it's put me on. So, I cannot wait to share this episode with you. We're talking about radical permission, writing compassion slips for ourselves. We're talking about being petty. It'll make sense when we get there. It's just such a beautiful conversation. So I'm so happy to share this with you. If you haven't already, please do go and leave a review. The reviews help us reach more people and gain the trust of more people. So, go ahead and leave a review wherever you listen, and let's get onto the show. Twitter and IG : @hcdawes Website: hcdawes.com FB Group https://www.facebook.com NEWSLETTER: https://www.hcdawes.com/newsletter ----- Kimberley: Okay, welcome. I'm actually so excited to have this conversation. This was a really, really great one to me because I have with me Hayden Dawes. He is an aspiring compassion warrior – which I can't wait to hear more about what that means – a PhD student. He is a social worker and has been practicing for many years. So, thank you so much for coming on, Hayden. Hayden: I am so excited to be here, no one else can see us, but to see your smile, just to see a little of me. That just makes me even feel more welcome and more excited to be here. So, thank you. Kimberley: Yeah. I'm really excited. So, let me fan go on you for a second. For those who don't know, and you'll hear all of Hayden's work, Hayden has these really cool Instagram profile. I love the work you're doing with compassion, but we're also going to share a couple of other things that I love about your work. We'll talk about that here very soon, but tell me about the work you're doing around like an aspiring compassion warrior. Tell me what that means and how you are putting that out into the world. Hayden: Yeah. So, one of the things, I was raised in the Catholic church and Roman Catholic, and I've looked for different faith traditions, things that felt close to me and really fit my experience. So, stumbling upon Buddhism and more contemplative practices like Quakerism and Buddhism, and finding the idea of a Bodhisattva, someone that is willing to just do the tough work of delving deeply into what it means to be human, the suffering piece to it, and learning from that experience and then trying to help others along the way as we're all on this human journey. So, I said, "Bodhisattva is a mouthful. Why don't I call myself a compassion warrior?" And part of that is delving deeply into my own stuff, my own pains, and challenges so that I can learn more about myself and be compassionate with that and I can be compassionate with other people. Kimberley: Yeah, respiring. I actually think you're a warrior. I don't think you're aspiring. You could drop the aspiring. Hayden: It's interesting. Sometimes I do, sometimes I don't. It's like, I think part of the journey is like, "Am I really aligned with that completely? What does the aspiring mean?" Sometimes taking it out of like, "Let me hold closer to this idea that this is what I am." So, I think that's influx too, but I appreciate that. Kimberley: Yeah, of course. Okay. So, we talk a lot about compassion here on the show, but I love those little twists that you bring into it. So, I'd love if you could share, you're often talking about the permission slip. Can you share it with everyone, for those who don't know what that means? Can you kind of give me a little rundown of what that is? Hayden: Yeah. So, back in 2018, I had a friend of mine share on Instagram, a haiku a day for 100 days. I thought, "I'm not counting out all of those syllables." But what I can do is following up on the work of Brené Brown. I was like, "I can write a permission slip to myself a day." I can slow down and center myself and think, "If I think about the whole day that I'm going to have, what is it that I most need? What is the thing that I might need to give to myself?" I also know from my clinical practice, and I'm sure you can relate to this, people will come in and they'll say, "I'm thinking about doing this," or "I'm thinking about doing that," and like, "Sweetie, let's slow down. You probably know exactly what you need to do." "What do I do?" I'm like, "Yeah, you're looking for me to give you permission to do that." So, I thought, "Well, what if we can just skip through that step?" What would it be like for me to start a practice that I was like, "I'm going to offer myself this permission to do whatever that I might need in the world for myself." Kimberley: Why do you think people need permission from other people first? Hayden: Yeah. I think there's a lot of different factors, but I think we have a lot of different noise, societal noise about who you're supposed to be, who you're supposed to love, how you're supposed to walk in the world. I think some of that noise trickles into our family spaces. A lot of us are taught to really trust our own intuition, our own inner guide. I might even argue the God that lives within us. So, we end up delegating that task to someone else because we've been practicing that, rather than really slowing down and listening and honoring the wisdom that dwells. I believe in each and every one of us. Kimberley: Okay. So, I love this, and I think that's so important, particularly for my community who have a tremendous degree of anxiety. They've sort of lost touch with their own guide and their own wisdom because fear runs the show all the time. And I think that's true for anybody who has fear, but especially the folks who have an anxiety disorder. So, I love that. Okay. So, can you walk us through? What would you do? What do you say like WWHD (What would Hayden do)? Hayden: Yeah. If I'm feeling really anxious, maybe my permission slip is, "Hayden, give yourself permission to just breathe." Or if that feels like too much, "Hayden, give yourself permission to feel your anxiety. Hayden, give yourself permission to feel your feet on the floor. Nothing else, nothing more, just feet on the floor." If your anxiety and sort of the thing that you need, you know you need to do is have that tough conversation. "You know what, I'm going to give myself permission to be assertive and to ask for exactly what I need." Kimberley: Yeah. I love that. So, it's in that compassion realm. It's got like the real boundary-setting one, but also the gentleness. So, there's both those pieces to it in many situations. I know on, I think Twitter, on Instagram, you post these. Are these ones that you're writing because you really needed to hear it yourself, or is it that you had a session with someone and you wanted to put that out for other people? How do you do it? Hayden: Yeah. What a great question. Honestly, all of my permission slips that I've written are generally for myself. I want to think that is what connects with people. They know I'm not a phony. They know I'm not trying to sell them some program that I'm not trying to work myself. I have not scheduled any of my posts really thus far when it comes to my permission slips. So, the ones I put on Twitter and oftentimes the one I put on Instagram, sometimes I'll pull back an archive of what I did in 2018, just to show people that I too am on this path, because I do think throughout my day, like, "What is it that I need?" Oftentimes with me, and I'm sure many of your listeners can really understand this, that I am someone that does a lot. So, if anything, I need a lot more like parasympathetic energy, giving myself permission to rest, giving myself permission to foster self-love and self-acceptance. But then there might be some people that your permission slip might be a little bit more of like, you need to get up poo and you need to go. Kimberley: Exactly. I know it's true. It's true. As you were saying that, I mean, my permission slips, I could write them for the next month. It would say, "I give myself permission to rest." I know it's going to say that, but there are other people who will need for the-- they'll probably be able to recognize that their permission will need to say like, "Face your fears and do the scary thing." So, that's beautiful. Hayden: Yeah. So, just to give you a little bit more of the story, I didn't know how much of a big deal that permission slips would be to my work until I was meeting with someone that was helping me to think about my social media a little bit with more strategy. She said, "Hayden, these permission slips are really cool. This is something that I think I could do," my friend, Emily. And I was like, "Really? I didn't see it." That was maybe two or three years ago. And then what happened was, last spring when I felt like COVID was making our world so much smaller. I was talking to my therapist and she was saying, one of the themes that kept coming up was this sense of reminding people the autonomy that they have. And so one big facet of this is permission slips remind us that we have the ability to choose. Even if you decide not to do that thing, it's so much more empowering to recognize that you're choosing not to do that thing. So then what happened was, I said, "Well, what if I open the permission slips for 14 days on social media?" My following was much smaller than it is now. I did it for 14 days, just how powerful it is to have a collective practice of people all over the world, all over the country, writing permission slips, because there's something so magical in that by you seeing me give myself permission. It's contagious. You then give yourself permission. Kimberley: I agree. I think that's why it's so powerful, right? It's interesting because-- and I hear people say this to me often too. I think people see therapists like, they're got it all together, which I most definitely do not. I'm not afraid to admit it. I'm totally fine with that, but I still am shocked. I tell people, I share my story because we're going to break the stigma that therapy is like this idea that you just get better kind of thing, like we're still so human. I love that you're a therapist sharing it, because I do think it helps people to recognize like, "Oh, that's not the goal. I'm not supposed to be perfect. I'm going to be giving myself permission forever." I love that you're doing that. Hayden: Yeah. It reminds me of-- I don't know, I was jabbering about something with my therapist. She was like, "Are you trying to hack the human out of this process?" And I was like, "I'm trying to hack the Hayden." It took me weeks later. I was like, "Gosh, she's so right. I'm trying to do this without feeling any discomfort." And that's not going to be possible. How beautiful is it that I can practice giving myself permission by practicing self-compassion literally for the rest of my life. Kimberley: Isn't that beautiful? Hayden: Yeah. I don't love it, but it's beautiful. Kimberley: It is beautiful. I actually have a book coming out on self-compassion for-- Hayden: Congratulations. Kimberley: Thank you. Yeah. It's not out yet. It'll be out in October. But a big piece of it is, if you can hold space for your pain, you're sad because you will have pain. We're not going to avoid it. But if you can always be that frontline person, that's what these permission slips are, right? It's you being at the front line. Hayden: Oh my gosh, I love what you're saying. Now you're making me think. If you hold space for your pain, you hold space for everyone else's. I think so much of the inner work really brings out an outward change. You feel so much more connected to the people in your life, maybe it's your children, your partner, it's your boss. And then you see the world just so much differently and you see yourself differently and you stop looking at other people's thinking. Like you said, they have it all together and they live these beautiful airbrushed social media lives. It's like, "Oh, we're all trying to be a part of this world and figure it out." And no one is ever done. If they tell you're done, I got this for you. They're lying. Kimberley: Well, they're completely in denial. Hayden: Right. Kimberley: Right. It's so true. So, I think I love that you're giving this very simple but impactful tool. So, thank you. It's so cool. It's so, so cool. I have one more question about that before we move on to the other piece of the work, which is, do you actually write them out? I mean, you do because you're doing it on social media, but I know with Brené Brown, she has had-- you can actually write the permission slip, like it was like, you're getting a permission slip to leave school early from your parents. Do you write them? Are you now at a place where you can just stop and think it through? What has been your progression with this? Hayden: Good question. No one's ever asked me that. So, for me, I generally write them and I think that has been a good practice for me to slow down and stop. But I had a conversation with a friend who has been writing his permission slips, and he said that he's noticing that he'll fall into giving himself permission. And then later he can say, "Oh wow, I just allowed myself to do that." Kimberley: It's just a new habit. Hayden: Absolutely. I really have to sit back and reflect on that to think about, what are the times that I'm just allowing something to happen that I generally wouldn't have allowed to happen before in the past? Kimberley: Right. Oh, I love it. I do. I really do. I really encourage people to go and follow you because I do think it is-- even though I know it's perfect for us and it's ideal for us to be doing it on our own, I do think it's lovely to have it be modeled for other people. I think that that's really powerful. Hayden: Oh, I have to jump in. I think for me, if you think-- so I actually had a class assignment where I had to really conceptualize what I think radical permission is. Honestly, I think there's three levels to it. It's nested within a community. And then the community has an instructional leader. I think of myself as that leader, as someone that is modeling both how to do a permission slip and also modeling how to support others with their permission slips. And then the final component of that is the self-practice. Kimberley: Right. Hayden: But one piece can exist without the other. If not, to me, I don't think it's radical permission. It's just not. We don't exist in containers. Some of the more Western mental health practices, especially in the last 30 years, are so individually focused. Kimberley: Yeah. I know I've got goosebumps listening to you say that because it is so true, isn't it? Hayden: This is a community endeavor. I think that's one of the elements of what makes it radical. Kimberley: Yeah, I agree. Hayden: But yet, one of these components can exist without the other. Kimberley: Right. It's the unlearning, isn't it? Right? So, as a child, if you're in an environment that doesn't support this kind of work, if you're in an environment where there are people, it is the unlearning of that. It's so important. Hayden: Yeah. And the unlearning, I just want to validate for people out there, is so exposing, so vulnerable, so raw. Kimberley: Right. Hayden: When you push someone trying to help you experience your own power and your own sense of autonomy over your body, your thoughts, and your ideas, and then your behaviors from that, wow. Kimberley: Yeah. It is. It's funny. I love when I have these teen clients and we're talking about a concept. I can see them shaking their heads and they're like, "Nope, nope, nope. Not going there with you. Nope. No, thank you." They'll roll their eyes or something. And then upon second and third conversation, there's a body shift for them. I'm like, "Really? I can do that? Really?" Interesting, right? And then there's a total body shift. I think, I mean, I'm just so grateful you're doing this for people all over the world. So, it's very, very cool. Hayden: Thank you. Kimberley: Yeah. Oh my gosh. Okay. I'm so geeked out right now because I love compassion, but I just really cannot wait to talk to you about this. I'm so curious-- Hayden: You can hear me fumbling around this. I just want to put that on the table. Kimberley: I'm going to fumble too because really, I don't-- let's just fumble together. Right? I follow Lisa Renee Taylor and she always says "Stumble bravely." And so I'm like, "Yes, let's stumble bravely." You on your Instagram have Petty Tuesday. Now, I'll be totally open with you. The word "petty," I had this visceral body experience. When I first saw this, I was like, "What is he doing?" These were like petty because in my mind, "petty' just had this connotation to it. I think again, it's the unlearning, right? It's the unlearning of like, "What, wait, we're going for petty? What's he doing now?" Hayden: Oh my goodness. Kimberley: But now I'm hooked on it. I love it. I can't get enough of it. And that's the thing, right? It's the unlearning. So, let's just go from the start. What is Petty Tuesday? Hayden: So, something was happening in the national headlines and I was just like, "Really? come on." It was like hearing about one of these talk show hosts having a really bad, toxic culture. I was like, "What on earth?" And so I just started talking on my stories about it. I literally would talk about it with my friends like, "This is a really messy situation. People are being harmed and people are being hurt." I was like, "Not to be petty about it. I mean, Petty Tuesday." And then people started DM-ing me and laughing about the fact that I said "Petty Tuesday." So then I just started incorporating it because I honestly started having fun with it. It feels really playful. Kimberley: It is. Hayden: It's interesting because I looked up the word "petty" and there's all these different definitions. But the one that I really like is, it's childish. It really is childish. It's playful. It's an opportunity. It's an invitation not to take ourselves too seriously. Kimberley: Yeah. You see, this is why I loved it. So, I have a Buddhist training too. I've really been working for many, many years – I had an eating disorder – since my recovery on, like trying to read petty. We don't want petty, right? We don't want to engage in too much anger because that's got its own pain and suffering with it. Not that I'm saying any of these things are bad, but then you're totally leaning in over here. Hayden: Yeah. I think the sort of idea of toxic positivity and how broken that is, and I think there's some wisdom about honoring our pettiness. not honoring it to be fixed to it, but to realize that there's space for it, because you either acknowledge you're petty or your petty will really rein you. Kimberley: Yup. I just love-- so the reason that this showed up for me and there was a shift for me, like I said, there was a three minute, like, "What is he doing over there?" And then it was like, "Wait, what he's doing is he's practicing non-judgment." And now I'm watching every Tuesday and then people are posting their petty things, and I'm just like, "This is so great." We're having an emotion and we're not going, "Oh, that's so bad. I shouldn't be feeling that way. What's wrong with me?" and all the things. We're just going, "Yup, it's petty Tuesday. That's what we do." Hayden: Yeah. I think there's something about the discipline of doing it on one day in particular that I have some people-- honestly, I completely stumbled, well, not bravely, but I stumbled into this, and now everyone's like, "Oh my gosh, I love Petty Tuesday." I will be honest, sometimes it's become a piece of, I'll use a term "brand" that I'm like, "People really like this?" but like, "No, I see myself differently than this. I see myself cross-legged on some mountain." But everyone's like, they're feeling seen by it. It's not-- Kimberley: I think it's the opposite of the position. The permission slip, when I think about it, that might be why I'm hooked because, on the permission slip, you're giving permission to do this beautiful thing. With Petty Tuesday, you're giving yourself permission to be around emotions that we would usually disavow. You've just got this whole spectrum going on. Hayden: You are articulating some parts of my process that I have not quite figured out yet. How much do I owe you for this session? Kimberley: No, actually, I'm trying to figure it out myself, right? Because this is why I really think, okay, so I'm a consumer in this perspective. So this has been learning for me. And even noticing in myself like, "Oh, isn't that interesting?" My first reaction was like, people can't see my hand over my-- petty. Hayden: It's taboo. Kimberley: Yeah. Like, "What are we doing here?" Hayden: Yeah. I think part of it is, being a gay man, it's like, pettiness and kind of cattiness, that's what the stereotype is of gay men. Yet, it's part of our culture. I think there's this idea of why folks love RuPaul's Drag Race is because it leans into the non-seriousness of living and how really a lot of these constructed boundaries about what's okay to do and what's not okay to do is socially constructed. So we have to socially deconstruct them, or to use your term, unlearn them. Kimberley: Right. I love it, and you do it so well. And this is why I love it, because if I think I did Petty Tuesday, it would just be like a venting session. It wouldn't look the same. Hayden: Well, yeah. I mean, it's interesting. I was going off about a celebrity couple that got back together. And then later, I felt guilty about that. I was like, "You know what? I felt like I went too far with that." But this is where the compassion works, is helpful. It's like, yeah, that might've been a tiny bit mean-spirited, but in the big scheme of things, it's not that big of a deal. Also, it's like, it's been so transformative for me to recognize that I can use my voice and the power of my ability to communicate. I might hurt people, and there are times that I have hurt people in my past. But wow, does it feel great that I can be accountable to my word and say, I'm sorry? I often think we wouldn't need a cancel culture if we allowed more space for radical accountability. Kimberley: Yup. I agree. No, I'm loving it. Don't change a thing. Don't, because I think it's beautiful. I'm really in love with it because again, I think that even from the anxiety-- the work I do, let's actually look at, you said toxic positivity, it's so important to address that. I had a lot of this in my childhood. We don't do petty. We don't do angry and we don't do those other things. So, I'm loving this idea of like, I can make space for all of the feelings and I can also just embrace the humanness that is petty, because I don't think everybody's thinking petty. Hayden: Yeah. This morning I went to the gym. This is my petty thought of the day. okay, so the gym has music you can hear throughout the whole gym space. And then you have folks that are walking around with their phones on speaker phone so that you can hear their music, like it's their own private boombox, and I'm like, "Isn't that what headphones are for?" And I'm like, "Oh my goodness, whatever. Okay." But in the grand scheme of things, this is a first-world problem, but the pettiness of me is like, "Come on now, boo." Kimberley: Right. So I'm liking this. This is what I'm saying. I was just actually about to say, give me your petty of the day. Yes. And my petty is probably more related to my children. I'm like, "Do I have to say it 12 times? Do I have to put your left shoe on? Come on." Hayden: Well, can I ask you a question? Kimberley: Sure. Hayden: I hate it when people are on podcasts and they're like, "Can I ask you a question?" That's a pet peeve of mine and a petty, right? Like doing it after going through your petty process about, with your children, what does that do for you? Kimberley: Well, I actually did a post on this, this week because I've actually been really working through my relationship with venting. I think this is why-- if I were to really look into it, you probably started this work I'm doing. Hayden: So you owe me [28:45 inaudible]. Kimberley: I do. We're actually even at this point, so we'll balance the sheets out at the end of the session. But I think that it probably was. If I really think it was probably spurred by this, it's to start to reflect on, when I open up space for this, like, I don't want to call it a negative emotion because it's not, but just for emotions that bring up some suffering for me, right? My instinct is to shut it down. I think what that means is it shuts down, it shuts down, it shuts down until I cut to the point where I need to vent. By that point, the boiler has gone and it's coming out. So, I've been working better instead of holding space for the petty. So I don't have to vent. I don't want it to get to that place. Not that there's anything wrong with venting either, right? Hayden: I love what you just said. I'm really going to slow down and hear that because I think what it brings up for me is-- a lot of our somatic practitioners would tell us that we need the energy to keep moving. Really pettiness is just another form of energy. It's not good or bad. It's just another form of energy. Kimberley: Right. Hayden: And I think what you're saying is, and what I'm hearing is like, let's open up the space to let the energy keep moving, so that way it doesn't become locked up like a dam, so that when it gets so full-- because I think the issue with that is it can get so full and burst. And then it starts this whole cycle of filling the shame and filling the guilt of a complete eruption. Kimberley: Right. Exactly. So, if I step into my petty, it doesn't feel good because of the learned judgment on that. But it's me learning. I'm learning that if I can stay with the feeling of that – it doesn't feel good, but it also feels good – it will save me from really not feeling good when I go into vent mode. And so for me, it's been really-- like I said to you, I just love it. I do. I really do. I think it's beautiful as long-- I think that the conversation we actually had on Instagram, because I did a post on this was, people's conversation around like, but you can't take that away from me. Really I'm at a stage in my life where I need to be a lot petty or a lot venting. I think for people, it's different. Hayden: Absolutely. Yeah. Thank you so much for sharing. Kimberley: Oh, of course. Thank you. So, do you have bigger petty days than other days? What's the influx of petty for you? Hayden: I don't think of myself as a petty person. It's interesting that I have an experience. I think being an immigrant and being a military child and accepting life as it is, a lot of acceptance energy of things that other people might complain about is part of my story. So, I think there are days where I may have to lean on my petty and get a little bit more. But that's anger, which feels a little bit different for me. Yeah, I might feel a little bit aggravated a little bit more often some days compared to others. It's not something that I necessarily am probably the most tuned into. So, you're offering me an invitation to think about that a little bit more and to contemplate on it. Kimberley: I love it. Okay. So, is there anything that you feel like we've missed here? We're stumbling bravely. Do you feel like there's something about Petty Tuesday, the concept of being petty for people that they may want to consider as they move into embracing this? Hayden: I think the thing that's really important to know is that it's vulnerable. Even being petty is vulnerable and allow your pettiness, allowing yourself to come out to your own inner pettiness because you're unlearning something and you're trying something else that you've never tried before. So, it's going to feel scary, especially when you're riding the wave of a new emotion. You don't know what's going to come out. You don't know who's going to come out on the other side of it. So, I really want to validate and normalize all of that. I do think there needs to be some safeguards on the other side. There's a difference for me between pettiness and mean-spiritedness and complete toxic negativity. Kimberley: Okay. That's helpful to hear. Yeah. How do you differentiate that? Hayden: Pettiness has a playfulness, for me. I think the playfulness, again, not taking myself too seriously. When you think about children playing and you think of yourself playing, for me, it's a wide-open field of discovery and mean-spiritedness. The energy just feels like a dark cloud or there's a monster and it's like, "Ooh, I don't really like that energy. I'm not judging it. I'm just saying I don't really want more of it." Kimberley: Right. Yeah. I mean, I think that there's a small shift in that it's intended to create harm, right? It's intended to displace whatever you're feeling kind of thing. I can feel that too. I think that that's a really good differentiation. I just love it, though. I can't help it. I just laugh when I think about it. Hayden: I mean, you're smiling about it. Kimberley: Yeah. That's not it. It's so perfect. Hayden: There's something fun about it. People look forward to celebrating Petty Tuesday. People are like, "Hayden, please create merch so I could wear a Petty Tuesday t-shirt," and I'm like, "Oh my gosh." Kimberley: You totally should. Yeah. Again, I think it's one of those important lessons that we have to unlearn, which is, there isn't really an emotion you can't touch on. Maybe that for those who are new to this day, permission slip could be, I'm going to allow myself to feel some petty. Hayden: I love it. Kimberley: Play with that. Hayden: Absolutely. I think so much of unlearning and learning something new is play. giving yourself space to try it out. Commit to it and try it out. Yeah. Permission slip to be petty or to be aggravated. I mean, one of the permission slips, and this is a different emotion, that has completely changed my life was right after the murder of George Floyd, Ahmaud Arbery, Breonna Taylor. I wrote permission slips to myself to channel my anger to rehumanize myself in the midst of dehumanization. I did not recognize the connection. But after that, I wrote this piece that went viral in the therapist community called An Invitation to White Therapists. It's completely changed my world. It's got me in conversations with mentors of mine, people that have huge followings and are famous in my world, because I gave myself that permission and to really, really experience and feel that emotion and to trust that my container, my nervous system, that my body could hold whatever might come out on the other side. I definitely think having relationships that are there to support you in your play of discovering who you might be on the other side is really important and fostering that. That's made all the world of difference to me. Kimberley: Yeah. I thank you for sharing that because I really do resonate with that as well. Feelings are scary. I think that we don't give ourselves permission because we don't want to feel what could come with that. Particularly around those conversations, those very difficult topics, I think it's so important that we slow down, maybe write out a permission slip first. I know I have to do that all the time with social media areas. Okay, how do I navigate this conversation? Can I be okay with it being imperfect? Hayden: Yeah. Kimberley: Yeah. Thank you. I'm so grateful for you bringing that up because I think that's amazing. Okay. I actually have one more question for you and then I want you to tell people. So you've said when we were pre-having this conversation that you are a curator of radical permission, what is that? Hayden: Yeah. I have to be honest. Some of this is based on Rising Strong process, a Brené Brown book, but I do think I've moved it forward in making it a collective practice. So, I think of myself as the curator because, do I own this? I think our Western way of we own things, like, do I own this? No. If anything, I feel like more of the shepherd of it. I hope that this lives beyond me, honestly. So, I think I love the word "curator," thinking about someone that is there to be a custodian of a space and of a process and there needs to be some editing. So, there has to be some power that I hold of the process because you need to make sure that it stays within the pathos and the ethos of really what the values are underpinning it. So, I think that's why I use the term "curator." Kimberley: I love it. Okay. Tell us where people can hear about you. I'm so grateful for this conversation. Really I am. I could literally talk to you about this for hours, but I'm not going to take your time up. Tell us where people can hear your stuff and learn well from you. Hayden: Yeah. So, you can follow me @hcdawes on Twitter as well as on Instagram. There is a Radical Permission Facebook group that you can search. You can also head to my website at hcdawes.com. I also have a monthly newsletter where I talk about all the things that are important to me, and I hope it offers you value. I always offer something for you to contemplate about your life, as well as there's always a petty moment, as well as different trainings that I'll be offering and different upcoming events. Kimberley: Yeah. Thank you so much. Like I said, absolutely just grateful for you. You're doing amazing work. Hayden: Thank you. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .

Jun 11, 2021

This is Your Anxiety Toolkit - Episode 193. Hello, my loves, how are you? So, recently, I've been having lots of conversations with my patients and my clients around one really helpful metaphor around managing mental compulsions. Now, before we go into this, let me just do a quick overview. We have obsessions, which show up in the form of intrusive thoughts, intrusive feelings, like anxiety and uncertainty and doubt and guilt and disgust. There's intrusive thoughts, there's intrusive feelings, there's intrusive sensations, which is whatever physical sensations you experience that are intrusive and repetitive, and then intrusive urges. Urges like this urge – you feel like you're going out of control and you're about to hurt someone or you're about to harm someone or do something that is ineffective or not helpful in your life. We have these intrusive thoughts, feelings, sensations, and urges, and sometimes images as well. It might be a quick flash image of something scary. In effort to either solve that or remove that or lessen the discomfort of that, we engage in a compulsion. Now, the compulsion could be physical, like washing your hands or moving an object or so forth, checking something, or it can be mental. I'm really specifically, in this episode, talking about mental compulsions – the mental compulsion of trying to solve and ruminate on an obsession. A lot of you have said that mental compulsions are one of the most difficult to reduce or prevent or stop, and I think that's very, very, very common. When I'm talking with my patients about this, usually, they report that once they have the obsession, because we know that – let's sort of just preface – trying to prevent the thought or suppress the thought won't work. You're going to have these thoughts. Thoughts suppression usually makes you have the thought even more. We're not talking about thoughts suppression here, but what we are talking about is, once you identify that you've had the thought, how much attention do you give it and how much leash do you give it? This is the metaphor I want you to think of. When you've had this intrusive thought, think of the thought like a really baby puppy, like a really active bouncy baby puppy, and you've got the baby puppy on a leash. You're taking the puppy for a walk. Now often I'll ask my patients, "When you take your puppy for a walk, particularly if you live in a suburban or city area, which I do, do you give the puppy a long leash or do you give it a short leash? As you're walking down the sidewalk, are you letting the puppy walk down the middle of the road with a long leash, and then it jumps over the sidewalk into the garden, it pees on the garden and then wraps its leash around your legs, and then it takes you off into some at the park that you don't want to go into? Does it walk down a street that you don't want to walk down? Or do you keep the leash shorter? And what you're doing there is you're pulling it back. You're not allowing it to go into areas that you don't want it to go." Now, that's what I want you to think of in regards to mental compulsions. Once you know that you've had an intrusive thought, your job is to keep that thought on a short leash, meaning you don't explore the whole neighborhood and what it means and what it could happen, and this could happen, and that could happen, and let's go down the rabbit hole of trying to figure this out. Instead, you want to keep it on a shorter leash. Again, in this case, you're being really skilled in what road you're letting yourself go down or what rabbit hole you're letting yourself go down. The whole idea here is, keep your intrusive thoughts on a short leash. You still have the dog. You're not trying to get rid of the dog. You're not cutting the leash short and going, "Runaway, I don't want you." You're saying, "I have this thought. It's going to be here. I'm going to be very intentional on where I allow this thought to go. I'm going to be very intentional on how much I let this thought be the focus of the walk I'm taking." As you're walking your dog, you're not only looking at your dog. You're also looking at the path that you're walking on so you don't trip. You're looking at the nature around you. You're waving to the neighbor or however. You're engaging with the outside world. You're not just gripping and holding the leash and fighting it. This is important for you as you manage your mental compulsion. I'm going to say to you, this may be the most important skill you'll learn. The skill of managing mental compulsion is so important if you have generalized anxiety, OCD, social anxiety, health anxiety, depression. It's so important that we are skilled at setting boundaries with our mental compulsions or our rumination and our worry. All of these things are the same. Worry is just a form of mental compulsion. What we want to do is, if you notice that you're going way down the wrong street and you're going in the direction of doing mental compulsions, you may want to yank on that chain and say no, as you would with your dog. "We're not going down that street. We don't poop in people's yards. We don't poop in our own yard. We stay on the sidewalk." And then the dog tries to go the other direction into that person's garden, and you say, "No, sorry. We're not doing that today. We're staying on this path. You can be here. The thought can be here, but I will not let it determine what I do on my walk." This is so important. Just think of it. Think about when you're in your daily life, do you allow your thoughts to be on a tremendously long leash and do they go wherever they want and they're pulling you in every direction, or are you in the practice of shortening that leash and taking more control over where you let your head go? Now, a major thing to remember: It's entirely okay if you suck at this. You are going to suck at this. Please, don't be hard on yourself. This is a practice. There are some days I am excellent at this. There are some days I am terrible at this. That is okay. It's similar to anything in your life. You're going to have ups and downs. But really reflect as often as you can, what's the intrusive thought, what's the intrusive feeling, sensation, urge, image. That's the obsession. We don't want to control that, but we do want to work on being skilled at how we respond. That's the most important piece. Be gentle. Be kind. Be diligent. Be patient. You will get this with time. Keep that dog on a shorter leash, if you can. Be gentle with the puppy on the leash too. Don't yank on it too hard because we don't want to get into a wrestle with our thoughts. Okay? I love you. I hope that is helpful. Please, please let me know your thoughts on this. It's just a metaphor, so it may be helpful for some and some maybe not for others. I just am so grateful that I get to spend this time with you. Please go and leave a review. I know I say it every single time. I cannot tell you how much it helps me and brings me so much joy to see the reviews. I love them. Thank you so much. I read every single one. Thank you. We will give a pair of free Beats headphones to one lucky person who leaves a review as we hit a thousand reviews. Thank you so much. I love you, guys. Have a nice walk, my friends. It's a beautiful day to do hard things.

Jun 4, 2021

This is Your Anxiety Toolkit - Episode 192. Welcome back, everybody. I am really excited to do this episode with you. It's a little bit different to episodes I've done in the past, which might be why I'm really excited about it, but it is a skill I have been practicing for several months. No, maybe more than that. I would actually say closer to six months to a year, and I was reflecting on, what are the things that... I took a lot about mindfulness skills and a lot about therapy skills and cognitive behavioral therapy skills, but is there something I haven't really talked about in terms of just lifestyle? And I thought this, of all the topics, is probably one of the things that helps me manage my anxiety and depression the most, literally the most. In fact, I would go as far as to say it has been probably one of the most important things that has helped me recover in my recovery, and I'm really excited to share it with you. Today, we're talking about how activity scheduling and managing your schedule can be a really important anxiety management tool. Before you completely sign off and say, "Oh my gosh, this is not for me," please just hear me out because there is so much greatness to being really intentional about your schedule and scheduling. A couple of reasons I say that is because, number one, if you are somebody who has a job or goes to school or has a mental illness, and that's really, really debilitating and taking up a lot of your time, or you have children or all of the above, it's really easy for the day to just come and go. And before you know it, you haven't gotten done what you wanted to get done. You're feeling more and more anxious about tomorrow. You're feeling more and more depressed about yourself and what you've got to do. You're feeling bombed out because you didn't get to prioritize your time. And that was exactly me. Every time I opened my eyes in the morning, I had this sensation of dread because I just was like, "Oh my gosh, today's going to be another huge day. I'm going to run all day. I'm in a rush all day," or "I'm going to feel anxiety all day." Let me tell you a couple of skills that I teach all of my clients because, as I've said before, this is something that they talked to me about, at least once in their treatment, is how to manage their time. Okay. I have learned and I have practiced this, like I said, for almost a year now – the art of scheduling in a way that is in the intention of benefiting my mental health. I don't schedule because I want to be super time efficient. I don't schedule because I want to get a ton done. I schedule for my mental health, literally. Forgive me, if you can hear beeping car alarm, it's been going all day. So I'm sorry if you hear that in the background. I literally schedule for my mental health. And what I have learned, I took a whole course on this, is one of the biggest mistakes we make with scheduling is we schedule what we have to do first, and that basically means we're prioritizing work and school and to-do's, instead of scheduling pleasure first. So that is what I want you to practice first. That already might be mind-blowing to you. You might be like, "Wait, what? Like pleasure? That's important?" Yes. Schedule your pleasure time first. Look at your schedule, even write it on a piece of scrap paper. What do you love to do? Make sure you schedule that something. Even if it's for 10 minutes, you schedule it every single day. Once you've done that, then you schedule what you need to do for your recovery. It may be different for every person. Some of you may need to schedule exposures, and again, be very intentional. Let's say you have a driving exposure. You have to go driving for your exposure and practice having intrusive thoughts, or you have to practice going and doing a certain thing that concerns you or scares you. You're going to schedule that time first. If you're not someone who's doing exposures, maybe you have to schedule time to correct your thinking or schedule your time to meditate. Schedule your time to read your mindfulness book. I have almost all of my patients read some kind of book that will complement their treatment all the time, meaning throughout treatment. Once they finish one book, I send them a book to read after that, and I tell them, "You don't need to read all day every day." I might ask you to read a page a day or a chapter a week, or whatever works for you, but schedule that in because really literally, I'll give you an example. I have a private practice and an online business, two complete businesses. I'm managing up to 15 to 20 people a week. If I worked at scheduling my to-do list first, I would never take care of myself. Never. I would only work for other people. I would only be doing a million to-do's. I would never get any exercise. I would never meditate. I would never have any time because I would have just clogged up my schedule with that. Reverse it. First, schedule your pleasure and then schedule your mental health practices, whatever that may be – your self-compassion practices, listening to a podcast, whatever it may be. Now, when it comes to the things you have to do, this is going to go against some of the advice you've been given. I know it will. But hear me out and you can take what you want and leave what you don't want. What I do is I sit down with a piece of scrap paper and I write a to-do list. Every Sunday, I do this. I write a list of all the things I need to get done this week. I write a list of what emails I need to write and what phone calls I need to make and what bills I need to pay, and who I need to talk to, who I need to consult with, and so forth. Now, for those of you who compulsively list-write, we're not writing things that are daily activities, like I'm not going to write "Brush my teeth." I'm not going to write "Have breakfast." I'm not going to write "Lock the door." I'm not going to write things that I would be doing anyway. I'm going to be writing the things that I have anxiety about and that are important that I get done and that I value. I'm not writing down things that are compulsions or things I'm doing to make my anxiety go away. These are just really logical things that I have to do. Once I've got everything down, I don't keep that list. I transport that list into my schedule. Of course, I have to see my clients. Of course, I have my clients in my schedule weekly. But then from there, let's say I needed to make an email to, let's say my website programmer, I would put that in the calendar. Tuesday at four o'clock or Monday at six o'clock or whatever it may be. I take everything from the to-do and I put it on the calendar. If you're noticing now that the calendar is full, something has to go, because what's happened in the past is you put all the to-do list in, and so the thing to go is your mental health, is your self-care. We can't do that anymore. That's why I'm telling you, like, that's why scheduling is so important because if you don't, you're going to realize that there is actually no time for self-care and there is no time for your mental health. If that's the case, like the whole saying is "Nothing changes if nothing changes." So this is so important. You may need to ask for help. I'm always talking with my patients about asking for help. Okay, you need to go out for a drive. You need to do your homework, but you also need to take the kids to school. Can you ask someone to help you? Can you pay someone to help you? Can you find creative ways where you take your kids and someone else's kids one day and they take their kids and your kids the next day? Again, I really love to do this on the cheap, so I don't want this to cost you money. Can you find ways to prioritize your mental health in your schedule, on the books, and open up time so that it becomes the priority? I know I've told you this story before about, I was at a lunch and I was with my friends and they didn't have children. They were all talking about these beautiful hikes that they were going on. I said, "Well, I can't go on a hike because I have children." He's like, "Yes, you can. You just haven't prioritized taking a hike. If you really wanted to, you would take your kids on a hike or you would find some time or find someone to take care of the kids so you could go on a hike. But you haven't prioritized that. You've prioritized being with your kids or working or taking a bath." There's no judgment. There's no judgment to what he was saying. He was just saying, "You can do it. It's just that you have to figure out what is a priority." For me, that was shocking because I was like, the truth is I say my mental health is a priority, but I don't. That doesn't show up in my schedule that way. This was many years ago, and it was a crazy aha moment where I was like, "Huh, I say self-care is important, but it's totally not evident by the look of my schedule." The other thing that I have found that's so fascinating is, once I started doing this, I started actually realizing how much I was working or how much I was doing behaviors that bring me no pleasure. I spoke with a client about this just the other day, is I wasn't feeling so well. I went to bed early. I laid in bed. I opened up Instagram. And two hours later, two hours later, I come out of a thick fog of Instagram and realize that I've lost two hours. The thing to remember here is, number one, that's neither good nor bad because some people love Instagram and it brings them tons of pleasure. But in that moment, as I checked in with myself, I didn't feel any better. If anything, I felt more stressed. So what I was doing was I was engaging in behavior that I could have done that would have felt so much better and aligned more with my mental health, which again is why I say to you, please, please, please, if you take one thing away from today, please schedule your pleasure. Please schedule your pleasure, the things that bring you joy. Now, some people say, "I can't do those because my anxiety has taken those things away from me." Even more reason to schedule them. If you love to read and your anxiety or your depression has sucked the joy out of reading or writing or whatever you love to do, schedule that and work at what's getting in the way. Talk with your therapist or journal or try and figure out what's getting in the way and work at making sure that fear isn't your scheduler. Fear isn't your assistant who schedules your day. That's not cool. That's not kind to you. Do not let fear schedule your day. Do the best you can is what I should say, because there will be times it will. But just do your best to make a deal with yourself. We've talked about transferring your to-do lists onto the calendar. You rip the to-do list up, you take it away. And then your job is to do your best to stick to the calendar. It's not going to be perfect. In fact, it'll be far from perfect, but really look at the end of the week or at the beginning of the week, and look at your calendar and make decisions with that. Now, of course, I understand that there is some degree of privilege involved here. I want to make sure we respect that some people don't have control over their schedules, and that's true for many people. But what I want to ask you is, if that is the case, where you have control, can you implement really good exercises and activities during that time, like really resting. I just read an amazing book where they were basically saying "Schedule rest." If you're someone who's working a double shift and money is tight and life is really difficult right now, maybe the first step is you just schedule rest. Maybe the only step is for you to schedule rest. Maybe we start really simple. This is a lot of change. I encourage you to take baby steps, even if you've got full control over your schedule. It's really important here that we take baby steps and empower ourselves to prioritize your mental health. Believe me, it is going to make such a change. The other thing is, and I'll say one more point, what was really interesting to me is, I really then, once I started scheduling, noticed all the "shoulds." Well, I should work out five days a week and I should go and help other people, and I should be putting this in my schedule, and I should be calling this person. As you do this, ask yourself, do you really want to? If it's not a "have to," meaning you have to go to work and you have to go to the staff meeting and you have to show up for school and so forth, really check in with yourself. Are the things you're doing on your schedule because you feel like you should do it, or because you want to do it, or because you have to do it? Be honest with yourself about that, because I found on my schedule a bunch of stuff. I would even say a bunch of swear words, a bunch of crap that I really didn't have to do. I was only doing it because I'd made up a story about the fact that I should, and it wasn't even a fact and I was doing it out of fear. That's why I really, really wanted to chat with you about this. Easier said than done, like I said, but really think about this. Look at your schedule. If you can – I schedule on Google calendar, it's free –look at your schedule and ask yourself, is it reflecting the level of recovery that I am wanting? Make small changes. This is really important. If you've learned one thing from today, it's please schedule your pleasure. Really schedule your wellness. Schedule your rest. Work the rest around that. Okay. I love you guys. Have a wonderful, wonderful, wonderful, wonderful, wonderful, wonderful day. I believe in you. I believe you can do this hard thing. Do the best you can with what you've got. I am so grateful for you spending your time with me and being on this journey with me and taking me along with you. Thank you. I know your time is valuable and I'm so grateful. Don't forget to leave a review. I would love nothing more than to get your honest opinions about the podcast. So, please do that, and have a wonderful day. If you're interested in any of the resources that we have, go over and look at cbtschool.com . Check it out, and have a wonderful day.

May 28, 2021

This is Your Anxiety Toolkit - Episode 191. Well, welcome friends. How are you? How are you doing really? I want you to reflect for a second on just that... on just that question. How are you? I have not prepared for this episode. I just thought I would sit down and take some time to reflect some of, I'm sure, what I reflect on will be the first time I've reflected on it and not just that for reflecting with you. So what I wanted to talk with you guys about is life with a chronic illness or a disability. This is something that has shaken me a lot over the last, I would say two to three months. A lot of you have the background story with me, but if you're new here, welcome, and I'll tell you a quick background. In 2019, I got very sick. Through that process, I also got very... not just medically, but mentally struggled because of the symptoms that were incredibly debilitating. After pretty much every single medical test under the sun, I was diagnosed with a lesion in my brain, that they still don't know what it is, and a disorder called postural orthostatic tachycardia syndrome. It sounds scary and it can be scary, but mostly, it's a disorder to do with your autonomic nervous system and it basically involves lightheadedness and fainting and headaches and overall exhaustion and nausea and very, very big degree of brain fog. It can be mild and it can be very severe and extreme to the point where you can't stand up. For months and months and months, particularly throughout COVID, I have been doing my very best to manage this disorder and this syndrome and have been doing really, really well. I'm not going to lie, I thought I'd mastered this disorder. I really did. I think there was a cocky piece of me that was like, "Oh yeah, look at me." Once again, hard work pays off. And yes, it does. Hard work does pay off. But recently, I have been hit with another... I call it an event, another wave of POTS – POTS is the acronym for postural orthostatic tachycardia syndrome – and it has knocked me off my feet literally. Not figuratively. I think both. For those of you who don't know, I was, two weeks ago, taking a tennis lesson, a part of my attempts to take care of myself as I have cut back immensely with work. I've mentioned my kids are gone back to school and my husband's gone back to work. And so I really decided, I made a conscious decision to put my mental health first. I had started taking tennis lessons, and in the middle of my tennis lesson, it was very hot. I collapsed and had to go to the hospital. I'm sorry if this is scary for some of you. It had to be monitored and got IV bags and medications and all the things. Again, once again, I really thought this was a short-term thing. What I am reflecting on today is the realization that I'm not going to manage this. I'm not going to master it. This is something I will probably have to handle for the rest of my life. I was expecting to bounce back and I didn't. I've had many days of not being able to stand. I'm not able to drive. I can drive on certain days, depending on how busy I am, but I have mostly not been able to drive. I am unable to work out. I wear these most fabulous compression socks right now, the compression socks I'm wearing. I have bright colors in stripes. I have ones with spots and reindeers and all of the things. So, that's very fun. But no matter how much I hydrate, I'm struggling to eat and so forth. The reason I wanted to share this isn't just to... of course, I can share. I want to share with you. But the main reason I wanted to share with you is to talk about what it's like to wrap your head around long-term suffering. I'm really interested in this because I've been really mindful and watching my thoughts about this syndrome. I wonder if this resonates with you guys because a lot of you are dealing with either. A lot of you have reached out and said you have a chronic illness too, or chronic mental illness, anxiety, depression, or any of the disorders. What has been really interesting for me is to catch the thoughts I have around disability. now, the first thing – and I'm really open about this, and I'm really happy to share how far I have to go – is I didn't realize I had all this stigma around the word "disability." I have a career in people with disabilities or struggles or long-term chronic stuff. I wouldn't judge anybody else, but interestingly, as soon as I had to recognize, I kept saying, "I don't know why this happened. I don't know why this happened. Why did this happen? This shouldn't have happened." My doctors said, "No, you're going to have really big ups and really big downs. That's going to happen. That is a part of this disability." I really was able to observe how judgmental I was about that in myself. The word "disability" was not okay with me, the word "long-term chronic illness." I was like, "Uh-uh, no way, I will solve this," until I had to be like, "Wait, that's a lot of energy, negative energy on something that does not serve me and is built around a stigma and a judgment of me having a disability." It's so painful folks to observe that. Thank goodness I have those skills to be able to go, "Okay. That was judgment. Interesting." I encourage you guys to take that approach when these types of thoughts come in. Because again, I'm always working with my patients and clients and people on social media around the stigma of the word "disorder" or "disability" or "mental health" or "mental illness." It's important that we catch those judgments. Now, once I caught it, to be honest, I didn't do much with it because I really just had to hold some space there to wrap my head around, "Whoa, okay. This is a long time for me now." I thought I was the special one who could get through it and it's not going to bother me again, but it's not. It's going to come back. This one has been particularly painful, physically 100%. This was probably my most serious event or wave of POTS. But also, just to be able to really look at how it has impacted me mentally. Now, here's the thing. Once I came to the understanding, not just the acceptance yet, but the understanding that this is long-term and something I have that I will have to continue to manage, it was so interesting how my thoughts wanted to go to hopelessness. "Okay, well, now my life's going to suck," or "I should give up. This is going to impact my life and terribly impact my life. This is going to ruin my life," and so forth. Again, it was being able to observe and catch and watch myself go into hopelessness and be able to... If you could see me, I would smile and go, "Ah, okay, interesting." That's the story I'm telling myself because here's the thing, I've had this since 2019. I've been managing it this whole time with the thought "I can manage this." And therefore, I was happy. Now, nothing has changed. I'm still having POTS. I had another incident. The only thing that changed was now that I had a recognition of this being a problem long-term and I started to think negatively about it. That's the only thing that changed. I've had POTS this whole time. I've had good days and bad days this whole time. I happened to have a significantly bad period and I'm still in that. The only thing that's changed is the story I tell myself, and I have to keep catching the story, catching it, catching it. Now, I know some of you are saying, "No, but my disability is making my life have a lower quality." I'm not saying that's just a story. I understand that it's a situation and a circumstance. So I'm not discounting that. But what we need to do, and this is why I wanted to reflect with you, is to catch the story we tell ourselves about things that are not true, like the future, because we don't know. We don't know the future. There may be a POTS drug that comes out and I take it and I'm happy for the rest of my life. I am going to recognize that having this disorder has had some benefits. It's forced me to slow down. It's forced me to be grateful for my medical health, for my legs and my arms, and for my heart and my brain. This is where I ponder how wonderful that our body tells us what to eat. How wonderful is that? Because when you have POTS, you have nausea. And when you have nausea, nothing feels good to eat. You have to force yourself to eat. Every meal, I have to force myself to eat. Sometimes, I have to tell you guys, I was cracking up. I eat mostly healthy, meaning I ate all varieties. There is no good or bad food. I have a very good relationship with food. I love food. Food brings me incredible amounts of pleasure. I never judged myself for what I eat. I was telling my sister, who's a doctor, she was like, "Well, are you eating?" And I was like, "Yeah, I had chicken nuggets for breakfast." And she was like, "Why?" And I was like, "It's literally the only thing I could eat. That's the only thing I could get down. It's the only thing that sounded good." And she was like, "Okay, what did you have for lunch?" And I was like, "I had ribs." And she said, "Kimberley, what is happening?" And I said, "No, this is how it is. I have to..." It's so hard. And I'm now so grateful for the pleasure around food that I have experienced and hopefully, we'll experience it again here very soon. I really want to watch (1) the story I tell myself and (2) the hope catch the hopelessness in its tracks. I know a lot of my patients and I know a lot of you because you're going through a particularly difficult season like me. You're telling yourself this season will never end, and it will. Seasons come and go. Some last for longer than others. Sometimes it's a particularly chilly season, sometimes it's not. The main piece here is for me to catch the judgment, the stigma. Here's another one guys and I hope this resonates. It's so humiliating. I collapsed right at the entry of the tennis. People were walking past me, and my instinct was to say sorry to every person that passed by. Even though I was pretty much not in consciousness, I was frequently apologizing to my tennis coach, my husband. My tennis coach called my husband. I frequently apologized to him. I apologized to anybody who saw it. "I'm so sorry. I didn't mean to scare you." And how much that apologizing was embedded in shame around suffering. I'm on the floor, completely limp, but I'm apologizing to other people. That is completely related to the shame I noticed that I am carrying around suffering and struggling and not being super, super-duper high functioning. This is dangerous. We have to check this. I'm going to encourage you to check this because the problem with that is it stigmatizes disability in general and it stigmatizes you being a human who suffers, and you will. You'll have illnesses or struggles like seasons that are difficult. It's so important that we break down that judgment we have around suffering and disability, meaning when you don't have the ability to do things. So important. When we break that down and we work through that, then when we do struggle, there's not this second layer or fifth layer of pain. It's just like, "Oh no, I'm just suffering. I'm suffering right now. This is a difficult season." Instead of, "This is a difficult season. I'm suffering. It's never going to go away, and I'm weak and dumb and stupid and inconveniencing other people for suffering." So, I really want us, hopefully, to learn from my own experience here. Hopefully, this resonates with you where you can really break down the stories and the beliefs and the judgments we have about disabilities. I think it will make a safer place for those who do have a disability. I think it'll make a safer place for you when you're suffering. I think it'll make a safer place for us as a human race around the idea of suffering. It's so, so important. The last piece here is when we're suffering, I noticed this whole back and forth on the solution. Should I do this? Should I go on this medication, that medication, that treatment, these treatments, see that doctor, see this doctor? I'm sure a lot of my patients are like, "Am I doing the right thing? Have I got the right treatment? Have I got the right therapist? Have I got the right medication? What's happening?" There's so much indecision around seasons that are filled with suffering. I just want to validate that. I don't want to give you advice. I don't want to guide you in any different direction. I think all I want you to do is to recognize that indecision and not punish yourself by staying there too long. Consult with your doctors. Consult with your therapist. Talk with respected people or people you trust. Be careful of how much mental space indecision takes when you're in a difficult season because you're suffering. It's enough. We don't need to add. We don't want to add. We don't want to make more problems and more suffering for you because you matter and your recovery matters and your healing matters. That's just something I'm noticing. It's funny, every morning, I am negotiating with myself in terms of like, "Will I take my meds today?" I mean, I always take my meds. So I'm not going to ever discard someone from making a medical decision without seeing your doctor. I always do, but I really catch myself going, "Maybe I won't take it today. This is just too much. It's too hard. It's too many side effects. It's too difficult, too painful, too scary." And I have to go, "Okay, Kimberley, get your head out of your indecision. Honor what's right. If you really need to do that, be effective and call your doctor. Don't spend time in your head." So, that's just where I'm at. What I will say, just in case any of your worries, I am okay. I have a great team. I have tremendous support. My husband, oh my God, he's just amazing at showing up when things fall apart. He is incredible. I'm so, so lucky. I hope that I don't worry you with me sharing this. Someone asked me the other day on social media, "Is it hard for you as a clinician to share this?" And I said to them, "No, really not." A part of my mission is to de-stigmatize therapy, to take the stigma out of going to therapy. I think a really big part of how to do that is for the therapist to show up as real humans. I think when we do that, when therapists show up as real humans, in the process, we do this stigmatize mental health and therapy because we don't see the therapist as this person who holds all the secrets and is the knower of all things and is analyzing you instead of just seeing them as humans. You're just going to therapy to talk to a human who also suffers. I just wanted to share that with you because I think it's important that I model that to you. That's one of the things that I hold very strong in my values. So that's that. There are my thoughts on struggling and going through a chronic illness and wrapping my head around the stigma of the word "disability" and the concept of disability. So, that's it. That's all I have to say. I hope this has been helpful. I hope that you feel seen and you feel heard. Maybe you have some insight as I spoke. If that's the case, we'll then, I'm a happy girl. All right. Thank you so much for listening. I do know your time is precious, so I'm so grateful to have this time with you. I will continue this conversation as I continue to unpack my own many layers of stuff, of glug around it. I'm very open to continuing to learn. I'm really, really looking and learning around the stigma of disability because it's something that I have been privileged up until now, not to have to really wrap my head around. So I'll do the work. I will stumble bravely through this, as I'm sure you are too. All right. I love you guys. Please go and leave a review. The reviews help other people see this podcast as something of quality. When they see other people's reviews, they are more likely to click on it, which means I get to help more people, and that is just a blessing. So, thank you. Please do go leave a review. Please take care of yourself. Please take some time to hold your heart tenderly and nurture whatever suffering you're going through because you're not alone and we're in this together. Okay. All my love to you. Be on the show

May 21, 2021

This is Your Anxiety Toolkit - Episode 190. Welcome back, everybody. Hello, Happy Friday, for those of you who are listening on the release day, and happy day to you who are not. Okay. Well, how are you? How is everybody doing? I am sitting in my bedroom. We've actually had to completely rearrange because our life is changing so much here at the Quinland house. Kids are at school and people are in and out of the house, and it's very, very different. So I'm coming to you from my room, and life just continues to change. Have you guys noticed that? It does continue to change. I cannot keep up with it. We embrace. We adapt. We are flexible. We keep trying. We are gentle with ourselves, and that's the best we can do. Today, I wanted to talk with you guys about questions. I have been sort of... What I would say is 'reflecting,' but I would actually say, a better word is 'studying' the art of asking better questions, and this has been life-changing to me. It has been a practice that I have adopted as per advice of a colleague and a friend in terms of catching the story you tell yourself and asking better questions. Catching the poorly written questions that we now ask ourselves on habit, right? We just habitually ask ourselves not very skilled questions. Let me explain to you more about this. When something happens – and you can even do it here together – when something happens in your life, let's say in the last week or so, something unexpected, unwanted, maybe not so ideal happens, I want you to check in and say, "What is the question I ask?" Some of you may say, it's a really simple what-if thought question. Like, what if such and such happens? What if ABC happens? What if XYZ happens? Not a super-skilled question mainly because it's so open-ended and it's so in the pursuit of removal of that discomfort. We've talked a lot about being uncertain. We've talked a lot about willingly allowing discomfort. Other questions that I have observed my patients asking themselves or reflecting on lately are questions like: What is wrong with me? So they have an uncomfortable, unexpected, not-so-great experience, and their immediate question is: "What's wrong with me?" And that question never ends. Well, rarely would you have the thought "what's wrong with me," and then you respond by going, "Nothing is wrong with me, I am a normal human being responding in the way that any other human being would respond." We don't answer those questions. The question sets us up for a failure, just like what-if. Another one is: "How can I make this go away?" Now, in some cases, this would actually be a really adaptive question. So, let's say you have an ant invasion in your house. It makes sense. Because we're highly functioning human beings and we have adapted over time, it makes sense that our question would be: "How can I make this go away?" That in and of itself could be a good question, a solid, skilled question. But when it comes to our emotions, it's really not. It actually gets us into tons of trouble. Asking ourselves how we can make this go away usually means we're going to probably have more of it and we're going into resistance mode. Another one, which I see a lot of, and I've actually done a whole podcast on this one before, which is: "Why is this happening to me? It's such an innocent question, but yet it gets us into so much trouble because the answer isn't that great. Why is this happening to me? Nobody knows. It's not the answer we are looking for. Or the answer you probably catch giving yourself is, it's because there's something wrong with you. Go back to the first question because you did it wrong or because you shouldn't have, or because you're bad, or because you're weak, or because... The list goes on and on and on. It's rare that you'll go, "Why is this uncomfortable thing happening? Oh, because uncomfortable things happen sometimes." Again, none of these are bad questions. They're just not super effective. Another one, and this is the last one I'll use as an example, is: "What does this mean?" Oh, that's a really bad one. It can get us into so much trouble. "What does this mean?" And before you know it, you're 20 minutes in going around and around, trying to give meaning to something, which probably has no meaning at all. The reason I really want you to first reflect on what questions are you asking yourself is you'll probably find that the questions you're asking yourself are setting you up for self-criticism, self-doubt, punishment, a lot of negativity, maybe for some really unhelpful emotions, and we want to get better at asking better questions. We want to be skilled at asking skilled questions. The questions we ask ourselves can then move us to and into an action that helps us and is beneficial and effective and kind and less work. Less work is good. We don't want questions that, again, can give you more work. Go back to "How can I make this go away?" Oh my goodness. That's a lot of work. Okay. Let me give you some questions that I am practicing when uncomfortable things happen, events, experiences, emotions, and so forth. Okay, first question. What emotion right now am I not willing to feel? So, let's say somebody you love has judged you. Okay, that's not going to feel good. Your instinct is to make it go away. But we're going to say, "What emotion am I not willing to feel here? Oh, it's embarrassing. It's vulnerability. It's sadness." Okay. That's the emotion. At least now we know, we know what it is. Again, what emotion am I not willing to feel? Let's say you did an exposure and you tried so hard and it fell apart and you had a big panic attack and you couldn't back out. Okay. Your question would be: What emotion am I not willing to feel? Maybe it's fear. "Oh, I totally backed out because I didn't want to feel fear. I didn't want to feel uncertainty. I didn't want to feel doubt. I didn't want to feel dread, impending doom." Next question: Is it true? Let's say you... This was me the other day. I'm unpacking the groceries and I'm so happy because we picked them up and we didn't have to go into the grocery store. I just love this. It's one of the silver linings of COVID – the grocery stores are so good at doing drop-offs. I bring in this huge bag of groceries, and off the counter I fell a spaghetti sauce bottle and glass and spaghetti sauce is everywhere. Your original thought again is like, "What's wrong with me?" And then my next question is, "Uh-oh," instead, "is it true?" The thought I had is like, "You're so stupid. Why are you going to be so clumsy? Is that true?" Now, I'm not asking that question to invite a long layer of rumination. In dialectical behavioral therapy, it's called checking the facts. When you say a negative thing to yourself, check the facts. If I said that in a court of law, what would the jury decide on? "Kimberley is an idiot. She should have known better." I'm pretty sure the jury would say, "There's no way Kimberley would have known the specific weight of that jar, and the edge was so close and that it was going to fall at this angle. We're actually going to probably let her off." Is it true? Check the facts. Now, a quick note there. If you're having OCD obsessions, we don't need to check the facts of those because that could become compulsive. I'm talking more here about things we say to ourselves like, "You are bad. You are dumb. You are stupid, what's wrong with you?" Those kinds of comments and more depressive thoughts like, "The world is bad. My future is going to suck." You may want to ask yourself, is it true? Now, if your instinct is to say, "Yeah, it's true. My past has been crappy. So, therefore, my future will be too," I'm going to say, "I don't know if that's going to stand up in a court of law. Because they did it once does not hold you guilty. If it's happened a hundred times, it still doesn't give me enough evidence to convict that your future is going to be bad." So let's just stop and check in with what we're saying. Another question. This is my favorite, guys. This is the king of all questions. I really want you to get good at asking this one – what in this situation would the non-anxious Kimberley deal? What does the non-anxious you do in this situation or with this emotion? Best question ever. That's a really solid question right there. It doesn't mean you have to do it all perfectly, but it at least let you inquire as to how you would act, given that fear wasn't there to make your decisions. How would your values have you act? How would your character have you act in this situation? So, if I, let's say, was going to take a test and my fear was saying like, "What if you fail? What's wrong with you? You should be better than this. You should be fully prepared. You're asking not-so-great questions," and you said, "Okay, what would the non-anxious Kimberley do right now?" It would be: "Okay. She would get a drink and get a piece of fruit and eat it and then go and take the test. She would be kind and she wouldn't be ruminating about how it's going to go bad." Okay, go do that. That's your blueprint on how you should be acting. That's the skills and the perfect outline of what direction you might want to go into. Fabulous. And the last question... You can have more, you can add more to this. I want you to really think about it because I want this to be specific to you. But the last question I want you to ask, the question I think is a really good question, which is: What do I need? Not what do I want, but what do I need? What will help me here? What will help me get my long-term benefit here? Get me to long-term recovery? What do I need? Let's use a couple of examples. You've just spilled spaghetti sauce all over the fridge and the counters and everywhere and there's glass everywhere. What do I need? I need to be kind to myself. I need to take my time cleaning this up because my instinct was to clean it up in a rush because I was like, "Oh, this shouldn't have happened. What's wrong with me? I'm going to clean it up in a real rush so that I can get to my happy things." But the problem with that is, it only ended up making me more aggravated because I was rushing. So what do I need? I want to clean it up gently and slowly, compassionately. Let's say you've just done an exposure and it didn't go so well and you had a massive panic attack. What do I need? I need to slow down. I need to celebrate my attempt. I need to breathe. I need to reflect on how that went and what got in the way. I need a nap. Sometimes when we do exposures, we need big naps, and that's fine. What do I need? Someone just said something really unkind to you. What do I need? I need to cry. I need to feel my feelings. I need to give myself permission to be sad. I need to call a friend. I need to maybe set a boundary with that friend. Much better than saying, "Why is this happening? What's wrong with me? how can I make it go away? What does all this mean?" So what I want you to do is I want you to leave today's episode and I want you to spend the day or the week or the month thinking about what are good questions, how can I ask myself really good questions, better questions? Be really intentional about this. I often say to my patients, if your thoughts are a dog and you're the owner of the dog, sometimes we let our thoughts just go all over the shop. We just let them go. We follow them. If the dog is sniffing into one corner, you go with it and you sniff into one corner. Sometimes with our thoughts, not so much the intrusive thoughts, but the thoughts we say about ourselves, the criticisms, the stories we tell ourselves, sometimes we're going to yank on that chain a little bit, on its leash, and be like, "Come on. No, no, no." We're not going over into that corner and sniffing out that horrible hole. No, we're not doing that today. We're asking better questions. You're allowed to do that. That's not thought suppression. That's being skilled with your cognitions. We're not trying to prevent thoughts. We're just catching when you're spiraling on them and you're yanking on the chain. And then come on back. You're going too far. You're resisting too much. Let's lean in. I hope that's helpful. Ask better questions. Thank you so much for listening. I am going to ask you for a favor. Would you please leave us a review? It would help us so much, us meaning all the team at CBT School. We are working really hard to expand our reach to help more people, provide free content. So if you would be willing, I would love nothing more than for you to leave an honest review on Apple podcasts or wherever you listen. We are going to give away a free pair of Beats headphones once we hit a thousand reviews. So I'd love for you to be in the running for that. Thank you. All right. I love you guys so much. I hope you're doing well. I'm thinking of you always. I'm so grateful I get to spend this time. Thank you. I know your time is valuable. Have a wonderful day. It is a beautiful day to ask better questions and do hard things. Let's do it. Have a wonderful day, everyone.

May 14, 2021

Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Hello friends, you are going to love this episode. Holy smokes, I just recorded it, so you've got me fresh, and I'm so excited. I just had such an amazing conversation with Mike Heady. He is an LCPC and he treats OCD and anxiety disorders. We talked about shame and shame and shame and shame, and he brought so much wisdom. You guys are going to love this episode. It is packed full of all the good stuff. So, I'm not going to waste your time. I just want you to get straight there and listen to it. Before we get started, if you haven't left a review, please do so. I love getting reviews from you. When we get good reviews, it doesn't just stroke my ego. That's not the point. It is because the more reviews we get, the more people will come and listen to the podcast, which means then I get to help people with these incredible tools, these science-based tools. Hopefully, even just from today, if you're first time listening, welcome. We are talking about shame, and you are going to get so much from this. So if you are listening, please do leave a review. I would be so grateful. And enjoy the show. ----- Kimberley: Welcome. I am so excited to have with us today, Mike Heady. He is an LCPC. That's correct. Right? Michael: That is, yes. Kimberley: Yes. We're going to have a conversation that actually might be my favorite topic in the whole of the podcast. We're talking about shame. So, welcome. Michael: Thanks for having me. I share your passion for the conversation. Kimberley: Yes. Not that I love shame, but I like talking about shame. Michael: Yes. I agree. It's hard to say you love shame. It's like saying I love fear. Kimberley: Exactly. So, why are you interested in this topic? Michael: It's been a professional evolution for me, originally being trained to treat anxiety disorders and OCD. We talk a lot about fear and uncertainty and we have a ceremonial way of responding to shame. We're like, "Oh yeah, and there's a shame too." In the last couple of years, I've really done a deep dive into like, "Well, what is this?" Because a lot of clients are having a hard time getting better. I don't think it's the fear that's hard for them to get past sometimes. I don't think it's the uncertainty. I think it's the shame. I think it's a different animal. When I started doing a lot of digging, I realized there's a whole world of shame out there in the literature, and how it applies to OCD fascinated me. So, that's my new passion project. Kimberley: Yeah. Same. Exact same experience. Also seeing how much fear in and of itself is a generator of suffering. But as you said, there's this shame that's generating suffering at exponential levels. So, I'm so grateful to have this conversation with you. for those who are listening and who might not really understand shame, would you be interested in giving me your working definition of what shame is? Michael: Sure. Are you okay if I elaborate on it a little bit? Kimberley: Yeah. Go for it. Michael: Okay. I think a good definition is that shame is a really painful, aversive, unpleasant emotional experience. Fear or disgust, it's natural or instinctive for us to want to back away and get rid of shame. Shame is often brought on by some kind of real or perceived violation of a social norm that we actually believe in. So it's not this mystical emotional thing. It's a thing either real or perceived occurred. And then I experienced this negative, painful emotion of shame. That's the short version of the definition. I think it's worth talking about shame as having two levels of shame. We might call an adaptive kind of shame, the shame where we view it as a response to a specific episode, rather than some generalizable character flaw or full-on assault of our identity. I violated something I believed in, I feel bad, which is different than guilt because guilt is about apologizing to the other person for something you've done. But I might feel bad for violating a norm I believe in. Okay, there's nothing toxic about that. There's another level of shame that we tend to want to talk about more. It's the toxic shame. That's the shame that is unworkable. It's always unhelpful. It is a response to a perceived or real violation of a norm that has broad sweeping characteristics to it. It is a full-on assault on our identity. It is a condemnation of the self. That's the toxic shame. I can wrap up this as saying, what was incredibly helpful for me when I was going deep dive into what shame was is, yes, shame is an emotion. We know what emotions are. We all feel emotions. We've all felt shame. You and I, as therapists, spend our careers trying to help our clients have a different relationship towards painful emotions, and understanding what an emotion is, specifically around shame, I think was really enlightening for me. I derive a lot of this understanding from some work that occurred in the sixties and seventies, probably before then, but the work from the sixties and seventies is what brought it to my attention, that emotions are an emergent experience constructed by an interaction between our biology and our biography. The biography piece comes out of Silvan Tomkins work in the late sixties where he suggested that, yes, there's a universal kind of biological experience that contributes to an emotion. But the part that completes it is our own narrative, which is unique to us. My interaction with the world, as I develop from a child to an adult, the experiences I have, my environment, that's the secret ingredient to my shame. So what makes me feel shame isn't necessarily what makes you feel shame. For instance, if I were to, while talking to you, suddenly break out into a red flush on my face, start sweating, and my voice start cracking, I might experience that as an embarrassment, like a small shame. But if you perhaps had terrible social anxiety disorder and the same thing happened to you, the same exact event, you might see that as a humiliation. Both are derivative emotions of shame. But humiliation is different from embarrassment in orders of magnitude of pain. Humiliation is closer to trauma than it is to anxiety. This is anyway my long-winded way of saying, yes, shame is a complex animal, and that's the working definition I tend to have. Kimberley: Yeah. It's a different way of explaining it. This opportunity makes me so happy. What you're saying is, it's on a spectrum, would you say? Michael: Oh, absolutely. Yeah. Kimberley: Now, let's play that out. We're talking about the biology, and then there's the story we tell ourselves. Would you give an example for you? You and me, let's say we both got embarrassed. Let's say we both made a mistake or something. We embarrassed ourselves in front of each other, which is not going to happen here. But if we did, what might be a difference in the story we told each other which would indicate that higher level of shame or toxic shame? Michael: Sure. Let me clarify the story. It's not just how we appraise the shame itself. That's a part of it. But the story is like my upbringing. I was brought up in a blue-collar family. There wasn't a lot of room for emotions, especially for the male members of the family. So if I encountered a situation where I felt vulnerable or sensitive or hurt, the expression of that emotion could be shut down. That expression of that emotion could be punished, ridiculed. Not that I was ridiculed, but it could have been. Someone's narrative about a negative emotional experience could have been that and ongoing. They could have been bullied for being a sensitive kid, whereas you may not have. now you both may experience the same thing as a generic sense of shame. "I wasn't the way I wanted to be. I wanted to be put together and intelligent and I made a stupid GAF, and I came across looking silly." One kind of embarrassment for one is not necessarily the embarrassment for the other. That's what I mean when I say "the narrative." Kimberley: Yeah. Okay. This is wonderful. I think that maybe we want to take a look at, and I know I have a few questions. What I'd love to take a look at is, why would, let's say someone feel shame for having a mental illness? Michael: Well, yeah, that's a great question. I think there's a whole lot of reasons why someone might feel shame. One of them could be, I feel shame because the mental illness – we can say OCD in particular since this is one of the things I primarily treat – is that the content of my obsessions themselves could have a taboo theme or they could be otherwise conceived as bizarre. That's going to create a sense of "I shouldn't have this thought, there's something wrong with me I have this thought." The helping field, in general, commonly misinterprets and doesn't understand OCD. If you present this set of thoughts to them, you're going to get a sense of judgment and rejection or humiliation, and that's not made up fear. That's a real fear. That stuff happens to people. That's an example of how someone with a mental health issue can develop shame. It's because they may have gotten that feedback or fear rightfully so that they would get that feedback. Another way of looking at it is just, "I shouldn't have this because having this means I'm not working properly. I'm otherwise defective or broken." It's a silent problem for people – these emotional and psychological things. We have a lot more empathy and understanding for people with a physical problem than we do for someone who has a psychological or emotional problem. So, I think that there's this built-in-- Kimberley: Stigma. Michael: Yes. Stigma. Right. Thanks. Yeah, exactly. And then there's the people who've tried to get better. I've certainly seen a number of clients who've gone through years of therapy. They've worked diligently with great therapists, all very well-intentioned, and they failed to get better. "What's wrong with me? I must be really broken." I'm sure there's countless other ways, but I'll pass that off to you, I think. Kimberley: Yeah. I mean, I think these are all societal expectations that are placed on us. It's funny, you brought up the question about the concept around being humiliated for having an emotion. Somebody had written a question like: How can I be considered "the man of the house" if I have anxiety? I mean, there's so much shame in that question. There's so much societal expectations in that question and stigma in that question. I think it's definitely there, and I think you're right. For the things that are unknown, I see that to be more shame. I think everybody understands sadness. So we don't feel so much shame around it. But fear of harming your baby – let's not talk about that. You know what I mean? Let's push that down. Michael: Right. And not only because it's universally taboo. We know that instinctually. We don't need to really be told that. We know that, because that's our response if we were to hear that from someone else. Until we have that intrusive thought ourselves and they're like, "Oh, me too?" Shame, I think it's distinguishing shame from the other negative emotions that people have, because I don't think they're all the same. Oh, negative emotions or negative emotions – let's just learn how to handle them. Fear, that's a tough one. But shame? Shame is the most painful. Kimberley: It's ouch because it's in silence too, I think. My thing I say all the time is that shame thrives in secrecy. One of the best things you could do is to tell it out loud. Michael: I was having a conversation with colleagues about this a couple of weeks ago, and someone brought up a slogan that comes from AA, which is, "We're only as sick as our secrets." It's such a powerful message. The idea that speaking that secret allowed, speaking that shame aloud can be healing. Now it can also be traumatizing. We can probably get into that later in the episode. But I think that there's discernment about how and who we share with, and us as therapists creating a space where that's good and healthy for the person. But you're right. Absolutely. The things that thrive in darkness are painful. Kimberley: Okay, so you have a client and they have just very typical symptoms of OCD, even if it's very typical taboo, obsessions – this is for people listening – any disorder, depression, BFRB, eating disorders, how do you work with that shame with your patients? Michael: That's a fantastic question. I'm always evolving on how I figure that out with a particular client. I think if I were to try to distill that down to something helpful to the listeners, I think as a therapist, it would start with the very first interaction I had with the client. The first contact is the first opportunity, probably the best opportunity to provide a safe space that's understanding, validating, authentic so that the client can then experience this interpersonal interaction that they're having with this therapist as welcoming towards disclosure of a secret or their shame. I think that that first contact is vital. You can come across as the kind of person they want to talk to and try to set the stage and make that an effort, build that therapeutic alliance, continue to work on a therapeutic alliance because if you don't, it might be a lot harder to build the work to let them disclose that shame. And then from there, I think education about what shame is, like I brought up in the beginning, that shame can exist on this continuum, that there is actually an adaptive kind of shame. We don't tend to talk about it. We don't tend to see it because we talk about the toxic and the pathological shame, the one that keeps people stuck in hurt. Through that education, through a demystifying of it, I think, is incredibly valuable. I'll talk about the compass of shame in a minute. I don't want to steal all the time from you. It's like I talk a lot. Kimberley: Go for it. No, do. Michael: I've been thinking about this in preparation for our conversation today. I was thinking like, how would I want to set up an ideal way of dealing with shame with a client and again, creating that therapeutic space that they'd want to share that. And then if we have this experience that once we hand our secret or shame over to another person like, "Here you go," that's what the clients are doing to us, they're handing it to us. If we receive it and hold it with compassion and understanding, if we hold it with acceptance of them as a person, I think we introduced them to common humanity – one of the three things that show up with self-compassion, that common humanity – perhaps for the very first time in their life. Because this is such a secret, quiet problem, this might be the first time they've ever been met with common humanity and acceptance when they've revealed this. I think that's immeasurably powerful for the client. I think it helps them create a healthy distance from that narrative that's been telling them to keep it a secret, keep it a secret, or else you'll get rejected. "Wait a minute. I wasn't rejected." Kimberley: Yeah. It normalizes it too. Right? Michael: Yeah. Kimberley: Sometimes when I hand over the why box that has all the different obsessions, that in of itself can be a shame killer because they're like, "Oh my goodness, all of the things I have are right here on this piece of paper and you don't seem alarmed at all." Michael: Yeah. I've had email interactions with clients who are like, "Have you ever heard of this kind of presentation?" I'll shoot them links to three books written about it. They've written entire books about this so you're not alone. It's so helpful for them. Kimberley: Yeah. Tell me about the compass. Michael: Yes. I was introduced to this through one of my mentors, and it really rang true for me as a useful concept. The compass of shame was developed in the 1980s by a psychiatrist by the name of Donald Nathanson. I don't want to bore the audience with the history, but he researched shame basically that was his career. Nathanson had found through his research that there are four predictable and common unhelpful responses to shame. I'll say toxic shame. We're all talking about toxic shame. Those four represented the four points of a compass – north, south, east, and west. It doesn't matter where they go. One of the points is withdrawal. Withdrawal is when we get quiet, silent, small. Like a dog who got caught chewing on the cash knows they did wrong. They get small, they get quiet. They try to disappear into the moment. That's one common response to shame. Another one is avoidance, behavioral avoidance of situations and people and circumstances, but also through substances, through food, through sex, through anything that would be a direct response to a cue, "I'm going to avoid this feeling." Then another part of it is to attack others. This shows up when you felt humiliated or embarrassed by someone else. Someone made you feel this way, so you're going to lash out verbally or physically. In a sense, the way I think of it is in the sense of trying to balance the scales. "You've made me feel small and vulnerable and insignificant. I'm going to try to balance that out by making you feel the same way." The last one I think by far the most common in the people that we're going to be working with is attack the self. This is self-criticism, this is berating ourselves, self-condemnation, degrading ourselves. It's often seen as "I'm going to be holding myself accountable for this failure real or perceived," and that's going to make it better, that there's somehow a utility to this attacking self-response. But when you poke at it just a little bit, it's completely unhelpful. It's just a massive perpetuator of the problem. So, that's Nathanson's Compass of Shame. I think his point in bringing this up is, look, everyone's toxic shame response is going to fall probably into one of those four. Where do yours? if we can bring awareness to that, maybe we can learn to pivot to a more functional or helpful response instead. Kimberley: Right. I think that that awareness, again, it's validating and it's normalizing the normal response to shame, which helps the shame, I think, in and of itself. Okay, so let's play this out. If something happens, you've made a mistake or you've had a thought that you've deemed unacceptable, or you showed up in a way that created shame, you did all four of those things, what do we do from there? Or you did one of them. Now that we have this awareness, how might we meet shame instead in your thoughts, in your mind? Michael: I think hearing that from a client and I was watching it unfold in the moment, I might say, "Can we pause for just a minute? I think shame showed up for us." He might even be able to see some of the behavioral changes in their eye contact and the postures. I think shame showed up. What are you doing with that right now? Because again, it's silent. It's not broadcasting this out loud. It's silent. What are you doing? What's going on in your mind? Probably reveal what you said, they did one or all four of those things – I would point that out, give it a name. We understand this process. This is somewhat of a predictable response. Can we hit the pause button and can we now make a choice to pivot to a different response. Pivot to what? Pivot to self-compassion maybe. That might be a teachable moment. What is self-compassion? Can I give you an experiential exercise on meeting this moment with self-compassion? I can model meeting this moment with you with compassion so you can see what that looks like and feels like. Instead of spending time in the head, in the verbal, in the ruminative come back to the feeling, because that's what we're trying to avoid. When we criticize ourselves, we're trying to avoid and escape criticism, or using criticism to try to avoid and escape shame and humiliation. Okay, let's come back to that. That's painful. We can learn how to sit with that without having to beat ourselves up or escape it. I think people can sit with it in different ways. You can use it as an exposure opportunity for people who are feeling smaller kinds of shame, like embarrassment, like let's do some exposure towards what it feels like to be embarrassed. If we're dealing with a much more painful kind of shame, that humiliation kind of shame, let's meet that with more direct self-compassion in this moment. I think it gets sticky a little bit when we introduce self-compassion, if we haven't already introduced it, because like any intervention, it hinges on the client buying into it and thinking that they deserve to receive it. Kimberley: Right. I'll give you my personal experience with this because I think, and I see a lot and I would add a fourth point to the compass, which is, now as you're talking, I think this even different than what we talked about in previous conversations, just the two of us, is I think if I were really to track it, I think that another thing that I did when shame showed up is I swing into perfectionism. The stronger shame was, the more I would do good or be good. It's an interesting reflection for me because I think the more I felt imperfect and the more shame that brought up, the more it's like compulsive do good kind of thing, which I think again, might be why some of our clients get stuck around shame because there is that sort of self-punishment. "Well, I did a bad thing. Well, I have to neutralize that with a positive, good thing." I don't know. Just something I'm thinking about. Michael: No, I think that's really great. I'm sure a lot of people listening are thinking right now, nodding their heads, "Yup, I go into perfectionism." If I can channel Nathanson for a second, I imagine he would say, "That's a type of avoidance. It's an avoidant behavior. You're doing this thing and it's a compensation to numb, or to balance the scale." If I do enough good, it cancels out the bad. The message is that that thing is intolerable to feel, and it's not. Kimberley: Good catch. That's true. It is. It's like neutralizing the compulsion, right? Yeah. Okay. This is amazing. I have some questions from the audience that I think is a perfect segue, and there's one that really hit me, really deepened my heart and I wanted to ask your opinion on. Somebody had asked, how do I manage shame for having symptoms? They didn't express which ones, but I'm assuming it's having symptoms of being a human of some respect. But I also have privilege and resources and the ability to get care, how do I manage shame when I have privilege? Michael: That's a really great question. I think if I can flip that around a little bit, I can say that the cost of your privilege towards access to care, towards a good community of people, the cost of that isn't more shame. We don't want to shame ourselves for having opportunities. In a way, it moves you away from doing something about that, about that privilege. If you recognize I have privileged shaming yourself is useless. Who's that for? That's a silent response to try to balance out this. It's an avoidance. It's a running away from. So can we try to meet that? I'd say first with patients and then recognition, yeah, there is some privilege here and I feel bad about that, and then move into a "what's next" kind of a mindset. Like, I still need to work on my own shame about having these symptoms. It's not like I have to suddenly stop working on that because I also happen to have the privilege and the capacity to work on those. But I think we throw it into the same mix. It's like, okay, so you're shaming yourself. Which one of the four points of the compass are you doing now in recognition of a privilege? Once we get off of that unhelpful response, we can then maybe find a more helpful way to recognize the privilege, to speak out against the privilege, to prop other people up and help other people have access, things like that. But we can't do that if we're shaming ourselves, because shaming yourself, criticizing yourself, avoiding isn't workable. Kimberley: Yeah. There's so much of this like self-punishment involved as a response to shame. Like, okay, so I have this one privilege, so I must be punished for that before I can address the problem that I have almost. I'm so grateful that you answered that because I have seen that multiple times, many, many times with my patients and I'm guessing you too. You've talked about shame around lots of emotions. Interestingly, there were two very common questions, and I'll leave these as the last two questions for you. There was a lot of questions around having shame for anger and there was a lot of questions around having shame for having a "groinal response," which I'm assuming is in relation to some kind of sexual obsession or maybe even sexual orientation as well. Can you share your thoughts on those? Michael: Sure. Shame around anger, I think... I'm trying to interpret the question a little bit. I imagine it goes beyond just the feeling of being angry, but maybe the act of being aggressive, if I can make some interpretation there. I helped the client recognize that anger, like any other emotion, is universal. It's an emergent experience. It's not really up to you about whether you get angry or not. We don't have to act on the anger. We don't have to become aggressive either passively or physically aggressive about it. So, teaching them that there is some workability in our response to anger and that if we accept anger as an emotion, if we make room for anger as an emotion, we don't need to have a response to it in the same kind of way. We can let it in. Susan David, in one of her Ted Talks, she said that emotions are data, not directives. I love it. Super helpful way of organizing your thoughts around that. It's just, let the emotion be data. It's if you're responding to something in your life, something happened that it shouldn't have happened and it wasn't fair, and then you felt angry. Okay, I understand that process. I don't need to do something about it to get rid of it because there's that relationship to an emotion that can be unhelpful. Now I have to find a way to control or get rid of it. Notice we only do that with the negative side of emotions. We don't tend to be like, "I have to get rid of my joy." Kimberley: Too much joy. Michael: Too much joy. Kimberley: Unless we feel privileged, so then we're not allowed to have too much joy. Michael: Right. Yeah. In response to the groinal stuff, I think, again, it comes down to your biological, your physiological, your groinal response isn't really up to you. I think Emily Nagoski does a really great job in her talk about unwanted arousal, and such a powerful Ted Talk and really great education around that. Your body's going to respond, whether you like it to or not. I used to joke around and say, the reason why the 13-year-old boy isn't standing up at the end of Spanish class is because he wants to get more lessons. It's because he's waiting to not be embarrassed when he stands up. It's not that he's attracted to Spanish as a language –maybe he is – it's because he had a response and it wasn't really up to him. Okay, so bodies respond to things. Can we separate that out from the thing that was in our mind? Bodies respond to sex generically. It doesn't matter who it's with, what it is. Just the idea of it, the notion of it, the hint, and it response. So even people listening to us now, using the words like sex, might respond to the word, and that doesn't mean you're attracted to the word or to this podcast. Maybe you are, but it's probably not. It's that your body responded to things because of all these associative learning cues that are going on. That education is powerful. And then, of course, I treat shame the way I treat any toxic shame, which is, the response to it is the biggest problem that needs to try to meet it with something a little bit more akin to self-compassion and common humanity. Kimberley: I love it. Thank you. Oh, you nailed it. Is there anything else you want to share? Michael: I mean, not off the top of my head. I'm sure that we could dive into so many different rabbit holes on the subject, but I think this was a good intro to it. Kimberley: Yeah. Intro, but also with depth. I'm really grateful. I love to give as many applicable tools as we can. I feel like there is some better understanding. The compass is so good. It's so helpful to be able to deconstruct it that way. Michael: Yeah. That was a game-changer for me when I heard about that too. I will add a couple of things, just in passing other ways of therapeutically addressing shame. Once we've agreed that those four points in the compass are not the way we want to handle it, we have to have a new way. There's a, what used to be, I think, a Broadway show called Get Mortified. It's now a podcast, and it's people sharing humiliating and mortifying personal stories. Again, this is going out to strangers and this is an idea that I'm normalizing these experiences in my life. Maybe someone else can relate to it and maybe we can bring some humor to it. It's not about making fun of the person or the situation, it's about saying, can we all just laugh at the fact that we're busy concealing something that is so universal and ubiquitous. Kimberley: Yup. Life happens, right? It doesn't go to plan. Michael: Yeah. I think that's the other piece. Once you're ready for it, humor is hard to think of a more helpful response to shame. Kimberley: I'm holding back every urge right now to be like, "What's the most mortifying thing that's ever happened to you?" Michael: That's a different podcast. Kimberley: I was once on a podcast where he asked that, a very similar question. It was on OCD and he asked me a similar question. I think I completely went into your shame compass, like all the things, "What can I do to avoid this conversation?" Michael: Yes, yes. I think that would be like a few cocktails and we're going to record a podcast and maybe we can talk about that. But again, you can see, you can notice how even here, I could easily come up with two very shaming experiences in my life, and the difficulty of sharing that when I think that other people are listening to it. Why should I care? It's because it's a painful emotion. So even us therapists have a lot of work to do with personally so that we can show up with the client in a way that's helpful. Kimberley: Right. When I was doing one of the Mindful Self-compassion intensives, this is with Kristin Neff and Christopher Germer, one of the activities where we had to stop and do activity with the puzzle we came with if you came with someone. And then you had to turn to a person you didn't know, and you had to tell them one of the most painful things that's ever happened to you. They didn't really give you a lot of choices either. They were like, you're here, you're going to do it. The whole act was there was tears everywhere, flying across the room. But the thing was then, the person who's listening was not allowed to say anything, except "Thank you for sharing." It was so powerful. It was so powerful. They weren't allowed to say, oh. You weren't allowed to touch them. You weren't allowed to say anything, except "Thank you for sharing." Michael: And again, an immeasurably effective and important thing. That wasn't self-compassion. That was compassion, right? This is why I think like you with your Instagram work and people like Chrissie Hodges and OCD peers, and anyone who's an advocate for OCD that is building a community of people where they can interact like OCD has a community of people. These communities allow other people who are struggling with OCD to interact with each other. You create this group acceptance. The group has accepted you in, shame and all. You no longer need to conceal or keep secret this thing. The weight, the anvil that gets lifted off your shoulders, you no longer have to be weighted in the past. It'd be nice if we could generalize that outside of an OCD community and just say, the community at large has now been sufficiently educated about what OCD is and isn't, what depression is and isn't, what eating disorders are and are not, trauma, so we can be a lot more understanding of one another. Perhaps that's a little Pollyanna-ish to hope for, but I think that that's the direction we should head on. Kimberley: That's the mission. Yeah. Well, I actually think that this is a perfect place for us to end because I think that that is where we're at. That common humanity, we all have it. You're not alone. Yes, it's the most painful thing you'll feel. You'll feel like your heart is breaking at the time. All of these things are so normal and part of being a human. So I love that that's where we're at. Thank you. Michael: Thank you for indulging the conversation. Kimberley: Easily, so easily. Tell us about where people can hear more about you and know about you. Michael: Sure. As you mentioned, my name is Mike Heady. I'm the Co-Director of the Anxiety and Stress Disorders Institute of Maryland. I work with my other Co-Director, Dr. Sarah Crawley, who's a Child and Adolescent Psychologist. The Executive Director and Founder is Dr. Sally Winston. She's written a number of books on OCD. We're in Baltimore, Maryland. We're an outpatient, private group practice. We have over 20 clinicians that specialize in depression, OCD, anxiety disorders, and other related conditions. Yeah, that's us. That's me. Kimberley: Amazing. Well, thank you. I really am grateful. I feel so calm after these conversations too because I feel like it's the more you guess, you get to settle into it. So thank you. I'm so grateful personally, and for the community here, who sounded like they were very excited about this episode. Michael: Well, thank you for having me on. Kimberley: My pleasure. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .

May 7, 2021

Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, everybody. Thank you so much for joining me. I know your time is very valuable and precious, so thank you for spending your time with me. Oh goodness, I have so much to reflect on with you today. I've had a few aha moments, which I wanted to share with you because I wondered if I'm having these aha moments, maybe you are too. Let's just actually get straight to it. Shall we? Because it's funny for me to say this to you. I'm sort of embarrassed to say this, but I also think it's very hilarious. I consider myself to be a very mindful person. I really do. When I'm struggling, I always practice what I preach. I observe that I'm struggling. I bring my attention back to the present. I engage back into the present and I usually feel better. This has been a profound practice for me in my life. I teach it to you guys because of how much of a huge difference it has made to me. What has been really interesting is, I have taken some time off. I'm slowing down with work. My children have gone back to school. To adjust, we've had some massive, massive adjustments in our family. My husband took a year off work to be with the kids, so he could be their teacher. I, when COVID hit, went deep into just so much work and was really working to support the family in a way that I hadn't had to do before. I'm so grateful and I really recognize how privileged we were to have this environment and this experience because I was writing a book and I had my clients and there's just no way he could have gone to work. So, he's gone back to work. My children have gone back to school. I'm still finishing up the final stages of the book. So, it's been such a huge difference for me. Because of this, I actually have been working with a coach, which usually I go to therapy every week. My therapist and I agreed that I would take some time off because I really felt like I was doing everything that she had given me. I was really feeling like my mindfulness skills are really helping me. What was so interesting was that my coach – and this is not a coach for anxiety, this is more of a life coach – brought to my attention – and this is where it's really funny – that even though my mindfulness skills are really effective and so healing and wonderful, he felt – and I thought it was shocking to start with, but I think he's right– that I'm using it to avoid feeling my feelings and avoid feeling the sensations of anxiety. Now, when he told me this, I'm not going to lie, I wanted to smack him upside the face. I was just really mad about it. I was like, "What? You're telling me, I'm just this girl of mindfulness?" I don't really see myself as a girl, but my ego was like, "I'm a guru at this. I'm so good at this. You're telling me that it's not effective?" I took some time. I shook off the pride, the pride issues that I was having, and I really let what he was saying to sink in. He's 100%, right. I really am so grateful for this opportunity to be called out on this one. So here I am sharing with you that I too am going through a layered experience of recovery. As many of you know, I've had an eating disorder, I've had anxiety my whole life. I have struggled with depression. I have struggled with medical issues that have been really, really stressful on myself and my family. I have handled them mostly really well, I think, but it never occurred to me in this idea of recovery that I may be bypassing the opportunity to really do some work around uncomfortable feelings and uncomfortable sensations. Here I am. I'm going to teach you what I'm practicing. Now, I've made some adjustments. Instead of noticing my discomfort and suffering, I tend to it with mindfulness and self-compassion. But instead of jumping straight into those skills, which are so good, by the way, I'm not discounting. These skills are gold. If you have mindfulness skills, it's better than gold. It's more valuable than gold or anything else that you could get. So I still am going to use those, but there's this teeny tiny little space before that where I'm actually practicing feeling, allowing, and tolerating uncomfortable sensations, allowing uncomfortable feelings to be there. Now, I know the title of this episode is How to Tolerate Uncomfortable Sensations. The reason I've done that is because even though I realized emotions was the thing I was avoiding, really when I get down to it and we break down a feeling, a feeling is just a combination of a thought with a sensation. I've done episodes on how to tolerate thoughts, but I really wanted to really practice, and this is what I'm doing: Okay, I'm feeling sad. I've had a lot of sadness lately show up in my body. Where does it show up? For me, it's right at the front of my shoulders. I want to just pull my shoulders forward and curl my spine into a C-shape and just contract and go into fetal position. When I feel sad, I just want to drop my head down onto the table. I want to drop the muscles in my face and I just go exhausted. Instead of going, "Oh, I'm noticing that I'm sad," be compassionate to your sadness, but bring it straight back to the present, pull your shoulders back. I'm actually just making space for the sadness. I don't slump and jump into bed and stay there all day. Not that there's anything wrong with that, but I'm not engaging in sadness. I'm not just responding to sadness with apathy or depression, but I'm actually just spending time there and just going, "Yes, Kimberley, this is sadness. This is the sensation of sadness. It's okay to have these." Let's stay with them. We don't have to stay with them all day, but let's just honor them first. Let's stop jumping to mindfulness and compassion really fast. Let's actually stay in the sensations. You can still go about your day. You can still be highly functioning. We still want you to be doing those mindfulness and those exercises. But my question to you is: Are you really allowing that to be there or are your emotions holding you hostage? – which I think is what was happening. As I've always said to you, if you have a fear, stare it in the face. That's how you get empowerment over that fear. If you avoid the fear, that fear has power over you. And then you're always going to feel like your fear controls your life. The same goes for sensations. If you have uncomfortable sensations and you immediately remove your attention from them to the present or other things, now your sensations have control over you. You're giving them all the power and you're afraid of them. This is where I pose another question: Are you afraid of your uncomfortable sensations? If so, let's practice feeling them as an exposure. Without knowing it, my coach who is not an exposure therapist is technically giving us a mini-exposure by saying, "No practice staying in the sensations of sadness or anxiety or happiness or exhaustion or whatever it may be. Practice tolerating and staying with them and still doing what the non-anxious you would do, or the non-sad you would do." Like I said, I'm not going to say, "Oh, I have to feel my sadness. I need to stop what I'm doing, stop this podcast and go and lay in bed." I'm still going to talk to you guys and do what lines up with my values, which is to talk with you guys, connect with you guys, and so forth. But I'm going to say, "Okay, I'm observing that my shoulders feel that heavy feeling or my head feels that heavy feeling or my heart hurts. Can I just breathe into that?" Now you may want to set some timers for this and say, once you identify it, "Okay, for the next 15 seconds, I'm going to just do this for 15 seconds." Then you may say, "Okay, let's try it for 30 seconds." While I feel this anxiety – shortness of breath, tingling, tight chest, derealization, lump in your throat, panic sensations, racing thoughts – while I tolerate these sensations, can I practice coupling them with my life? So, while I'm feeling the emotion and the sensation, can I type up my email? Can I couple those two together? And when I do that, I might even say to myself, "Okay, this is me doing an email, writing an email while having the sensations of sadness or anxiety or anger or shame or whatever it may be." Just by that, you're having this experience of learning how to have emotions and sensations and you're learning a sense of mastery over them. Now, some of you have probably thought like, "Well, she's told me this before," which is why I said I'm slightly embarrassed because I know this stuff and I've probably said it on this podcast before, but I wasn't practicing it. Now, humbled to say that we're all working this out. We're all figuring this out. I was just listening to this wonderful meditation from my meditation teacher. He was saying that meditation is really like a huge Ashram. If you had the job of cleaning a large Ashram, you'd start in one room and you'd go to the next one, you'd go to the next one, and you'd go to the next one. You'd slowly get it done. By the time you finish, the first room you cleaned is dirty again. So you got to start again. He's like, the goal of meditation is not to get the house clean and be like, "Good, I'm done. I'm all done," slapped my fingers together. "It's all good." That's not what this is about. That's not what recovery is. I really resonated with that. I feel like I have to tell my clients these stories as well because recovery isn't a one-and-done. For me, literally, that's me. I've cleaned every room in the house. I've circled back. And now I'm like, "Oh, there's another thing. There's another area of improvement for me. Oh no. Oops." You know what I mean? My son always goes, "Oops." It is total "Oops, okay." This is a wonderful opportunity for us. This is not about learning how to be uncomfortable and you're done. This is about really having mastery over any sensation, any thought, any feeling that you may have. Any urge, any image, anything – having mastery over that. Not even mastery. Let's just actually scale back. Let's actually say, "Just knowing you can," that's enough. Let's not talk about mastery. That sounds too big for me right now. Let's just talk about knowing that I can. If I had to have anger or I had to have sadness or had to have anxiety, I know I could. Let's stay there. I hope this has been helpful. I am more than happy to share with you my shortcomings because I think that it makes me very human. It gives you permission to be very human. You guys know that I try not to take myself too seriously. I am on a journey with figuring this out too. Hey, let's just keep cleaning one room at a time and enjoy this learning. Thank you so much for listening. Please do leave a review if you enjoy the show or not. Please leave an honest review. We would love to get a review from you. I'm just sending you much love. Take care, everybody. These are difficult times. I want to really offer my loving-kindness to you, offer a gesture of kindness and warmth and compassion to you if you are struggling. Have a wonderful day. I will talk to you soon. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .

Apr 30, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have on Christian Newman, the Health Anxiety Coach, to continue our discussion on health anxiety . Christian was on the podcast a while back and because we get so many questions about health anxiety, we decided it would be great to have him on again to answer some of your questions. On this episode, Christian answers "How do I know if my symptoms are anxiety or something else?", "Is there anything other than CBT and ERP that I can use to treat health anxiety?", "How do I stop googling my symptoms?", "How do I stop focusing on sensations?", and "How do I learn to accept a doctor's diagnosis?" Christian also shares a bit about his 30 day detox program to help you recover from health anxiety. Follow Christian on Instagram @healthanxiety.coach If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Apr 23, 2021

Welcome back to another episode of Your Anxiety Toolkit podcast. Today, we are going to talk about BFRB's. Now, a BFRB is body-focused repetitive behavior. Many of you know, I am an Anxiety Specialist; I specialize in OCD and OCD-related disorders. Those related disorders can involve body-focused repetitive behaviors including hair pulling, skin picking, and nail-biting. Today, I want to give you eight tips to help you manage your BFRB. This is also really helpful if you have any behavior in your life that you want to adjust and change. It is also helpful if you are a family member or a loved one of someone with a BFRB. The eight tips we are going to discuss today are: Identify specifically where you're engaging in your body-focused repetitive behavior. Identify when you engage in your BFRB. Identify what emotions trigger your BFRB. Identify what thoughts you are having. Find alternative behaviors. Block the behavior specifically related to the body part. Find support. Practice self-compassion daily. Above all else, I want you all to remember that you are not your BFRB. You are way more than this thing that you struggle with. You have so many other beautiful characteristics and strengths and abilities. If you can introduce a self-compassion practice, you will find immense benefit from just gently nurturing the suffering that you are feeling. This is so important for everybody, but particularly for those who are really hard on themselves. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Apr 16, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to talk to you about a question that recently was asked by one of my awesome Instagram followers. This person asked me "Kimberley, how do I relax and be self-compassionate when I suddenly find myself with extra time on my hands?" This is such a fantastic question and a really timely one as well. So today we are going to discuss the skill of sitting still. Ask yourselves "When was the last time you allowed yourself to sit still?" and "When was the last time you allowed the discomfort you may be feeling to just be there?" Maybe you are thinking to yourselves that you have done nothing but sit still since COVID began, but even if this is true when was the last time you sat still and created space for your emotions to rise and fall? When was the last time you allowed yourself to experience your emotions and feelings without judgment? This is key. You may have been sitting still, but you may have been judging yourself at the same time. True restoration begins when you allow those emotions and feelings to be there without judgment . Are you resisting, pushing away, avoiding, or judging? Or are you willingly allowing yourself to feel all of the feelings? Often when we are stressed, we try to busy ourselves. This is usually an attempt to not feel the discomfort. Ask yourself, are my actions effective in the long term? Resisting, avoiding, and distraction may feel helpful in the short term, but is it really effective for the long term? I invite you to slow down and gently and compassionately make space for the present moment. You may not feel an overwhelming sense of calm and that is OK. Your self-compassion is not done to remove your discomfort, it is done to soothe the discomfort. I am asking you to try slowing down. To schedule time to just be still. Allow the discomfort and the quiet. Make space for all of your feelings and emotions as they rise and fall. I hope this was helpful and I hope that you remember to be kind and gentle with yourself. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Apr 9, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have on the amazing Joshua Fletcher who some of you may know from Instagram as Anxiety Josh. Joshua is a psychotherapist in the UK as well as someone with lots of lived experience with anxiety disorders. He is here today to talk to us specifically about panic attack s and panic disorder. Joshua shares his lived experience with panic, derealization/depersonalization, agoraphobia, and anxiety. He tells about his first panic attack and how that led to multiple panic attacks per day. This led him to planning his days around how to avoid having another panic attack. He shares the importance of psychoeducation for people who are experiencing any kind of anxiety disorder including panic. This is not for reassurance purposes, rather it is important to demystify the experience of anxiety. Once you learn what is happening, the anxiety loses some of it's grip. We know that anxiety thrives in the uncertainty and the unknown so becoming educated on what is happening in your brain and body is really so crucial for recovery. Joshua discusses hypervigilance and how this really is at the heart of anxiety disorders. He gives some tips and tools to help if you have been diagnosed with an anxiety disorder including panic disorder. We end the discussion by talking a bit about self-compassion and how important it is to recovery. I hope you enjoy this conversation as much as I did. Joshua has so much wisdom to share and I think you will find his words not only helpful if you are struggling with an anxiety disorder, but also really inspirational as well. Instagram @AnxietyJosh Click here to find links to Joshua's books, podcast, and more! If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Apr 2, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to share with you the 5 mindfulness tips that I use with my clients to help manage symptoms of anxiety and depression. The first tip is to observe. Instead of taking thoughts as fact, try simply observing your thoughts. An example may be "I am having the thought that bad things may happen." The second tip is to be curious. If you are able to be curious, you can actually change the narrative. Instead of being rigid, try being open to other possibilities. The third tip is to leave judgment behind. We often make the statement that our thoughts and feelings are wrong. Instead leave out the judgment and try "I am noticing this feeling is making me uncomfortable." This brings you back to a place of objectivity. The fourth tip is to be present. Bring your attention back to the present moment. Try to not focus on the past or the future. The fifth and final tip is to catch the stories you tell yourself. Be very careful when you say things such as "I can't handle this." Try to reframe that statement with "I can tolerate the discomfort." or "I can do hard things." I hope these tips have been helpful to you. I know that I find them incredibly helpful and use them often myself and with my own children. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Mar 26, 2021

Welcome back to another episode of Your Anxiety Toolkit. Today we are discussing Exposure and Response Prevention or ERP. So what exactly is ERP? Well, many years ago a psychologist created exposure therapy, which is where we expose people to their fears. If you were afraid of dogs, we would expose you to pictures of dogs and then videos of dogs and then we would probably ask you to go pet a dog, that is exposure therapy. This was found to be highly successful; however, over the course of time, more research suggested that doing exposures alone is good, but it doesn't completely address the whole picture of OCD because OCD does not just involve obsessions, it also involves compulsions. Exposure therapy did not really address compulsions. So a different method was added on and that is the response prevention. You expose yourself to your fear and then you would do response prevention, which would mean you would not engage in the compulsion to remove the discomfort, uncertainty, or anxiety that you are feeling. ERP is a treatment that addresses both the obsession by exposing and the compulsion by doing response prevention. Now, this is groundbreaking and the research has shown that the outcomes are really good, which is wonderful because for many years, we did not have a great treatment for OCD. Since then we have actually added on other modalities to make it even better. We have inhibitory learning, acceptance and commitment therapy, compassion focused therapy, and mindfulness-based cognitive behavioral therapy. All of these additional modalities really help to increase motivation and help to manage your discomfort as it rises and falls. A lot of people will ask if ERP can work if you do not engage in physical compulsions because as we know many people with OCD will engage in hidden compulsions that no one can see. Those are typically avoidance and mental compulsions. From the outside you may never know that they are struggling with mental compulsions all day because they are ruminating and playing out potential scenarios in their minds. It is so important to identify the mental or avoidant compulsions you are doing and that would be a part of your ERP as well. So that's ERP in a nutshell. Is it easy? Oh no, it's not easy. Is it hard? Oh yes, it is hard. But what am I about to say, say it with me everybody, it is a beautiful day to do hard things. Can you do hard things? Absolutely. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Beginning today March 19th and continuing until April 1st, ERP School will be available with bonus material. This will be an amazing training on the motivational skills Kimberley teaches her clients to help them in their treatment and recovery! Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Mar 19, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we are so lucky to have Dr. Jonathan Grayson on with us again. Dr. Grayson is a psychologist who has been specializing in the treatment of OCD for more than 40 years. He is also the author of Freedom from Obsessive-Compulsive Disorder and founder of The Grayson LA Treatment Center for Anxiety and OCD. He is here today to talk to us about magical thinking. I am actually getting asked a lot recently about magical thinking. People have a lot of questions about what it is and how it relates to OCD and anxiety. Dr. Grayson starts off by giving us his definition of magical thinking. He explains that magical thinking is really on a continuum. On one end you may have a person without OCD who engages in minor superstitions and on the far end you may have a person with OCD who has magical thinking that is actually interfering in their daily life. He says that most of the time with OCD, the magical thinking does not seem to have an obvious connection between the fear and the ritual. Dr. Grayson spends a good amount of time discussing magical thinking in the context of spiritual and religious beliefs as well as how magical thinking relates to scrupulosity. He also shares his thoughts on scapegoating as a form of magical thinking. He shares with us a bit about how someone can get better and overcome magical thinking. He says that this is really just about taking the risk of uncertainty similar to all OCD treatment. He says you should ask yourself "Is this magical thinking actually working? Is it bringing you any peace?" This episode is full of such wisdom. I learned a lot myself and I hope you all will find it helpful. Dr. Grayson's book, Freedom from OCD , is now out as an audiobook! Click here for more information. The Grayson LA Treatment Center for Anxiety & OCD If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Beginning today March 19th and continuing until April 1st, ERP School will be available with bonus material. This will be an amazing training on the motivational skills Kimberley teaches her clients to help them in their treatment and recovery! Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Mar 12, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. We have a lot to tackle in this episode! We are going to be talking about a really important topic which has a lot of confusion surrounding it. Today we are going to explore the difference between an intrusive thought and a mental compulsion. OCD starts with an obsession. This is an intrusive, repetitive, unwanted thought, feeling, sensation or urge that you cannot control this. Once you've had that intrusive thought, feeling, sensation and urge, you usually feel anxious and uncomfortable because it is unwanted. You then have this natural instinct to try and remove the discomfort and the uncertainty that you feel. This is what we call a compulsion. Usually we feel some form of relief from the compulsion, but this becomes a problem because it only reinforces to our brain that the thought was important. Your brain continues to send out the alarm that the thought must mean something. Now many of us are aware of the form that physical compulsions can take such as hand-washing, jumping over cracks, moving objects and so forth. Actually one of the most common compulsions is mental and that takes the form of rumination. The problem people run into is that rumination is sometimes hard to identify. That is why I am doing this episode because so many people have asked, how do I differentiate between the intrusive thought and a mental compulsion? And what do I do? We know we should not be blocking thoughts, so how do we stop mental compulsions. If I'm not supposed to suppress my thoughts, what am I supposed to do if I catch myself doing mental compulsions? Is stopping mental compulsions thought suppression?" I would say, technically, no. But it depends. Let's go straight to the solution. We want to acknowledge that we're having an intrusive thought, feeling, sensation or urge or an image. our job is to do nothing about it. We need to do our best not to solve that uncertainty or remove ourselves from that discomfort. That's our goal. And then our job is to reintegrate ourselves back into a behavior that we were doing, or we would be doing, had we not had this thought. So here is an example. Let's say I'm typing. I have an intrusive thought about whether I'm going to harm my child. So I have this, I'm going to acknowledge that it's there. I'm actually going to practice not trying to make that thought go away. But instead, bring that sensation or thought with me while I type on my computer. As I'm typing, I'm going to notice the sensations of my fingertips on the keyboard. I'm going to notice the smell of the office. I'm going to notice the temperature of the room I'm in. And I'm going to then catch if my mind directs away from this activity towards trying to solve. If I catch myself trying to solve it then I am going to bring my attention back to what I'm doing. I find that if I'm getting caught in some kind of mental rumination, I get down on the ground and I start playing with my son. The OCD may continue to try and get your attention, but you are going to continue with what you are doing and not engage with the thoughts. It is important to remember that compulsions feed you back into a cycle where you will have more obsessions, which will feed you back into having more compulsion's. It's a cycle. We call it the Obsessive Compulsive Cycle. So we really want to sort of be skilled in our ability to identify the difference. This is really, really hard work. I think about when you're originally first learning anything, everything is really confusing and everything looks kind of the same. When you first start doing it, these are going to look very similar and it's going to be difficult to differentiate the difference, but once you get better at being around this and labeling it and catching it, you will be able to see the differences in these two things, even if it's very, very nuanced or they look very, very similar. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Coming in March 19th ERP School will be available with bonus material! Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Coming March 15th, we are offering our free training, The 10 Things You Absolutely Need to Know About OCD. Transcript of Ep. 180 This is Your Anxiety Toolkit episode number 180. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, everybody. Hello. Thank you for being here with me. We have a lot to tackle in this episode, so I am going to jump in as quick as I can. I know this is such a huge concept and topic, and there's so much confusion around it. So let's really today talk about the difference between an intrusive thought and a mental compulsion. We also want to figure out which ones we want to work with and which ones we want to allow. We want to talk about the difference between allowing a thought and engaging in a thought. There's so much to cover here. So before we get started, a couple of really exciting things, I really want you to keep an eye out for. On March 15, 2021, we are relaunching the free OCD training. It's called the 10 Things You Absolutely Need to Know About OCD. It's not called the 10 things you need to know. It's called the 10 Things You Absolutely Need to Know About OCD. I have shared this free training multiple times, tens of thousands of people have taken this training. I've gotten nothing but amazing responses back. And the coolest thing is people even said, "I've watched it before. This is the second or third time I've watched it when you released it. And it really reminded me of these core concepts that we have to remember when we're talking about OCD." So even if you've watched it before, even if you're pretty well versed in OCD, I still encourage you to listen and take the free training. It's just jam packed with information and science and all the good stuff. And even if you're a therapist, I encourage you to take it. So if you're interested, go over to cbtschool.com/10things, or you can click the link in the show notes. I am so excited to share that with you. Now, one more thing, keep an eye out, because as of March 19th, we are relaunching ERP School with some exciting bonuses, which I will announce in next week's episode. So excited again to share this with you. And what an amazing community, what an amazing opportunity I've had to teach so many people about ERP. And now also teaching therapists. We have now got ERP School approved by The National Association of Social Workers. So if therapists out there, you can actually get CEUs for taking ERP School, which is very, very cool. All right, let's get straight to the show. Let's talk about the difference between an intrusive thought and a mental compulsion first. So the first important piece to remember here, as we pull apart what to do with what thoughts, because that's really what this is about. We must first understand the foundation of OCD. So OCD starts with an obsession. This is an intrusive, repetitive, unwanted thought, feeling, sensation or urge. It's not just a thought. It could be a sensation. It could be a feeling like de-realization or guilt. It could be a sensation like a feeling in your left finger or feeling in your nose or whatever that may be, everybody's different. But it does start with this intrusive thought. And the thing you must remember here is you cannot control this. This is the first experience of OCD, right? You have the intrusive thought, feeling, sensation or urge, and this is the thing you can't control. So there's a really big point right off the bat. The second piece here is once you've had that intrusive thought, feeling, sensation and urge, you usually feel anxious and uncomfortable and it's unwanted. And so your natural instinct is to do something to remove it. You'll do it to remove the physical discomfort, the emotional discomfort, the uncertainty that you feel. And that is what we call a compulsion. Now, as many of you know, we know the kind of more mainstream compulsions that are known in our society. Hand-washing, jumping over cracks, moving objects and so forth. But one of the most common compulsions is mental. It's thinking. It's rumination. And that's the thing that's really hard to catch. And that's why I'm doing this episode because so many people have asked, how do I differentiate between that intrusive thought and a mental compulsion? And what do I do? Like I said at the beginning, I'm not supposed to block thoughts, but I'm not supposed to do mental compulsions. And that's thinking too, and what this does, right? So let's go back to the cycle. You have a thought, feeling, sensation and urge. It makes you uncomfortable. Then you do a compulsion to make it go away. And usually you do get some form of relief. But the problem with this is that then it reinforces that that thought was important. Therefore, your brain continues to send out the fire alarm, the safety alarm, the smoke detector, it sets off all of those alarms in your brain and then sends out more anxiety with more of that thought, feeling, sensation and urge. So let's go back to the main concept. You're not to try and suppress your thoughts because the more that you suppress your intrusive thoughts, the more you have them. I've done full episodes about this in the past. So if you want to go back and listen, suppressing your thoughts will only make them worse. But here is where it gets tricky. People will say again, "If I'm not supposed to suppress my thoughts, what am I supposed to do if I catch myself doing mental compulsions? Is stopping mental compulsion's thought suppression?" And this is where I would say, technically, no. But it depends. So what we want to do, let's go straight to the solution. We want to acknowledge that we're having an intrusive thought, feeling, sensation or urge or an image, right? It could be an image too. And then our job is to do nothing about it. To do our best not to solve that uncertainty or remove ourselves from that discomfort. That's our goal. And then our job is to reintegrate ourselves back into a behavior that we were doing, or we would be doing, had we not had this thought. So let's say I'm typing. I have an intrusive thought about whether I'm going to harm my child, or I have an intrusive thought about whether I cheated on my partner, or I had an intrusive thought on whether I'm gay or straight, or I had an intrusive thought about harming somebody, or a religious obsession, or a sensation, or a health anxiety sensation. So I have this, I'm going to acknowledge that it's there. I'm actually going to practice not trying to make that thought go away. But instead, bring that sensation or thought with me while I type on my computer. As I'm typing, I'm going to notice the sensations of my fingertips on the keyboard. I'm going to notice the smell of the office. I'm going to notice the temperature of the room I'm in. And I'm going to then catch if my mind directs away from this activity towards trying to solve. If I catch myself trying to solve, yes, I am going to practice not doing that thinking. I'm going to practice not trying to solve it. And then bring my attention back to what I'm doing. I find that if I'm getting caught in some kind of mental rumination, I get down on the ground and I start playing with my son. He's really into Lego right now. And so I fully, fully throw myself into this. I do my best to fully engage as best as I can. Now, I'm still going to have the presence of intrusive thoughts because I cannot control that. So it's going to sound a little bit like this. OCD is going to say, "Hey, what about this? What if this happens?" And I'm going to say, "Hi, thought. I'm actually typing an email right now. And that's what I'm going to do. You can be there. I'm going to allow this uncertainty to be here and I'm going to keep typing." So then I start typing. And then OCD will be like, if I were to externalize it, would be to say, "No, no, no, no. This is really important. You really have to figure this out." And I'll go, "No, thank you. I'm really cool that you're here, but I'm going to type." And then it's going to say, "Hey, Kimberley, this is really important. And if you don't give me your attention, I'm going to... Something really bad is going to happen." And I'm going to go, "Thank you. But I'm writing an email right now." And then you're going to be like, wow, I'm doing pretty good. Look at me go. I'm fully practicing the skill of not engaging in my intrusive thought. And then it's going to say, "Listen..." Let's say I'm impersonating OCD. It's going to say, "Listen, I am not going to stop bugging you until you give me your attention." And I'm going to go, "That's fine. I'm actually going to call your bluff on that. I'm writing this email. You do not get to tell me what to do." And it's not going to give up. It's going to keep going. "Kimberley, Kimberley, Kimberley, Kimberley, you must pay attention to my thoughts. You must pay attention. I'm trying to alert you to a very big danger." And often this is where people get worn down. They're like, "Oh my gosh, it's not going away. Maybe it is right. Maybe I should do it. Maybe I can't handle this anxiety. Maybe this is too much for me. Maybe it's just easier to do the compulsion." But I'm going to be here with you, urging you to keep allowing that intrusive thought to be there. It will basically roll over and start crying and fall asleep at some point, like a toddler, who's too tired and is rejecting his nap. But all he needs is to nap. It eventually will die down, but you have to be willing to stick and be consistent with not engaging in the pleads of OCD, the urgency of the obsession, the catastrophization of the obsession. Because it's going to be making it into a... What do they say? A molehill into a mountain. It's going to be making a small problem, a big problem. And what I mean by that is the present of a thought is not dangerous. It doesn't mean it's a fact. It doesn't mean it requires your attention. Some people with OCD have a part of your brain that's going to set this thought on repeat. And because we've tried to suppress it in the past, it is probably going to want to be very, very repetitive. And your job is to do nothing at all. If you do, and I'll say this again, if you do catch yourself doing mental compulsion's, it's okay to stop doing that. That's not thought suppression. As long as you're... You don't want to over-correct. So if you catch yourself doing mental compulsions, don't over-correct by also trying to block the thought. That's where we get into trouble. Instead, you just do a small correction back to what am I doing? What am I engaging in right now? What do I value? Because we do not value compulsion's. Compulsion's feed you back into a cycle where you will have more obsessions, which will feed you back into having more compulsion's. It's a cycle. We call it the Obsessive Compulsive Cycle. So we really want to sort of be skilled in our ability to identify the difference. If you can't identify the difference it's going to be really hard to know which is which, and how to respond in those moments. And a lot of this is when we're super anxious, it's really hard to think logically. It's really hard to think... Is this true or is it not? Or so forth. It's not even helpful in that moment. Whereas, it may be like three days later. You're like, "Oh my goodness, what was I thinking? That was a bit strange. I wonder why I got so caught up in that." And that's because when we're anxious, our brain has a difficult time coming up with problem solving that is effective. So the more you can be able to identify it, and I encourage my clients throughout the day is catch yourself doing mental compulsion. Don't beat yourself up, but practice this idea of going, "This is me doing a mental compulsion. This is me having an intrusive thought. This is me having an intrusive thought and wanting to do mental compulsion." And being able to label them so that in the moment when you really are at a nine or a 10 out of 10 of anxiety, or uncertainty, or discomfort, you're able to be more skilled in your response. Super, super, super important stuff here, guys. But we don't want to shame here. Again, this is really, really hard work. I think about when you're originally first learning anything, everything is really confusing and everything looks kind of the same. I always think of like The Devil Wears Prada, this is a crazy example, but the actress is laughing at these people because they're looking at a belt that looks almost the same, but it's very different in their eyes. And the one main character is like, "They're the same belt." And they look at her like she's crazy. And this is the same, right? When you first start doing it, these are going to look very similar and it's going to be difficult to differentiate the difference. But once you get better at being around this and labeling it and catching it, you will be able to see the differences in these two things, even if it's very, very nuanced or they look very, very similar. Okay, that's all I'm going to say for now. The tools are the same. If you really want to go back and practice and learn these mindfulness skills you can practice, go back and listen to some of the previous podcast episodes. I actually encourage you to go back and listen to some of the earlier episodes, because in those episodes, I totally, I was laying out this awesome content on how to be mindful. Some of my best podcasts are the very first few ones, which is like back-to-back major skills, major tools. It was laying the foundation for how to be mindful with obsessive thoughts. So go back and listen to those or sign up for the free training coming up or, and you can also sign up for ERP School, which is coming back very, very soon. We also have Mindfulness School for OCD, which is a course that really deep dives into practicing mindfulness related to obsessions and compulsions. So that's there for you as well. Okay. A lot. Sorry, I'm talking so fast. It's something I'm so passionate about and is something that I really wanted to make sure I covered and get very clear on. I've had a couple of you reach out and really be stressed about figuring out the difference. I'm hoping that's super helpful. One last thing before we go, please do leave a review. I know I keep begging you at the end of every episode, but it really would mean the world to me. If you get anything from the podcast and you want to give back in any way, I would love a review from you. Your honest review, you don't have to fabricate anything. I really love them. I read every single one. And once we get to 1,000 reviews, we will give away a free pair of Beats headphones so that you can hear me crystal clear in your ears. And you of course can pick the color of your choice with those. So all my love to you. Please do go and leave a review. I hope today's episode [crosstalk 00:17:05] was helpful. And get excited [crosstalk 00:17:05]. All right, have a good one, guys. All my love to you. It is a beautiful day to do the most beautifully difficult hard things. Please note that this podcast or any of the resources from the CBTschool.com should not replace professional mental healthcare. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day. And thank you for supporting CBTschool.com.

Mar 5, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to focus a bit on OCD treatment. I want to share with you all 8 tips that I think will really help to fast-track your OCD treatment . The first tip is to get support. That may people from people in your life or it may be from social media, organizations in the OCD community, or online support groups. The second tip is to pace yourself. Find a pace that works well for you, not too fast, not too slow. The third tip is to give yourself time to feel all the feelings about your OCD treatment. You are likely going to ride a wave of emotions and that is OK. The fourth tip is to stop judging yourself for your obsessions and compulsions. Being critical of yourself on serves to get in the way of your recovery. So go easy on yourself. The fifth tip is to embrace uncertainty. Learning to live with uncertainty is key to recovery in OCD treatment. The sixth tip is to stare your fear in the face everyday. Remember when we turn away from our fear, OCD only becomes stronger. The key is to do those hard things. The seventh tip is to find your motivation. What is your motivation for wanting to get better? The eight and final tip is understanding and accepting that you cannot control your thoughts. The only thing you can control is your reaction to those thoughts. I hope these tips will help as you progress through your OCD treatment. If I can leave you with just one thought that would be "It's a beautiful day to do hard things." If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Coming in March 19th ERP School will be available with bonus material! Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Coming March 15th, we are offering our free training, The 10 Things You Absolutely Need to Know About OCD. Transcript of Ep. 179 This is Your Anxiety Toolkit - Episode 179. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, my friends. Hello, Happy Friday. This is when it's released. If you're not listening to this on a Friday, Happy whatever day you're listening, Happy Day. How are you? Take a breath. Where are you? What are you doing? What do you see? What do you smell? It's a beautiful day. Thank you for being here with me. It is a beautiful day to do hard things, as always. But today, we're actually talking about exactly that, talking about how to do really hard things in the form of talking about the eight things you can do to fast-track your recovery. It could be OCD recovery, it could be health anxiety, panic disorder, eating disorder, whatever it may be. But we're probably going to put a focus today on OCD, mainly because I am getting ready. This is very exciting. Let me go off on a tangent. I'm getting ready to relaunch the free training that we offer twice a year called The 10 Things You Absolutely Need to Know about OCD. It's a free training. We've offered it now for almost three years, and I offer it twice a year over... not over a thousand, over tens of thousands of people have watched this training. It's quite amazing. So many people have given me amazing feedback on it. A lot of people have said that this was their first introduction to OCD and the education to OCD. I'm just so happy to share this with you. We will be releasing this training again on March 15, so get ready. I will send you all the details when we get there, but for right now, you could just get really excited and you can listen to this episode, which is really again, talking about not the basics of OCD, even though a lot of people who've taken that free training said they go back every time I launch it and rewatch it because it's a really great reboot on these major basic concepts. Today, we're going to talk about bigger concepts, like really looking at treatment and how to fast-track it. So, let's get started. Before we start, actually, again, I'm going to ask you for a favor, if you would have a moment and you feel so inclined, please go and leave a review. I am on a massive... What would you call it? Effort to get more reviews, not because I need the ego stroke at all, but because I have been told by multiple business people that if you want to help more people and get this free resource out to more people, you do have to have a ton of reviews. The more reviews you have, the more likely people are to click on the podcast and try it. My goal is to create really, really good content, but they have to actually click the content to get helped by the content. So if you could help me with that, that would be amazing. I have offered an incentive. We are having an exciting challenge where we're challenging ourselves to get a thousand reviews. Once we get a thousand reviews, I'll be giving away a pair of Beats headphones to one of the lucky reviewers of your color choice as a thank you. So, that's there. I would love to have you write a review. All right, let's get into the show. We're talking about the eight tips to fast-track your OCD treatment. Get support. This was actually the #8 point, but I actually brought it up to #1. If you are willing to do hard things, which you will because OCD treatment requires you to do many hard things, you will need support. Now I know what you're probably thinking. "I don't know anybody who has OCD," or "I don't have enough money for treatment," or "I don't know who to ask." And that's why this podcast is here. This is a free service to help you feel supported. And if listening to this podcast is your form of support, well, I am so, so grateful and blessed to have that opportunity. But even better than that is to get support by people who are in a similar situation and it does not have to cost you money. It does not have to cost you time. The use of getting support for OCD might look like social media accounts. There are so many advocates on social media, Instagram, Facebook. This is a really wonderful way to get support. You might go to OCD Gamechangers or the International OCD Foundation, where they have programs and free town hall and fireside chats where you can feel supported because you're in an area of like-minded people. You might join a support group. There are many GOALS support groups. It's G-O-A-L-S support group. If you Google it, there are many around the country of the United States where they're free support groups for people. They are online forums. I have a free Facebook group called CBT School Campus, which is a group of the most kind of supportive people who are also on their journey. So, get support. You can't do hard things on your own all the time. You can do them on your own some of the time, but it fast-tracks it if you really do have support and people cheering you on. The other thing to remember is you don't have to know someone who has OCD. Find somebody who's also doing something difficult and say, "Hey, I'm doing a hard thing. You're doing a different hard thing, but I wonder if we could support each other." Most of the time, people are so relieved not to do hard things on their own. So, get support. Pace yourself. When you want to fast-track your treatment and your recovery, your instinct is to go in great guns. In Australia, we call it great guns. Great guns is full-on going in, giving it your biggest effort. And that's good. Great guns is awesome, but you have to pace yourself. You can't sprint a marathon. You'll get into the first mile and you'll collapse. This is about pacing yourself and having a clear plan. One of the biggest areas I make as a clinician is when I create a treatment plan for my patient or my client, and it's not a good pace. It's not a good beat. You can hear me clicking. You can't go really fast and then taper out. You lose momentum. So what you want to do is pace yourself at a cadence that feels really right and is doable and is realistic, that you can make a part of your daily life because it's not realistic to do four hours today and then zero hours tomorrow, and then two hours the next day. Try and find something that you can do a little bit every day. Give yourself time to be mad, sad, sad, resentful, and have whatever feelings you have about this OCD treatment or this recovery process. You're going to have lots of emotions and you have to prepare yourself for that. You have to be willing to ride the many emotional waves of recovery. It's not just a matter of sitting down and doing exposures and going on about your life. You are going to have to feel all kinds of emotions, and that can be really overwhelming and painful. So give yourself time to have those emotions. Stop judging yourself for your obsessions and your compulsions. One of the things that is the most demotivating actions we can do is criticize ourselves for where we're at. This is a podcast episode about fast tracking. This means what slows us down, looking at what are the things that slow us down so that we can go at the fastest pace possible that is healthy and realistic. And that involves not being critical. Being critical literally does nothing good. It slows you down. It de-motivates you. It disempowers you. It makes you feel more secondary emotions. It does no good. I know you know that, but sometimes we have to remind ourselves that in the moment, when we catch ourselves judging ourselves for the thoughts or feelings we're having or judging ourselves for the compulsion we're doing is to go, "Wait, that's not helping. That's not effective. That doesn't get me closer to the goal." Even if I feel that way and it feels true, I am going to catch this and step out because it's not effective. Uncertainty is key. If you are not being uncertain, you are taking a detour. Think of it like you're on a road and you've got a destination and you're getting there. Every time you go off the road, let's say, you're going from A to B, going off the road, going towards C is the equivalent of going to certainty. You want to get off the road of certainty and get back on the road to being uncertain. And you will naturally, oops. Whoops, it's easy. As we took a little detour back into certainty land, turn around, do a U-turn, come on back to the road of uncertainty. That is the fastest route to your recovery. Then you've got like a GPS. Over the GPS if you had one in your car, it would be like, "Please do a U-turn. You have taken the wrong route. You are on the road of certainty. Turn around and proceed to the road of uncertainty." That's how I imagine the GPS lady or man speaking to you when you've gone down that wrong road. Again, when you catch yourself, don't beat yourself up. The GPS doesn't go, "Bad you. You're a bad person for going on a detour." She just goes, "Would you please do a U-turn and proceed to the route?" Stare your fear in the face every day, learn to play this game, and it is a gap. This is talking about a Reid Wilson approach who I adore. Reid Wilson's approach is, this is a game. Your job is to accumulate points. Every time you stare fear in the face, you accumulate points. And we want more points. We want to take the points away from OCD. I'll often say to my patients and clients, "I want you to accumulate a hundred points a day." Let's say if touching... my bike's right in front of me. So I'll say, let's say touching the handlebar of my bike is a 5 out of 10. If I do that, I get five points. Good job. I've only got 95 more to get today. If letting myself have certain thoughts, if that's a 9 out of 10. Okay, great. Now I've got 14 points. I'm getting there. I'm getting closer to my goal. You could say 50 points. If you wanted to start early or easier, you could go to 10 points to start with. That's fine. But learn to stare your fear in the face every day and play the game. We don't want OCD getting and accumulating and racking up all the points because they win. Because when we avoid, OCD gets points. We want to try and prevent OCD from hitting its 10, a 100 mark every day. We want to be like, "Nope, I'm going to win this game today." Treatment requires motivation and fast-tracking requires motivation. Your job is to identify what will happen if you don't play this game and stare fear in the face. Identify what OCD has taken away from you. PS, little teaser. Next week's episode is all about motivation. If you struggle with this, we're going to deep dive into motivation. It's something that I have been asked about so much lately. So I, of course, scheduled to talk to you about it. Again, the motivation, it does require a ton. If you want to fast-track your treatment, it does require that you get your wheels moving and you don't slow down. And that will require keeping in your mind's eye right in the front. Like, I'm doing this hard work because if I don't, OCD will take A, B and C from me. Now, little side note, and we'll discuss this next week. If that feels a little like pressure or shaming or guilt-tripping on you, we can learn to shift the language around that. Your job again is to try not to judge yourself for what it has taken from you in the past. That's a really important piece here. But again, I'll pause there because we'll go through that next week. Drum roll... The final major thing that you have to remember to fast-track your treatment, and I did originally have this as #1, but I'm going to finish with it because it's probably the most important. Your recovery requires a deep understanding and acceptance of the fact that you cannot control your thoughts. Most people, by the time they come to me, have wasted so much time and so much of their life in a wrestle, trying to control their thoughts. No judgment there. That is the natural inclination of a human being. But you have to really drop down and recognize that trying to control, which thoughts come in and out of your mind, is a lose-lose for everybody. The only thing you can control is how you respond to your thoughts. Massive, massive point. That is one of the points we do cover in The 10 Things You Absolutely Need to Know about OCD training, but I really wanted to bring it up again because it's so important. Everyone gets caught in this one. So it's just a matter of catching it and going, "All right, I'm in a wrestle with my thoughts. I know I can't control my thoughts. So I'm going to have to try something different." The only thing you can do differently is to change how you respond. The answer to that, let me give it to you, is just to do something different. It's basically to go, "Oh, this is too big. I can't solve this. It's unsolvable. I'm just going to walk away." It's sort of like, sometimes my son's doing a Lego and he's getting really frustrated because he just can't seem to figure out this next step and he's getting more upset and he's getting more upset. Now he's sort of ripping at it and pushing out it and things are suddenly breaking apart. I'll say, "Whoa, this isn't working step away. Let's go do something else. We'll come back later." That's really important. I love you guys. That is the eight tips I have for you to fast-track your OCD treatment. If some of that went too fast and too much, get ready, we'll do the free training here very soon. I strongly encourage everybody to take it, even if you've taken it again, because I've added a bonus point this time. Really now it's 11 things you have to know, but you'll see that when we get there. All right. I love you so much. Have a wonderful day. It is a beautiful day to do one hard thing. Whether you choose the hard thing or it's naturally happening, that's okay. Just do the hard thing. Be in the hard thing. Give yourself permission for things not to be right and perfect. Okay, I love you. Have a wonderful day and thank you for listening. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

Feb 26, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have on an amazing guest and therapist, Menije Boduryan. Menije is an OCD specialist as well as a specialist on perfectionism. She is here today to talk to us about perfectionism and to give us some tips on how to manage perfectionism in our own lives. Menije defines perfectionism as a drive to do things perfectly with anything less than 100% being unacceptable. It is a desire to want everything to be flawless and in that desire, comes a lot of expectations or rules that people set for themselves. She explains that perfectionism becomes a mindset and you begin to operate in the world expecting yourself to be perfect, as well as your partner, your best friend, your clothes, your work desk, what you eat, and how you exercise to all be perfect. It becomes powerful because our self-identity becomes so attached to this idea of being perfect. It is not just about the desire to do things perfectly, but it also becomes a belief that once you do things perfectly, then you are enough, you are worthy. Menije shares with us a bit about her own struggles with perfectionism and how perfectionism impacts our relationships. She describes how it is really possible to fall into a cycle with perfectionism. If you fall short in something you are doing, which you inevitably will, you start into the cycle of feeling shame and that you are not good enough so you then strive to work harder the next time to achieve that level of perfection. Menije shares with us one of the best ways to break out of that cycle of perfectionism is really to just give ourselves a tremendous amount of self-compassion. Recognizing that whatever happens today, I am worthy and I am enough. She also describes that breaking out of the cycle involves being able to tolerate your imperfections. Really being able to sit with the discomfort and anxiety that will come when you have done something that is not perfect. She describes it as very similar to exposure therapy. This interview is full of so many amazing insights. I hope you will find it as helpful and as meaningful as I did. Menije's Instagram @dr.menije If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Coming in March ERP School will be available with bonus material! Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Feb 19, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to talk about a concept that is really important to long-term recovery or just life in general, which is this question: Does this bring me closer to my long term goals? Now, human beings are very reactionary. When there is an event, we quickly do a little data check in our brain. Is it safe? Can we proceed? Should we run away? Should we freeze? Should we just freak out? We have the whole process that happens in a millisecond, and then we respond. Now the fight-flight-freeze system of the brain keeps us alive. It's a reaction we have to danger. So if there is a lion, we know to either freeze, run away or fight it. For those with an anxiety disorder, we often go into the fight-flight-freeze when there isn't any real danger. The more we react, the more we enforce our fears and the more that we get stuck in a cycle of reaction. One of the most helpful things in life for me has been to step back and look at the cycle, look at the trends and ask myself, does this behavior, does this reaction bring me closer to my long term goals? If you can, just practice slowing down and pausing and saying to yourself "Wait a second. Is there a trend in my reaction?" I often say to my clients that my job is pretty simple. My job is to help you find the trends, find the patterns. If there is a pattern of reaction, that is where I intervene. I want you to be able to look at the patterns and the trends, and then decide for yourself what is good for you. We cannot live just in reaction because that is when we get stuck. So I want you to try asking yourself "Does this behavior bring me closer to my long term goals?" Remember to be gentle with yourselves and give yourselves a huge amount of self-compassion. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Coming in March ERP School will be available with bonus material! Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Transcript Ep. 177 Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, friends. I am so happy to have you with me. How are you doing? How are you all? Sending you so much love. Checking in with you. Hey, how are you doing friend? Number one, thank you for being my friends. It really, really is wonderful. Up to this point, let me just reflect on something really quick. When I first started creating the podcast, I would look at the microphone and just talk into the abyss. Just talk, talk, talk, talk, talk, say what I want to say, and get done. The cool thing is I was just reflecting on this before. Now that I have met quite a few of you at either conferences or events or on social media or on the Facebook group, which is CBT School Campus, you can go to it's a private group, and I know your faces, now I have this wonderful experience where I can look into the microphone and actually see your faces. It's been so fun to actually meet you guys and just be like, "Oh great." I know I have another face. Hello, welcome. Thank you for being here. I know your time is so precious and I'm so grateful that I get to spend this time of yours together. Let's get straight to the episode. In the last few episodes, these are building on each other. We talked about self-compassion. Last week, I talked about the lies we tell ourselves which, PS, was a really hard conversation. Ain't going to lie. I hope that was a safe, healthy conversation. If you didn't hear it, go back because it was me sharing my own experience of telling lies to myself and to my family, and really just breaking down the judgment around that. So, go back and listen. And me sharing with my family and with you guys about how I'm going to change. Now today, I want to talk about a concept that is really, really important to long-term recovery in or just life in general, which is this question: Does this bring me closer to my long-term goals? Now, human beings are very reactionary. This is why we have survived for millions of years. When there is an event, we quickly do a little data check in our brain. Is it safe? Can we proceed? Should we run away? Should we freeze? Should we just freak out? We have the whole process that happens in a millisecond, and then we respond. Now the fight-flight-freeze system of the brain, we call it the FFF response, is a part that keeps us alive. It's a reaction we have to danger. So if there is a lion, we know to either freeze, run away or fight it. We instinctively know this. But what happens is, if we have an anxiety disorder or little glitchy in the brain, often what we do is we go into the fight-flight-freeze when there isn't danger and we're in reaction. And the more we're in reaction, the more we enforce that fear and the more that we get stuck in a cycle of reaction, reaction, reaction, reaction, reaction. Now, one of the most helpful things in life for me has been to step back and look at the cycle, look at the trends and ask myself, does this behavior, does this reaction bring me closer to my long-term goals? There's this moment where if we can, we can just practice slowing down and pausing. This will be really important for you, folks, who do compulsions on autopilot. Slow down and pause and zoom out and go, "Wait a second. Is there a trend in my reaction?" I often say to my clients and patients, "My job is pretty simple. My job is for you to tell me how you're doing, for you to explain to me what's going. My job is to find the trends, find the patterns. If there is a pattern of reaction, that's where I intervene. If the reactor action is problematic, that's where we intervene. If the reaction is really helpful and productive and brings you long-term joy and quality of life, I have no business messing up with that. I'm here to look at disorder." That's what disorder means, is to look at where there is a problem in the order of your life, to look at the trends. The question here I want you to do is, take a step back, look at the trends in your life and see what is and isn't working, and ask yourself: Does this behavior bring me closer to my long-term goals or to my values? Last week, I shared about the lie that I told myself and my family about, "Oh, I have to work. I don't have a choice. I have to work this hard." And then I was like, "Wait a second. That's a lie. I don't have to work this hard. I make myself work this hard. I pushed myself to work this hard. I allow myself to work this hard." I have to look and stop and go, "Okay, it's cool. It's fun. I get a lot done. I get a lot of fulfillment from it." But if I step back and go, "Wait a second, does this bring me closer to my long-term goals?" some of it does. Yes, it helps me feel more fulfilled in my work. It gives me more success in my work. It makes me write a good book. But it doesn't fulfill the long-term goal of me wanting to be a present parent, a good wife, have a connection with my family. This trend has its pros and cons. from that, I'm going to make a decision for myself on what brings me closer to the long-term goal that matters to me most. Now, again, as I said last week, no judgment here. Last week, my husband said, "I think that maybe you're pushing yourself a little too hard." I might go. "Yeah, you're right, but I'm still going to choose to do it because that's what I value. That's my choice." You get to make those choices. No one gets to tell you what's right for you as long as you're being honest with yourself about what is the long-term goal. Often with anxiety, clients will say to me, "No, no, I know that I'm doing this as a compulsion, but I'm cool with it because it doesn't impact my grades or nobody knows I'm doing it. It's just my time. It doesn't take up all the people's time. So I'm cool with it." My job is to go, "No judgment. It is your life you get to choose, as long as you're comfortable with the long-term outcome, which will be you're going to keep having OCD or anxiety or panic disorder or health anxiety or social anxiety or phobias, because the more you react in that way, the more it reinforces that disorder." Again, I'm not here to judge. I just want you to be able to look at the patterns and the trends, and then decide for yourself what's good for you. We can't be just in reaction because that's when we get stuck. If we're only focused on short-term relief, we will get stuck. I feel really in this moment, I want to just stop and just check in with you guys. How are you doing? What's coming up for you? Is there a lot of negativity or judgment around yourself? Maybe there's some defensiveness of like, "What the heck is Kimberley saying? Why is she saying this to me? She's so mean." Often when I say this to clients, actually, let me share with you. When I'm with a patient and they'll go, "You know? Yeah, I just avoided it. I'm fine. I'm not going to do it. I'm not ready," and I'll go, "That's fine. I'm not here to judge you as long as you understand the long-term effect of that on your life." They're like, "Oh, Kimberley, you just always call it like it is. Why are you going to be so mean?" And then we giggle together a little. That's right. Yeah, I'm not doing it to be mean. I'm trying to be a truth-teller. I'm trying to get them to come on board with just telling the truth to themselves because that's how we get better. Now, some people will say, "Oh, but I don't know what the truth is." True, I get it. But you do know what your values are and you do know what matters to you most. I'm guessing it's not staying stuck. That's it. Does this behavior bring me closer to my long-term goals? We may need to weigh it up. Like I said to you, with me is, there may be pros and cons to it. We need to have a little conversation with ourselves. We still have to accept that nothing's perfect, right? I think then we will wrap it up with self-compassion, and then the big bow on top is, it's not going to be perfect. The long-term process may not look the way you want it to be. Then we just be gentle with ourselves. We can't have it all, but just really lean into what's effective, what truly brings you a sense of fulfillment, which brings you closer to your values. Sending you guys love. I love you guys so, so, so, so, so much. Got a little secret for you here. ERP School is coming back. It will be available in early March. Get very excited. We are offering ERP School again with bonuses. Even though it's been available throughout the year, we always offer it twice a year with extra special bonuses. Keep an eye out. We will be offering that in March. Now we usually offer it in February. But remember how I told you I was going to walk a little less. There you go. Made some changes. Delayed it a little bit. How do you like that from being honest with ourselves? It will be available in March. Stick around. We are going to give you a little more information. We'll be doing the free training again and offering some great bonuses. Also, let your therapist know. If you have a therapist who doesn't know how to treat OCD, let them know that we now have ERP School with CEU so you can get continuing education units with the course and an extra training from me on how to be a stellar Exposure and Response Prevention Therapist. It'll be here in March. So stick around again for that. Now, if you want more and more information, and if you want to get a ton more free resources from me, head over to Instagram, I'm most present there. I'd like to be more present in all the others, but again, cutting back on work. Go over there and follow me @kimberleyquinlan. That's where you get a ton of free content every single day. I love you guys. One more thing, please go and leave an honest review either on iTunes, Stitcher, Podbean, all of the places where you can listen to podcasts. We are giving away a free pair of Beats headphones to one lucky person who leaves a review once we get a thousand reviews. I will send them your way. You get to pick the color. I'm very excited about these. Not the teeny tiny ones, the bigger ones. I'm so excited to offer that, that you can listen to the podcast with the best quality into your ears. Yay. All right. All my love to you guys. Sending you much love. I hope you're taking special care of yourself. It is a beautiful day to do hard things. See you next week. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.co

Feb 12, 2021

Welcome back to another episode of Your Anxiety Toolkit. Today we are going to have a hard conversation and it honestly is causing a little bit of anticipatory anxiety for me. I want to talk to you about the lies we tell ourselves. You might be thinking "I don't tell lies. What are you talking about? I am a good person." So I want you to hear me out for a little bit and I want to share an experience I had this week. I realized that I had been telling a lie to myself and to my family about my choice to continue working so hard. I really want to take the stigma, the judgment, and the shame out of lies and just admit that we do it. That's my main hope for today. Let's just acknowledge that we sometimes lie to ourselves. We lie to other people, and we do it, not because we're horrible human beings, but because we're trying to protect ourselves. It's a safety behavior. We're trying to protect the story we create, and I had created this whole story of why I had to work so hard. So I sat down and thought about the lies we tell ourselves and I want to share those with you today. The first lie is "I can't." We have to stop saying "I can't." We may want to start replacing it with "I won't" or "I'm not choosing to". That is actually a better way of saying the same thing without it being a lie. The second lie is "I am less worthy than other people." We sometimes tell ourselves that we are less than, but that is a lie. We have to catch ourselves before we buy into that story. The third lie is "Just this one time." As we go to do something, even if we know in our hearts it's not healthy, by just saying, "Oh, just this once I'll do it." That is a lie, because typically is not just this once. The fourth lie is "I should be able to do this by myself." Let's get rid of the word 'should' here. If you need help, it is ok to ask for support. The fifth lie is "I can't upset other people." Actually it is not that you do not want to upset other people, you really do not want to tolerate your discomfort that goes along with hurting other people or making other people upset. So there are a few lies we tell ourselves. Think about them. Be very gentle and tender with yourself. Take your time with this. You may want to put your foot in the water and pull it out really quickly because it's too painful, but then practice. I've been doing this for several years and it has very much benefited me. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Transcript Ep. 176 This is Your Anxiety Toolkit - Episode 176. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, guys. Today is going to be a hard conversation between you and me. Are you ready? Oh my goodness. Thank you for coming. I'm actually really excited about these episodes. Some anxiety-provoking. I'm having some anticipatory anxiety. I'm noticing some tightness in my chest, shortness of breath. That's what we want to do when we're feeling anxious. We want to just check in, where is it? We want to breathe into it and allow it. We want to honor it. We want to just go, "Yeah, it's okay to feel this. It's not my fault, but I'm going to allow it." And then we want to lean in to do the hard thing. Today, we're going to do that. Today, we're going to talk about the lies that we tell ourselves. Now, your initial reaction might be like, "Huh, I don't tell lies. I'm a good person. I'm not a liar. Don't tell me I'm a liar." That is not what I'm saying, but I am, mainly because I have to tell you something that happened to me this last week because I, myself, am a liar. If you're not a liar, that's fine. I am a liar. So, let's address that. This last week, I have been editing, editing, editing, editing. There are so many stages of writing this book. I thought you just wrote a book and sent it in, and were like, "Thank you for letting me write a book. Good luck with finishing it." It turns out that's not the case. You write the book. Then they check the book. They send you back notes. You write more. They check it. They send me back notes. You have to change a bunch of stuff. Then you write some more, and you finish the book. You go, "Hooray, I finished the book," and they go, "Psych, just kidding. Now, we're going to review the book and edit the book. And then you have to go and fix and correct and approve all the changes we made. And then we'll do it one more time." I'm like, "Boo, I didn't want to do this. That's not what I signed up for." Being so naive, that's what I am. Anyway, I've been working my butt off. In my private practice, I'm trying to do some really big changes to CBT School and make it much, much better. I'm trying to hire more staff because we're so busy right now. I really want to make sure we're not turning people away too. I'm not a specialist care. I want to be a good mom. I want to be able to do podcasts. I want to do social media. I want, I want, I want. And then I get to do this additional book edit. Now, on Saturday, I was in a terrible mood. The stress that was overwhelming me was just painful. It was so much. I thought I was being a rock star. I was using all my skills. I was still engaging with my kids. I was breathing. I had meditated. I had taken a walk. I was using all my skills. At the very end of the night, my daughter came up and she shared a balm as she often does at the very end of the night like, "Okay, I'm not doing well and I need your support." Usually, I handle this really well, but on Saturday night, nope, not me. I did not handle it well. My reaction was like, "Come on, you've got no problems. I've got problems." Number one, PS, that was not a good response. I don't encourage you to practice that because that's not helpful and not kind and not productive. Of course, I slowed down. I caught myself in my reaction. I am a human. I make mistakes. I caught myself in my reaction. I apologized to her and I sat down and we talked it through and we came up with some solutions. I offered myself self-compassion and her, just like we did in the episode last week. And then when she went to bed, my husband sat me down and he said, "You're working too much. This is not okay. It's obviously impacting the family." He said it kindly, but he said, "We try to be as honest as we can with each other." My reaction was this: PS, it wasn't great either. So go with me here. I am a, like I said, so much more to learn we're all on a learning curve. But my reaction was, "How dare you say that? I'm working so hard and I don't have any choices. It's not my fault that I have so much work to do. I didn't ask to do this second edit of the book or the 15th edit of the book. It's not my fault that the links on the website are broken and blah, blah, blah." And I stood by my theory. This is where the lie was. I doubled down. He backed off a little because he could tell I was super triggered, but I doubled down on this lie. And then I had to step back and go, "Okay. That was a lie because I don't have to work this hard. I don't have to put this much pressure on myself." I like to work. I love to work. I love what I do. I love talking to you guys. I love being a therapist. I love having businesses. I really love having a person who does business. I really love the therapy work and I also really love the business side of things. I'm just a bit of a dork that way. I love growing things. I love creating things. This whole lie that I was saying, like, "I don't have a choice," it's just ridiculous. It wasn't true. It was straight up a lie. It got me thinking, well, number one, let me backup. I went to my husband. I said, "I'm so sorry. You're right. I am working too hard. I am pushing myself too hard. I need to find some better balance. I can't burn myself down to nothing and have nothing left for you guys at the end of the day," even though I thought I was using my skills, that's just not okay. I will talk about this again next week in a different concept. But I was telling lies when I reacted and I'm sorry about that. It got me thinking, "What other lies do we tell ourselves?" Let's take the stigma and the judgment and the shame out of lies and just admit that we do it. That's my main hope for today. Let's just acknowledge that we sometimes lie to ourselves. We lie to other people, and we do it, not because we're horrible human beings, but we do it because we're trying to protect ourselves. It's a safety behavior. We're trying to protect the story we create, and I had created this whole story. "Oh no, it's not my fault. I worked so hard because A, B, C, D, and it's not completely in my control." It is if I'm going to be honest. Maybe not for you in your case. Maybe you do have a situation where you have to work these certain hours. I'm not talking. I'm just a bit talking specifically to my own lives here. So then I thought, "Okay, let's just go through." I sat down, got a piece of paper, and I thought, "What are the main lies that I probably tell myself or I've heard my patients and clients say to themselves?" I'm going to bang through them really quick. 1. I can't. This is a lie. Not a good one, not an easy one. Again, when I talk about "I can't", I also want to preface that there are certain situations where people can't do things like certain disabilities, medical disabilities. They can't run a marathon or so forth. I'm not speaking specifically to that. I'm talking about "I can't" when it comes to feeling emotions or facing our fears, or doing things that are hard. The main reason I say "It's a beautiful day to do hard things" is to counter the thing I hear the most, which is "I can't". Yeah, you can. It's going to be hard, but you can do hard things. It's a lie. We tell ourselves. Now I'm not saying that from a place of criticism or even lacking compassion. There's deep compassion in what I'm saying here. I'm not saying, "Oh, you can." I'm not saying it in a condescending way. What I'm saying is, be honest with yourself. It's not that you can't. We're talking here about being honest with yourself so that we can actually solve the problem. I can't solve this problem of overworking until I'm ready to be honest with myself and go, "You know what? You're right. You're 100% right." I have to be honest with myself. I am choosing to work this much and it is impacting my family. That has to change. Let's say I decided it wasn't going to change, that's my prerogative. But at least I have to start by being honest with myself. We have to stop saying "I can't." We may want to start to replace it with "I won't" or "I'm not choosing to". That's a much more wise way of saying the same thing without it being a lie. Ouch, I know it's not fun to hear this. I'm saying this to myself. Please don't feel like I'm bullying you here. I'm also telling myself this, because a part of me wants to go, "No, I can't. I can't slow down. I have A, B and C." It's like I won't slow down. 2. I'm less worthy than other people… Because of my weight, the way I look, my social media, following, my mental disorder, my income. We tell ourselves these lies all day long, this lie was the absolute basis of the eating disorder I had. I'm less worthy than them. The only way I can get more worthy and be as worthy is if I drop a body size, if I exercise compulsively. For some people, if I can be as popular, or if I could have as much money or have the same car. We tell ourselves it's a lie, that we're less than. That's a lie. We have to catch that we buy into that story, and that when we do, that story can feed many problematic behaviors in our lives. 3. Just this one time. "I'll just do it one more time. It was no big deal. This one time won't hurt." That's a lie guy. Ouch, I know, right? But we do it all the time. It's fine. Just this once I won't do it. Now, let me also stop for a second and go, you're not going to be perfect. I'm not going to be perfect. We're humans and we're going to make mistakes. If there are times where you have fallen off the wagon, or you do a compulsion or you engage in a behavior that's not helpful, this is not about me saying, "You're bad for that," and you get a rap across the knuckles. Absolutely not. We're talking here about stories we tell ourselves, the lies we tell ourselves. As we go to do something, even if we know in our hearts it's not healthy, by just saying, "Oh, just this once I'll do it," that's a lie, because it's not just this once. I have a dear friend and this dear friend has OCD. I love when I hear this dear friend say, "Kimberley, I'm going to be honest with you. I know I shouldn't do this, but I am choosing to do a compulsion this time. I know it's not what's right for me. I'm going to do it. And then as soon as I do it, I'm going to A, B, C, and D." That's the truth. That's honesty. That's not saying, "Oh, just this one time. I'm just going to do it once." What she's saying here is the truth. "I know I shouldn't be doing this, but I'm going to do it. And then I'm going to take the consequence for it." That is so much more healthy for you and honest for you than any other way of saying it. Some of you may say, "Well, if I say that, then I'll beat myself up." Well, a part of telling the truth and not lying is also not beating yourself up for the truth, because the truth is the truth. No matter what you say. 4. I should be able to do this by myself or any other should that you do. I hear a lot of people say, "No, I don't want to get therapy. I should be able to do this by myself." I want you to recognize that the stigma at play. No, often we need help. We need lots of help. Often people will say, "No, I should be able to do this without medication." No, that's not true. That's you telling yourself a lie because maybe you're afraid of taking medication. These are just ideas, guys. I don't want you to walk away feeling bad here. I just want you to reflect on, could any of this be possibly true? Maybe even just listening to this is you opening a small door into you being really honest with yourself. I promise you, being honest with yourself will be the most freeing thing you ever do. When I really made a deal, it was like two years ago, I was like, "You know what? No more easing anyone, Kimberley. Just tell it like it is." Don't be mean about it. Don't criticize yourself. Don't be unkind. But just be honest with yourself and others, please. No more shoulds. "I should do this. I should do that. I should be able to do it by myself." If you're struggling to do it by yourself, you need help. It's very factual. It's pretty A to B. If you're struggling to do it for yourself and you need help, there's absolutely no shame in that. I really hope you can ask for help, whether it be a loved one, buying a book, buying a course, going to therapy, going to a doctor. Whatever it is that you're trying to succeed with, ask for help. Here's a big one. I have one more to go, then I have a bonus flippity-flop lie for you. I'll explain it in a second. 5. I can't upset other people. I often hear clients say, "I can't do that because it'll hurt them. It'll upset them." No, that's not the truth. It might be the case. It might be the truth and that is the consequence, but that's not why you're not doing it. You're not doing it because you don't want to tolerate the discomfort that goes along with hurting other people or making other people upset. A lot of this is like teeny tiny details, but I really want to inspire you guys here. Be as honest as you can with each other. It hurts, but it's better. Then you can actually work with the system. Now, here is a flippity flop. When I say flippity-flop lie, it's often, a lot of my clients will say, "Bad things are going to happen. Bad things can happen. Bad things are going to happen." Often we will go, "Oh no, that's just my anxiety talking." We're reacting to it in a really negative way. I want to flippity-flop lie this one. What I'm saying is, that one's actually not a lie. Bad things will happen. That is a part of life. We must accept that scary things do sometimes happen in our life. I don't want you to talk yourself out of that one. Instead, I want you to practice being honest, which is when I'm having the thoughts, "Bad things are going to happen," I go, "Yes, Kimberley, you're right." How can we practice being accepting of that? It doesn't mean all of your thoughts are going to happen. It doesn't mean if you've got an anxiety disorder, your thoughts are on rapid-fire telling you all the 17,000 things have gone wrong. I'm not going to say all those things are correct. But the general idea that bad things will happen is not a lie. I want you to actually settle into that a little bit and be honest with yourself in that, instead of trying to control your life, thinking that that control will protect you from bad things from happening. See, it's like a flippity-flop. What I'm saying is it's not a lie. It's actually a truth. If you can handle it and respond to it like a truth, then you're not getting yourself into trouble. I'll talk more about this next week, I promise. So there are a few lies we tell ourselves. Think about them. Be very gentle and tender around these. Take your time with this. You may want to put your foot in the water and pull it out real quick because it's too painful, but then practice. I've been doing this for several years and it has very much benefited me. Let me share with you to round the story out. After I had 24 hours to simmer myself down, give myself a talking to, and pull myself out of my own lies, I sat down with my children and I said, "Daddy brought up that he felt I was working too much. How do you feel about it?" I'm not in the business of trying to talk myself into being who I'm not. Interestingly, one said, my son is five and he's learned the art of expression in his voice, and he went, "Oh yeah." When I asked, "Do you feel like I work too much?" his response was, "Oh yeah." So there is an answer. Honesty, thank you, five-year-old. My daughter who has more of a need to protect me went, "Uh, kinda, no, but you're still a great mom and you're too great and I love that you work hard." And then her dad was like, "No, please. Mom asked you to just tell her the honest truth and you can be honest with us. How are you feeling about how much mom's working?" "Yeah, I think she does work a little too much." "Excellent." Now, my team, the people I care about the most, have shared with me their opinion, whether I like it or not. I hear it. I take it into consideration and I choose whether I'm going to implement it. No more lies. I could go, "My husband is wrong. My kids are wrong. I didn't even want to know about their opinion because my story is that I have no choice." I could do that, but that doesn't help me. It keeps me stuck. It cuts me off from the relationships that matter to me most. So I'm going to choose honesty. Does that make sense? Tough conversation, friends. How are you doing? Are you guys all right? Are you having a panic attack over there? Are you breathing okay? Check in. Take care of yourself. None of this is a judgment. This is mostly me giving you real-time on a stuff of my own that I work through. Often when I'm going through something, I want to share it with you because I'm guessing you are going through something similar. I'm trying to be ballsy enough to say, "Hey, let's just talk about the real stuff. Let's address the real stuff that impacts our daily lives and our mental health and anxiety." I love you so much. Please go and leave a review. We are giving away a pair of free Beats headphones so that you can hear the podcast so clear and wonderfully to one person who leaves a review once we get 1000 reviews for the podcast. So go to wherever you listen, leave your honest review. I would be so, so grateful. I do not take any sponsorships for the podcast. I do not do much sales here at all. This podcast is really here to help people who don't have access to medical or mental professional care in these areas. Please, if you have a moment, go and leave a review. I would be so, so grateful. Have a wonderful day guys. I'll see you next week. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

Feb 5, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to talk about something that is so important to me. This is also something I think we all need a little reminder about from time to time and that is the importance of self-compassion. Today I want to share an exercise on how to practice self-compassion. I want you to imagine that someone you care about comes to you and says that they are struggling or having a hard time. What is your first reaction likely to be? You probably will say something along the lines of "Oh I'm so sorry. How can I help you?" Now I want you to try this same approach the next time you are struggling. You can learn how to practice self-compassion by treating yourself how you would treat a loved one or even a stranger who is struggling. Stop and say to yourself "Ok you are in pain. Let's tend to that pain." Our work is really to tend to ourselves the way we would tend to others. Respect ourselves the way we respect others. There is no exception to this. You deserve kindness every step of the way. The awesome thing about self-compassion is that it has been shown to reduce depression and anxiety , improve treatment outcomes and improve quality of life. So let's learn how to practice self-compassion and really honor how we are feeling, giving ourselves the same loving kindness that we show to others. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Transcript of Episode 175 Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back lovely, lovely friends. How are you? How are you doing? Just checking in with you guys. Thank you again for being here with me. Once again, I am so grateful that you choose to spend your time with me. So thank you so much. Today's episode is a little bit of an impromptu, mainly because I recently did an Instagram post, and it's on a concept I talk about all the time, but it got a lot of traction. It really made me realize that maybe you needed that reminder. I always think it's interesting when a concept sticks really heavily with people. It makes me realize like, "Oh, okay, that's where I need to head. That's the direction that people obviously need help." Let me share with you what this concept was. One of the core concepts of self-compassion is to treat yourself how you would treat someone else if they themselves were suffering. What I want to do is, I want you to go with me on a little exercise, just to check in and see if there are any areas that you could up your self-compassion game, because if you're going to up your self-compassion game, every single goal of mine has been won and we can all go home really, really happy. It's one of my core missions. A part of my mission statement is to hopefully create a world of people who have anxiety, who stopped to treat themselves better, kinder, more compassionately, more respectfully, just nicer. Here's the exercise. I want you to think back to a time where someone you love deeply was struggling. If you can't think of a time, just imagine it. Think of someone who you care about, who you genuinely wish well. Think about them coming to you and them saying, "Hey, I'm having a hard time." Now, when someone you love, someone you care for, someone you wish to be well, comes to you and says, "I'm having a hard time. I am suffering," what is your immediate response? Usually, our immediate response is, "Oh my goodness. That is so painful. I'm so sorry. You're going through that. How can I help? What can I do to support you?" That's the best kind of care. Now, for those of you who, when I originally asked the question, had a different reaction, that's fine too. It's common that when someone else is suffering, sometimes we may feel defensive or we may feel angry because we haven't got the space for it. Or we may feel resentful because we assume their pain doesn't compare to our pain. If you had any of those reactions, that's fine. I'm not here to tell you how to feel. And that may be something you want to go and work through because if those reactions were strong, those reactions need to be tended to with self-compassion too. We don't want to just judge you and go, "Oh, that's wrong," and move on. No, no, no. That does not add to a self-compassionate practice. That just takes you away into self-criticism and self-punishment. So we don't want to do that. Back up a little. We don't want to do that. But let's just go to this genuine innate reaction that most humans, almost all humans, or actually all humans were born with, which is the genuine care to help and take care of each other, which I know is you. I know it's you deep, deep down. Now, that reaction, that desire, that impulse to go, "Hey, how can I support you?" that is exactly how you need to tend to yourself when you're suffering, when you're having a moment of pain. Disregarding where the pain came from, disregarding whose fault and who's to blame and how you could have prevented it, I want you to lean towards speaking to yourself, how you would speak to another person or even a stranger. Sometimes we treat strangers better than we do our loved ones. That's the truth too. But again, I'm not here to judge. I'm not here to tell you how to feel and how to treat others. I'm here to talk about how you can up your self-compassion game. When you're in pain to say, "Hey, I am so sorry you are going through this. How can I be there for you? What do you need? What will get you through this?" And often the person, let's say we were talking to a loved one, they would have some wisdom for us often. If I were to say like, if my husband came to me and he was venting and he was telling me how much pain he was in, usually he just wants me to listen and be there. Very few people want advice. That's what I try to do for myself. There will be times when I'm in pain, where I need to stop and go, "Okay, Kimberley, you're in pain. Let's tend to this, but let's also work to solve this problem." The long-term problem, not the short term problem. We don't want to just get rid of short-term relief. That usually ends up flopping. We end up falling on our butt when we do that or getting stuck in a cycle of problematic behaviors. But we may want to zoom out and go, "Okay, let's take a really big look at the big problem here." Our work is to tend to ourselves like we would tend to others. Treat ourselves as we would treat others. Respect ourselves as we would respect others. There is no exception to this. You cannot give me one reason why you are exempt. A lot of my patients and clients will say, "Oh no, but I deserve this. I did this to myself." It doesn't matter who you did it to, why you did it, and who's to blame. You're in pain. You're suffering. You may have chosen this suffering or this behavior that caused suffering because you were in pain. There is no exception. You deserve kindness every single way, every single step of the way. That's all I have to say. Put it into practice. Nothing changes if nothing changes. We really want to focus in on this as being our highest priority. A little bit of science, self-compassion helps everything. We don't have scientific evidence of exactly that, but almost we do. It helps with motivation. It helps with anticipatory anxiety. It helps with treatment. It helps with treatment outcomes. It helps with success performance. It helps with quality of life. It reduces depression. It reduces anxiety. It increases quality of life. Go for it. That's our in sparks. Don't stop. All right. I'm going to say goodbye. Before I do so, I'm going to let you know, again, please do go and leave an honest review wherever you listen to this. I would absolutely love it. It would be the best, best, best thing for me if you could. We are going to give away a pair of Beats headphones of your choosing of color for one lucky person who leaves an honest review. I'm not just saying the people who leave the best ones, but I have loved reading all of the reviews. Thank you so much. It really does help me find other people who need my help. So, go ahead and leave a review if you feel so inclined. Have a wonderful day, and I'll talk to you next week. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

Jan 29, 2021

Welcome back to another episode of Your Anxiety Toolkit podcast. Today I want to share with you all something that has been going on for a while now. For months, I have been harassed online by an anonymous troll who has been leaving really terrible, disgusting comments on my social media accounts. I want to share with you today some ways that I have dealt with this situation and to really give you some tools to manage the bully in your life, whether that takes the form of a real person or if that bully takes the form of fear and anxiety . Initially I tried doing what I would do when I am faced with fear. I simply tried not engaging. These are the same tools you would use to manage intrusive thoughts and anxiety, which is, you just don't engage with them. You set strong boundaries and you bring your attention back to the things that you value. So I was trying that for a while. Then I realized that I wasn't setting strong enough boundaries. I was keeping what was happening a secret because I was feeling a lot of shame around this situation. When shame shows up, we tend to go underground. We keep it from people. But shame lives in the darkness. It can't survive in the light. So bringing it out into the light is where you actually have less pain because you've shared it with someone and you are validated. That was an incredible lesson to me. If you have a bully in your life, or if fear is your bully, you can apply the same things, which is, I am not engaging in any bully-like behavior. Not today, not tomorrow because I matter. My values matter. The people I love matter. I'm not giving attention to this, which is ineffective. I hope that this podcast today gives you some empowerment and permission to set boundaries and disengage with people who are ineffective in your life, who hurt you, who say unkind things, who do not treat you well. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Transcription of Ep. 174: Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, friends. How are you? I'm really happy to be here with you. I actually needed this moment to just slow down, settle into my chair, pull out my microphone and say, "Hey, how are my crowd? How are my people? How is this amazing community doing?" First of all, thank you for being here. Second of all, I'm grateful for you guys. So grateful more than I ever, ever have been for reasons I will share in this episode. I have to first start by saying, I have literally got the best community. You guys are so cool. I have learned this through a very difficult process in the last couple of weeks, months, year, because it's been going on for a while. For those of you who don't follow me on social media, I have been just recently public about one or two social media trolls who have recently really heavily and aggressively attacked me both verbally and, mostly verbally, but with significant sexual content. If this is a trigger for you and you have some trauma around this, I won't be giving details, but I just want to give you a little trigger alert because the degree in which I was being harassed on social media was sexual harassment. I wanted to just reflect on this today. I'm always going to be honest with you. I'm going to keep it real. I'm going to share what I feel is helpful, and I hope that this is helpful because there is a really, really powerful message here. I'll give it to you right up the front. The powerful message is: Don't ever allow a human being to change the way you think about yourself. That's going to be one of the main messages. The second message is, I have been on this podcast for many, many years, telling you guys how to manage intrusive thoughts and anxiety. It turns out the cool news is that you can handle other social media trolls or people who don't really bring a ton of value to your life in exactly the same way that you do intrusive thoughts and anxiety, which is you just don't engage with them. You set strong boundaries with them and you just bring your attention back to the things that you value. It's a cool approach. Let me tell you the story. For many months, I am and other OCD advocates actually, probably ones you know very well, have been receiving these most hateful, disgusting, just mean comments and messages, and that's fine. That's okay. I mean, it's not fine, but what I'm saying is, that happens, unfortunately, to anybody on social media. Unfortunately, we live in a world where people can get behind an Instagram handle or a Facebook account and spinelessly throw a bunch of mean hateful words at people. It happens all the time. A lot of my high profile clients that I see in my office have reported this to me for years, that social media can be a really, really scary place. Like I said to you guys, and let me segue back to, this has made me appreciate you guys more than ever, because you guys have been nothing but supportive to me, kind, helpful, warm, supportive with each other and me. It is so cool. I'm so grateful for you. I really, really am. But for almost a year, I have been getting these messages, and my approach was, like I said, to do what I do with anything that doesn't bring me value in my life, which is I delete it or I block it, and I don't engage with it. So that's the piece I do with fear. Fear can show up. I don't block that, but I don't engage with it. I'm not going to give it my attention. Often it doesn't require my attention. It's just going to be there. So that's how I handled it each time. But what was happening is I would delete and block this person or these people. At a higher and higher frequency, they were creating more and more and more and more accounts under different names and doing the same behavior. The reason I knew it was one to two people is because they were using exactly the same hateful language. There's a couple of messages here, a couple of lessons myself, and I just wanted to share them with you and reflect. At one point, it was getting to be so disturbing that I started to share with a couple of really trusted friends what was happening. They immediately said, "Huh, this is very similar to OCD work. You have the thought or you have the feeling and you don't do anything. You just don't engage." I thought, "Yeah, that's so cool." But what quickly became apparent is they started to say, "Why aren't you calling this person out? Why aren't you setting stronger boundaries with this person?" I had reflected on this, and I thought, "Well, I think underneath, I had a tremendous degree of shame around this. I had a tremendous degree of distaste about this and I wanted to just push it away." It got to the point where, one day, I basically deleted probably up to 20 accounts. I spent pretty much the entire day on social media, trying to block this person. They said, "Why would you put in all that effort? Just tell people that you're struggling with this and call it out." I thought, "Huh, that's such an interesting thought." It was shocking to me that I had a ton of shame around that. I wanted to tell you this, not because I just wanted to blab on about my experience, but I'm just hoping that you, if anything similar, or someone has been unkind to you in person or on social media, that you can recognize that when shame shows up, we tend to go underground. We keep it from people. We hide it from people. But shame lives in the darkness. It can't survive in the light. So bringing it out into the light is where you actually have less pain because you've shared it with someone and they've acknowledged you and they're validated you and they're helping you. You're not alone now. That was an incredible lesson to me, which is ironic because I talk about it all the time and I share about this concept all the time. Because it was happening to me, I got short-sided. Again, I'm going to keep saying, if this is happening to you, catch how much you're silencing your own pain. Catch how you're doing it on your own in isolation, not sharing it with people. What was really wonderful is, once that they said, "Hey, shout it out. Let people know what's happening. You can't protect people from this all day. You can't be blocking this person all day just to protect others from seeing this message about you. Tell them what's happening." You know what shocked me here guys? Within four hours, a whole bunch of people who I know, but not that well, came out in support of me. They were ready to support me, and that blew my mind. It made me realize how incredibly strong this community is. It made me realize how much of a team we are, that they, on a topic that I had a lot of shame around, came out and stood up for me and said, "We stand with you in solidarity. This is not okay." I want you to know that you have a community right here who will do the same for you, who will stand up and say, "Please be aware of your stigma that you're saying about mental illness. Please let me educate you about what OCD is because it's not what you think it is. Please let me help you understand that depression is not laziness. Please let me help you understand that people aren't struggling because they want to, they're struggling because they're stuck." There's a part of a community who's willing to stand up for you as well. This was just mind blowing to me. And for any of you who have been trolled on social media or harassed, or have any kind of bully in their life, I want to really, really encourage you to treat it with the tools that you've already been given to manage fear. Don't engage in it. Stand up for yourself. Set strong boundaries with it. We just did a huge podcast on that the other day. Set boundaries with it. And then you return back to the thing you value. What I noticed is, this was so shocking and horrifying to me that I couldn't stop thinking about it for a little bit. And then I was like, "Wait a second. My children are right here. I don't value this human being. I value my children. I value my husband. I value you guys, my community. I value my work. I value my health." Let's practice. While we have this discomfort, while this event happens, which means nothing about me - it means everything about the person and nothing about me - while this happens, I'm going to go back to engaging in what I value. Now my mind kept saying, "Oh no, no. You go back on. Just check, check, check, just to see." I'll be like, "No, I'm not," because I'm not going to let that kind of behavior change how I act today. I want to look back on today and say, "I'm really confident and proud of that." This was huge to me. I wanted to share it with you because if you have a bully in your life, or if your fear is your bully, or if you are your bully, you can apply the same things, which is, I am not engaging in any bully-like behavior. Not today, not tomorrow because I matter. My values matter. The people I love matter. I'm not giving attention to this, which is ineffective. Now, what am I going to say? Totally easier said than done. Let's be real. Totally easier said than done. But I hope that this podcast today gives you some empowerment that gives you permission to set boundaries and disengage with people who are ineffective in your life, who hurt you, who say unkind things, who do not treat you well. One of the most important pieces of self-compassion is self-respect. Self-respect comes first, which was respecting that you matter, that you're worthy and that no one's allowed to say bad stuff about you, including ourselves and what we say about ourselves. Last piece of the puzzle here is that once I came out and said, "Hey everybody, this is what's happening." I don't endorse it. It's terrible. It's disgusting. Please, if you see it, ignore it. Treat it like an intrusive thought. Everyone came out in drones and supported me, DM to me, commented, was so kind. What was so fascinating here is, this person then created another account and said, "Oh, you just took it too seriously. I was just giving you compliments." I was like, "Wait a minute. That's the definition of gaslighting." For those of you who don't know, gaslighting is someone doing a behavior or acting in a certain way and then turning around and blaming you for it. It's a huge problem in communication. We want to try to eliminate gaslighting in communication. Again, I felt gaslit, and my immediate response was, "Huh, was I being too sensitive?" That last did literally like a millisecond. And I was like, "No, that's gaslighting." If you're in a situation where someone is being a bully to you, and then they tell you you're being too sensitive, that's gaslighting. You're not being too sensitive. You deserve to be treated well. You deserve to be taken care of. Really, really important stuff. In those moments, if you do feel like someone's now blaming you for something that they did, your job is to step down into compassion and go, "No, I'm going to honor that that was painful for me." This is the same for when someone goes, "Oh, I'm so OCD," or "I'm so bipolar," or "I'm so psychotic today." They're using it as a joke and it hurts you. And then they turn around and they say to you, "You're being too sensitive. Why does everything have to be so pissy?" You're allowed to go, "No, you just gaslit me right. It's painful for me. Therefore, it matters. Therefore, it's real. You can't discount that." Really important stuff. It happens a lot around mental illness. There's a lot of stigma there. I think there's a lot of opportunity for people to gaslight about that. I really want to make sure I brought that in as the final piece of this episode. So that's that. I'll keep fighting the fight. This person didn't go away, and I don't care, to be honest. What did I learn? 1. You guys are amazing. 2. I feel so supported by you, thank you. 3. I don't need to engage in this stuff. It doesn't deserve my time. 4. Catch when people try to redirect blame on to you because that can help you go down a spiral of self-criticism and self-punishment. I love you so much. Thank you so much for being here. Last of all, I'm going to ask you another favor. I'm going to stop mentioning this often in the podcast. My goal is to get a ton of more exposure with the podcast this year. It is a free service that we offer, offering free tools for those who don't have access to treatment, or if they do, it's to supplement that. If you have the time and you're interested, would you do me a huge favor and go and leave a review, an honest review? Let me know what you think of this show, with this episode. I would be so grateful. I have decided that once we get to a thousand reviews, I will give away a free pair of Beats headphones so you can listen to the podcast on full volume and hear my voice full volume. Add just one review by random. I'm so excited to do that, and I'm really excited to get that up and running. Go leave a review. I would love to see it. I might even start to highlight some reviews here in the next few weeks because I will be reading them and valuing every single one. Thank you so much. Have a wonderful day. It is a beautiful day to do hard things that includes also sometimes being bullied by people or trolled. But we are strong, we are resilient and we are able to do this together. I love you guys so much. Have a wonderful day. Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

Jan 22, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I would like to discuss with you a question that comes up quite a lot when I am starting with a new client. So often my clients will say to me "What can I expect during my first session?" I want to share with you what I tell my clients about the things to know when starting therapy . The first thing I say to my clients is that your brain can change. You may have a disorder that was inherited or triggered by a certain event, but the good news is that by changing your behavior, you can actually change your brain. The second thing I say is that no matter your mental health struggle, there is a science proven way to treat that disorder. We have evidence based treatments and you can absolutely can get better. Thirdly, I tell my clients that no matter what struggles they are going through, it is not their fault. This is not something they asked to have happen. We are going to move away from assigning blame and move towards self-compassion. The fourth thing I would say is that you should not enjoy coming to see me. The work can be really hard and it will mean facing your fears, so if you are enjoying coming to see me then we may need to look at the reasons why. The goal is to actually give my clients the tools they need so that they do not need me anymore. Finally I tell my clients that they need to be prepared to do the hard work. There will be lots of homework and a lot of facing your fears, but nothing changes if they are not willing to do the work. I always remind them that it is a beautiful day to do those hard things. If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. We are going to give away a pair of Beats headphones of your choice of color once we hit a thousand reviews! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information. Ep. 173 Transcript: Guys, I am so grateful to have you with me today. I know your time is incredibly precious and valuable, and so I'm so happy to just be with you. How are you doing? Just checking in. How is everybody? It is well and truly 2021. Lots and lots of happening in the world. Lots and lots of changes. I'm just wrapping my head around them all. In this new year, I made a deal with myself to spend a little bit more time on social media, which is so funny because I think most people were saying, "No, I think I'd like to spend less time." I'm actually saying, "No, I'd like to spend more time on social media." I hang out a lot on Instagram and on the Facebook group called CBT School Campus or on my Facebook page. I promised myself I'd spend more time there because I'm realizing after last year that I felt really disconnected to you guys and I really wanted to get back into feeling connected. I have loved it. If you're on Instagram, go over and follow me @kimberleyquinlan, or you can go over to the Facebook group. It's CBT School Campus, or my Facebook is Kimberly Quinlan with CBT School after it. That being said, I just wanted to let you know that today, I wanted to chat with you about something I have not talked about, but I thought it would be a really great topic. A lot of people in the new year have been reaching out, looking for clinical services – help for OCD, help for anxiety, help for an eating disorder, or help for a BFRB. We love helping people. I have a great staff of seven licensed therapists who all treat the same disorders that I do. It's just been so wonderful to see all the new clients and people coming in really ready to get help. It really came across my mind in that one of the questions new patients and clients have is: What should I expect in the first session? What does the first session look like? What would you tell me in the first session? I thought this would be a great topic to talk to you guys about. So I want to share with you the five things I tell every single client or patient in their first session. Are you ready? Let's do it. Once I have introduced myself and they've introduced themselves and they tell me a little bit about their struggles and what they're wanting to work on, I, at some point in the session, are going to tell them I'll do a thorough assessment. But I will, at some point, either at the beginning or at the end or somewhere, wherever it's most appropriate, share with them one major piece of good news. 1. Your brain can change. Even if you have a disorder that may be is hereditary, has been passed down from generation to generation, or you have a disorder that was triggered by a certain event, or you have a disorder or a problem that was triggered by societal expectations, such as eating disorders, I always share with my patients and clients the great news, which is you can change your brain. In some cases, for those of us who have anxiety, even though your brain might be firing away, setting off the alarm bells all day long, "Danger, danger, danger," you can change the way your brain reacts to these misfires. Now, you can't do it by simply trying to change your thoughts. We know that. Changing thoughts sometimes can be very, very important. I'm not going to deny that. It's an important piece of depression work. It's an important piece of, like I said, eating disorder work and so forth for everybody. But the cool thing here is more importantly, by changing your behaviors, you can change your brain. By changing the way you react to fear, you can change your brain. You can connect parts of your brains that weren't connecting. You can strengthen parts of your brain that is weak or they're not connecting and the connection isn't so strong. Your brain can change, and this is good news. This is great news. When we found this out in science, we all had a big party because it was really reinforcing that if you do a scan of someone pretreatment of their brain, and then you did a scan of their brain post-treatment, we would be able to see the changes in their brain, and this is really cool. 2. If you have OCD or a phobia, generalized anxiety, panic disorder, social anxiety, health, anxiety, hair pulling, skin picking, and eating disorder, any of these, any of the mental health issues, that there is a science proven way to treat your disorder. This is good news. I fill you with hope by saying, I understand that what you're going through is really painful, but the good news is, we have scientific evidence to prove that we're on the right track and we're going to be administering the correct treatment. If you have OCD, the science proven treatment is exposure and response prevention. If you have hair pulling, skin picking or nail biting, the science proven treatment is habit reversal training. If you have depression or an eating disorder, the science proven treatment is cognitive behavioral therapy. If you have health anxiety, you're again going to have a combination of cognitive behavioral therapy with the focus being exposure and response prevention, same goes for phobias, same goes for social anxiety. All of these, we're going to, let's say the frosting on top is that we're also going to apply science proven techniques, such as mindfulness and self-compassion. This is not woo-woo stuff here. This is science. We have tons of evidence to show that you can get better, that your disorder isn't a mystery. Thank goodness. Imagine back in the sixties if you had OCD, at that point, or even the seventies, there was no treatment for OCD that was proven. If you had OCD, you were told "Good luck." A lot of disorders had this. If you had hypochondria, if you had agoraphobia, a lot of times back in those years, people said, "I'm really sorry. You have to just accept that your child is going to be this way." But no longer. 2.a We have tons of evidence to show that we're on the right track. We're using the right treatment and you can be hopeful. Really cool. 3. The struggles you're having were not your fault, you didn't ask for this. You didn't want this. This is not your fault. The high levels of anxiety that you experienced, that's not your fault. The depression that you're experiencing is not your fault. The fact that you get stuck doing behaviors that you don't want to be doing, but you feel like you have to do, that's not your fault either. This was not your fault. We're going to work on this treatment journey. We're going to work at not assigning blame to anybody. Mostly you were going to work at being compassionate instead of self-critical. This was not your fault. You didn't ask for this. Most of the time, people with OCD or anxiety, panic disorder, health anxiety, eating disorders, they say, "I would never wish this on my worst enemy." Again, if you wouldn't wish it on your worst enemy, you wouldn't wish it upon yourself. It was not your fault. 4. If you're starting a journey of recovery, you're in treatment, you're ready to get the work done, here is one thing you should remember: You should not enjoy coming to see me. You should not want to see my face. I should make you happy. I should make you feel comfortable. I want you to trust me. I want you to enjoy my company. I want you to respect me, but you should not enjoy our sessions together. I know you are probably thinking, "What is she saying here?" But hear me out. The work that I do, and the fact that you're listening to me and hopefully you've listened to me for a while, shows me that you have had struggles with anxiety. This is Your Anxiety Toolkit, so we're talking about anxiety. And the natural response to fear is to run away, is to fight it, is to freeze. Naturally, you are biologically set up to go into fight, flight, or freeze when you have fear. The treatment that I use, the gold standard science proven treatment is the opposite of that. Treatment with me and with anyone who's trained in these disorders is going to mean that you are going to have to stare your fear in the face. You're going to have to in-session, be doing scary, hard things. Therefore, you shouldn't want to see me. If you want to see me and the sessions are only enjoyable, I'm missing the point and I'm not being the best therapist I could be to you. I really gauge myself. I tell them not to hold me accountable. I don't want to be giving treatment to people where they're not being forced to grow. Not forced, I shouldn't say forced, because I never make my clients do anything. But what I'm saying is, the session should be focused on this major concept, which is the more you lean into fear, the less power fear has. And so therefore, I say to my clients, "Please, if at any point in treatment you are looking forward to sessions, let me know, because it means I need to up the ante." I don't want to be diddle-daddling. I want to be effective. I want to be immediate. I want you to get results. I want you to not need me. That's another thing. 4.a I want to treat you. I want to give you treatment. I want to give you tools so that you don't need me anymore. I want to put myself out of business. I want to train you so well to do this, that you know what I would say and how I would say it and what you need to do. For those of you who have OCD or a BFRB, you can go and download the courses, ERP School and BFRB school, which is me training you on what I would teach you. The cool thing about the courses is I'm teaching you what I would teach you in session. My goal is to teach you how to do it so that you can do it for the rest of your life, not just for a little while. I'm beginning to feel like I'm giving you guys a big fat lecture, and I hope that's not the case. I'm getting all empowered here. You can tell I'm super passionate about the first session, and I am. These are key points to treatment. These are key points to providing good care. These are key points to your recovery. So they're really important to me. If you feel like you're getting a lecture, I'm very sorry about that. It's not a lecture. Pulling all the punches here. Sorry, you guys. So that was a bonus point there for you. 5. Be ready to do hard work. The patients and clients I have hear me say something often, which is nothing changes if nothing changes. Be prepared to do a ton of homework. The cool thing about cognitive behavioral therapy is there is usually a heavy component of homework. I give homework to all my patients and clients every session. I'll say at the end, "What's your homework? I'll put it in your notes. I'll hold you accountable. We'll check in next week." Be ready to have an assignment. And then be ready to execute that assignment every single day. I recently just finished the book on self-compassion for OCD. Yay! I know I'm really excited. The thing that was right at the very front of the book, and I'm giving you a spoiler alert here, which is, be prepared to do this work for around 45 to 90 minutes a day. That is important. Be prepared to do the work. Be prepared to practice because nothing changes if nothing changes. I know it sucks. I know that's hard truths, but I'm only telling you because I really want you to get your life back. I know a lot of you don't have a therapist. I'm telling you this because I want that to propel you into a journey where you feel really empowered and you understand what is needed so that you can get it done. Knowledge is power here. But then once you have the knowledge, you got to put it into play. Now you guys know what I'm going to conclude here on, and this is something I should say. There are six points here really. So there's actually two extra bonuses. 6. It is a beautiful day to do hard things. I say it every day. I say it at every podcast, I say it in every Instagram post. I'm going to leave this podcast episode with that. Be ready to do hard work, but it is a beautiful day to do the hard things every day. I love you all. I'm going to ask you one big favor. I am early to announce this, but I'm actually just going to announce it now because I want to get the ball rolling. In 2021, I made a deal with myself because I love doing these podcasts and I love doing all these things. But one thing I noticed last year is, in order for these to really pack a punch, my hope and my goal is to get it to more people. The podcast is free. I don't make any money off the podcast. I don't do promotions or anything like that. The best payout here for me is that I get to help more people. After research, I'm learning the best way to do that is to get more reviews. The more reviews I have, the more likely someone is to click on the podcast. Once they click on the podcast, then I get to help them. But if they see the podcast and they move past it, then I don't get to help them. So would you do me a favor? If you get a moment, please go over to wherever you listen to podcasts, whether that be Apple Podcast, Stitcher, Spotify, Podbean, and leave an honest review. Tell me how you feel about it, whether it's helping you, what you'd like to see. I encourage the feedback. I'd love an honest review so that other people can see that we're doing a good job and that you're getting help so that they can too. If you would be willing to do that, I would be so grateful. I am actually following what another influencer did, that I love her podcast. She made a deal with her listeners that once she got a thousand reviews, she would give away a free pair of Beats headphones. I was like, "That is a banging idea. Let's do it." I haven't formally announced it, but I am now. We are going to give away a pair of Beats headphones of your choice of color. Once we hit a thousand reviews, we will randomly take a review and we will put you into the competition, the box. I don't know what you'd say. But even if you've already left a review, you will still go in. So for those of you who've already left a review, thank you, and you'll get put into the drawer. There we go. You have a chance to actually win something amazing, so we can go from there. Go leave a review. Have a wonderful day. I love you guys. I appreciate you guys. Again, really, really from the bottom of my heart, thank you for spending your time with me. I know your time is valuable. I just feel super special that I get to spend some time with you. Have a wonderful day.

Jan 15, 2021

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I am so happy to have Jon Hershfield on with us. Jon is an author and the Director of the Center for OCD and Anxiety at Sheppard Pratt. The second edition of his book, The Mindfulness Workbook for OCD, has just been released and his new book, The Mindfulness Workbook for Teens, is scheduled for release in March. We had a great conversation about both books and Jon shares many of the OCD mindfulness tools that he describes in his books that are used to enhance treatment. In this interview, Jon explains why he wanted to write a book for teens and how he decided to approach the topics of mental health, OCD , and mindfulness in a way that would be relatable to teens and young adults. He discusses in more detail some of the topics in his book including how to understand your diagnosis, how to respond to intrusive thoughts, and how to incorporate meditation and mindfulness into your daily life. Jon also shares some OCD mindfulness tools that he describes in The Mindfulness Workbook. These include thoughts are thoughts, not threats; feelings are feelings, not fact, and sensations are sensations, not mandates to act. He shares that mindfulness really involves calling things what they are. Towards the end of this interview, we discuss Exposure and Response Prevention and the difference between habituation and inhibitory learning. He shares with us the five things we should consider when doing ERP with the goal of inhibitory learning. This is a great interview full of so many wonderful mindfulness tools to help you manage your OCD. I hope you enjoy! The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsion Using Mindfulness and Cognitive Behavioral Therapy The Center for OCD and Anxiety IG @ocdbaltimore If you have some time, I would love it if you would please go and leave me an honest review wherever you listen to podcasts – Apple Podcasts, Spotify, Podbean, or Stitcher. This would really be helpful to me in achieving my goal for 2021 of being able to reach and help more people. Thank you so much! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Jan 8, 2021

Welcome back to another episode of Your Anxiety Toolkit podcast. It's a new year and as we settle into 2021, I am actually going to ask you guys to set a little bit of a goal. Not a resolution, a goal. I am so excited to talk with you all today about this topic because I really hope that this will be the goal you set for yourself this year. I would like for you to start the year by setting boundaries with fear. Now why do I think setting boundaries with fear is so important? Think about it this way, if someone came into your home, you wouldn't just allow them to behave any way they wanted. Right? No, you set boundaries in your home about what kind of behavior is going to be allowed and we know that those boundaries must remain consistent. I want you to try setting those same boundaries when fear shows up in your life. I would encourage you to sit down and actually write out what boundaries are you going to set with fear this year? And then the work begins by holding those boundaries consistently. You may say to fear "No, fear. I see that you're here. It's okay that you're here. I'm not going to wrestle with you and I'm not going to do the thing you told me to do. I'm going to hold that boundary very strongly." I also want to encourage you to to set some boundaries with yourselves in the way that you speak to yourselves. Really try to be compassionate towards yourself and not use unkind words towards yourselves anymore. That's a strong boundary. You hold it, you set it, and you consistently put it into place. For example, let's say you don't hold the boundary very well with fear, instead of using unkind words about yourself try saying, "Okay, I'm not going to beat myself up. I made a deal and that's where I'm going to hold the consistency." I hope you will try starting the year by setting those strong boundaries with fear, uncertainty, disgust, OCD , your eating disorder, your body-focused repetitive behavior, whatever it may be. Not letting them walk all over your life. And most importantly, I hope you can start the year by being very kind and gentle with yourself. If you have some time, I would love it if you would please go and leave me an honest review wherever you listen to podcasts – Apple Podcasts, Spotify, Podbean, or Stitcher. This would really be helpful to me in achieving my goal for 2021 of being able to reach and help more people. Thank you so much! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Dec 25, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. As you all know, I traveled back to Australia to visit family last month. The Australian government requires a 14 day quarantine for any visitors coming into the country. When my plane landed, I was escorted by police to a hotel in Sydney. I was then taken to my room and told that under law, I am not allowed to leave or even open a window for 14 days. Now that I am home and reflecting on my time in Australia, I really want to share with you some of the skills that I had to practice all day every day to get me through that quarantine. I hope some of these skills can also help you when you are facing a difficult situation. The first skill was to become an observer to my thoughts. It is quite common to be feeling fine and out of nowhere this overwhelming sense of panic takes over and you start to think "Oh my goodness I can't handle this." When this happens, you really have to recognize that you are not in danger. This thought can be so powerful that if you don't work to simply observe it, it can easily become truth or fact in that moment. By observing your thoughts, it actually helps you to diffuse from them which takes away some of their power. The second skill is to validate your pain. Once you have observed the thought, it is so important to validate that this is really hard. Try being gentle with yourself and not engaging in self-judgment. The third skill is to keep a routine. Now this does not mean keeping a compulsive, rigid routine; rather, simply take an inventory of what is important to you and make sure you schedule those activities into your day. For me, this meant scheduling phone calls with my family and friends. The fourth skill is to become aware of your small wins. It is so easy to become negative in a situation such as quarantine which is why it is so incredibly important not to discount your little wins. You may also want to try finding pleasure in the small moments or delights of your day. When you are deprived of pleasure, it is easy to overlook those little moments of joy, but it is important to recognize them when they appear. The final skill is one you hear me talk about a lot and that is "It's a beautiful day to do hard things." So many people have said to me that they could never do what I did. The thing to remember is that you actually can. It may be hard, but you can do it if you chose. When those moments of doubt creep in that you can't handle something or you can't do this anymore, just remember that you are so much stronger than you think. ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Dec 12, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I am so thrilled to share a fantastic interview I did with Sommer Grandchamp. Sommer has OCD and anxiety and she, just like so many people, went through some not so great therapy until she found the gold standard treatment for OCD, Exposure and Response Prevention. However, along the way she found that she needed some additional skills to help with her mental health. With her therapist, she learned a type of therapy called Dialectical Behavioral Therapy (DBT). Sommer is here today to talk with us about DBT and mindfulness and how these complements to ERP have been so useful in her recovery journey. I am a huge DBT fan and I actually use it a lot with my patients and clients, even though I tend not to discuss it too often. It really is so helpful to many people especially as an addition to ERP. Sommer not only shares some of her OCD story with us today, but she also shares the tools and different DBT skills that she uses to compliment her recovery from OCD and anxiety. Sommer has a tremendous amount of knowledge on this topic and so many awesome tools to share with us. Sommer is also the founder of the Discreet Journal. She created this journal to help people be more mindful and to practice some of these DBT skills that she is going to share today. I just love when people are able to create something to help others out of the hard times that they have gone through. I hope you enjoy this episode that is full of so much wisdom and some great tools that I feel will benefit anyone struggling with OCD or anxiety. Follow Sommer on Instagram @sgrandchamp and @discreetjournal www.discreetjournal.com ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Dec 8, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. I am so excited because today we are so lucky to have with us again Dr. Jonathan Grayson. Dr. Grayson is a psychologist who has been specializing in the treatment of OCD for more than 40 years. He is also the author of Freedom from Obsessive-Compulsive Disorder and founder of The Grayson LA Treatment Center for Anxiety and OCD. We did an episode a couple of weeks ago that I hope you all were able to hear and at the end of that conversation we both really felt that we needed more time to talk about acceptance. I first want to ask you all how often do you get stuck wrestling with the way things are? Feeling that you don't really like the way things are, that you're sad about the way things are, that you're anxious about the way things are. Maybe you feel anxious or uncertain, or you are beating yourself up because you do not feel that you are good enough or smart enough or well enough? If that sounds like you then you are going to really love this episode on acceptance. Jon is here to share his amazing knowledge and experience on this topic and he does a great job of walking us through some of the biggest roadblocks to acceptance. I am so grateful that we had this conversation because you all know that I talk a lot about radical acceptance. As we continued through our conversation, I really thought to myself that I need to readjust my definition and my practice of acceptance. I hope you enjoy this conversation. I think it is such an important discussion and I am so thankful to Dr. Jonathan Grayson for coming on and sharing his wisdom with us. FreedomfromOCD.com - You can purchase Freedom from Obsessive Compulsive Disorder as well as download Dr. Grayson's forms. The Grayson LA Treatment Center for Anxiety & OCD ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Nov 29, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today on the podcast, I am so thrilled to have such an amazing and talented guest, Georgia Lock, on with us. Georgia is an actor, presenter, OCD advocate, and poet. She lives in London and has so much wisdom and beauty to share with us. Georgia is here to share how she has used poetry to turn the pain of her experience with OCD into beauty. Georgia shares her OCD story and recovery journey with us. We also have a great conversation about shame, guilt, and grief. Georgia shares several of her poems with us and you will see why she is an award winning poet. Her poetry explains so well what it is like to live with mental illness, anxiety, and OCD. I just love when people can use words to perfectly describe what it is like to experience something, whether that be really joyful or really, really painful. Her poetry takes the pain that she has experienced and wraps it in such beauty. I truly hope you enjoy this conversation. It is a lovely story about someone who has struggled so deeply, but who also has done the work and is now moving on in her recovery journey in such a beautiful way. Follow Georgia on Instagram @georgia_nathalie Click here to purchase Georgia's book of poetry, With Every Wave ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Nov 20, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I wanted to talk to you about something that I have been struggling with recently. So you all know that I made the decision to travel back to Australia to visit my family. This decision caused a good deal of anxiety initially, but I also soon recognized that feelings of hyper-responsibility, such as am I being irresponsible by going home, were popping up as well. I had to break this down. Why do we have this sense of hyper-responsibility to always do things "right"? That level of responsibility can cause us a tremendous degree of anxiety . We tend to put expectations that are unrealistic on ourselves to be perfect, good, the fixer of all things broken. So how can we take a step back from that? We actually exist on a spectrum. When you are anxious, maybe you need to recognize that so much of that anxiety is driven from these feelings of hyper-responsibility, from this fear of being irresponsible. That's key, my friends. Just because you feel it doesn't mean it's the truth. Just because you feel irresponsible doesn't mean you are irresponsible. We sometimes have to check the facts. I'm encouraging you to do a check on this hyper-responsibility and see if you can tone it down to a place that's healthy. You can check yourself as you start to respond in a compulsive or an avoidant or reassuring way and you can say, "Hey, is this being led by hyper-responsibility? And if so, where can I land that's healthy." I want you to challenge yourself in this area. Practice stepping back and letting somebody else be the responsible one for a minute or an hour or a day or a year. Try recognizing that yes you have some responsibilities, but also recognize where that hyper-responsibility may be getting in your way. ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Nov 15, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. As I am working on this podcast, I am about to embark on an international trip where I will be gone for a long time, away from my family, and part of the time isolated, in a quarantine hotel for several weeks. My emotions, I'm not going to lie, are all over the place. I swing from being grateful to angry to sad to happy to fearful. So I thought this was actually a perfect time for the subject of this episode which is your feelings are meant for feeling. Right now, I am having all of these different feelings, opposing feelings. Some of them are pretty strong and aggressive. Some will cause me significant discomfort and pain and some will be new, and I'll be curious about them. We tend to get into trouble when we start to believe that we are supposed to control our feelings and be the gatekeeper of them. We allow some feelings and push others out. I want you all to know that you are supposed to feel your feelings, all of them. When you feel them and you wade your way through them, you heal them. I have learned that instead of being the gatekeeper, I pretend that the feeling is a guest and when it comes to the gate I say, "Hello, anger. Hello, fear. Hello irritability. I see you come on in." I allow them to be there as long as they need. I honor that each and every one of these emotions has a purpose. I'm allowed to be angry. I'm allowed to be anxious . I'm allowed to be whatever I feel. None of these feelings make us bad. None of these feelings define who we are. They are temporary emotions that we are supposed to feel. When you take away the judgment of good and bad and right and wrong, you can start to see these feelings as waves that flow through you. Your sense of empowerment over these emotions also increases. It is a very empowering statement to say "I allow you. Welcome. Come on in." It is a gift to say, "I'm giving myself permission to feel. I'm not going to push my feelings away. I deserve to move through my feelings." That is my goal is here today. For you to recognize that there is nothing wrong with the feelings that you have. Give yourself tons of compassion and honor each and every one because your feelings are meant for feeling. ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Nov 11, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. On today's episode I am so excited to have Sean Shinnock with us. Sean is an amazing artist and mental health advocate and he is just one of the sweetest souls that I know. I am so thrilled to have Sean with me today to talk about the monsters that live inside us. Now, for those of you who have heard Sean speak before, you know that he has a project called Draw Your Monster. The idea is for you to draw your monster, personify it, and actually bring that monster to life. You can then begin to have a conversation or a relationship with your monster which actually helps you with your recovery. In our conversation today, we talk about our own monsters and what they look like, but we also go on to discuss the stigma and shame that lives within us and the pain that we go through when living with a chronic illness as well as a mental illness . We discuss the importance of accountability and strong support systems and we also have a beautiful conversation about vulnerability and simply being human. It really is such a lovely discussion with a dear, dear friend and I'm so excited for you guys to have a listen. I hope you will enjoy this conversation as much as I did. Sean's Instagram @sshinnock or @drawyourmonster Sean's website www.sshinnock.com ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Nov 3, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we are going to be talking about a subject that I hope will resonate with a lot of you. We are going to be discussing the stages of grief because I really want to normalize the experience of grief and give you all permission to grieve what we are collectively going through right now. The stages of grief were first identified by psychiatrist and researcher, Elisabeth Kubler-Ross. The first stage is denial. You may deny that the event happened, or deny your feelings, or you isolate away from people so that you don't have to talk about your feelings. The second stage is anger. You are grieving the loss of something and that makes you angry because it feels unfair. You may be angry about coronavirus or the loss of a loved one or maybe even your mental illness . The third stage is bargaining. You may do an analysis of the event and then start to go into a negotiation process in your mind. "If only I hadn't done this, it would have been better." The fourth stage is depression. In this stage, things feel really hard and you deeply grieve and have a deep sense of sorrow. The fifth stage is acceptance. In this stage, you come to an acceptance of the situation. You start to reintegrate into your life and begin to move on. There is a final stage that has also been described called the making meaning stage. In this stage, you try and give your grief meaning by turning your pain into purpose. These steps are here to help you acknowledge the normal experience of grief. So often people have these feelings and are not quite sure what it is, which can make the experience far worse. I want you to remember that these are normal processes that we go through during life. With life, there is loss. Your job is to be your own most compassionate, supportive friend as often as you can and as unconditionally as you can. I hope that you are finding some peace and joy in these very difficult days. If not, just keep reminding yourself that is a beautiful day to do a hard thing, and this is a very hard thing that we are all doing right now so please give yourself tons of grace. ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Oct 29, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today on the podcast we have a wonderful interview with OCD and mental health advocate Mimi Cole. Mimi is currently working on her graduate degree in counseling and she is here to talk with us today about her lived experience with OCD , scrupulosity, and an eating disorder. Mimi so beautifully states that she wants to share her story in order to increase awareness, education and resources while decreasing the shame and misconceptions surrounding OCD. Mimi shares her OCD story, specifically her struggles with scrupulosity. She describes how her religion and her religious upbringing became intertwined with perfectionism and OCD. She shares a bit about her exposures for scrupulosity and what motivated her to begin ERP. Mimi also describes her experience with orthorexia and her obsessions surrounding clean eating and how she feels this became a link between OCD and an eating disorder. We discuss that intersection between body image, clean eating obsessions, restrictive food intake and how these are all connected to OCD. Mimi is currently exploring a research project on eating disorders as a coping mechanism for OCD. Towards the end of the interview, Mimi shares how she manages her OCD in recovery. She talks about self-compassion and accepting our common humanity as a few tools she uses to help. This interview is full of such great information particularly about scrupulosity, a theme of OCD that is not often discussed. I found it so uplifting and informative and I think you will as well. Mimi's instagram @the.lovelybecoming Mimi's website www.mimi-cole.com ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Oct 20, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today's episode comes out of a conversation I had with a client and I thought you all might need to hear this as well. Today we are going to be talking about guilt and this idea that feeling guilty doesn't mean you have done something wrong. I know that idea might feel strange. When we are feeling guilty, we usually assume that means we have done something wrong. Try thinking of guilt as an intersection. When the feeling arises you can chose to take the road that you have done something wrong or you can go in a different direction and try asking yourself "Is this real? Is there actually evidence that I have done something wrong? Is there a chance that my brain has made a mistake and set off the guilt alarm without there being a problem?" If you see that there is no evidence that you did something wrong, you can try practicing compassion and mindfulness and just allow those feelings of guilt to be there. If you recognize that yes you made a mistake then you can work to address the situation. A lot of us simply have a little glitch in the guilt system and our guilt gets fired off a bit too easily, too often, and at times where guilt isn't really that appropriate. Guilt is just an emotion and when it comes up it provides an opportunity for growth. Guilt can be painful and it can make us feel bad about ourselves, but remember that you have a choice when guilt shows up. You can choose that road of compassion and simply allow the emotion of guilt to be there. ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Oct 15, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today on the podcast, I am so excited to interview Dr. Jonathan Grayson, a psychologist who has been specializing in the treatment of OCD for more than 40 years. He is also the author of Freedom from Obsessive-Compulsive Disorder and founder of The Grayson LA Treatment Center for Anxiety and OCD. In this interview, Dr. Grayson discusses the power of embracing uncertainty in the treatment of Obsessive Compulsive Disorder . In the beginning of our conversation, Dr. Grayson discusses how he explains OCD to his new clients. He shares that the core of OCD is trying to be absolutely certain and that the goal of treatment is to learn to live with that uncertainty in the same way that we live with all of the many uncertainties of life. We then go on to discuss the ways he helps motivate his clients to do ERP and to begin embracing that uncertainty. He has his clients fill out a form that asks certain questions including the one that he finds most critical "Why would I take this risk?" He also has his clients write down "What have you lost to OCD?" "How have you hurt the people you love because of OCD?" and "What do you hope to do with your life when you are free from OCD?" I found another question he asks his clients to be particularly helpful. When asking clients to begin embracing uncertainty and to take the risk that X may happen, he asks them to imagine how you will attempt to cope if the most terrible thing you can imagine actually happens. We also have a great discussion about mindfulness and compassion and how he uses both in his practice. This interview is full of so many fantastic insights. I learned so much myself and I hope that you will find it as enjoyable and informative. FreedomfromOCD.com - You can purchase Freedom from Obsessive Compulsive Disorder as well as download Dr. Grayson's forms. The Grayson LA Treatment Center for Anxiety & OCD ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Oct 7, 2020

I know it continues to be a really tough time for everyone. I am definitely not immune to those struggles. In taking time off, I came to a realization about why I was having such a hard time. It wasn't about COVID or anxiety or stress. I was struggling because I had been having a mental tantrum inside my own head 24/7. My mental tantrum sounded something like this "It's not fair. This should not be happening. I'm supposed to be healing. This isn't the way it should be. It's not fair." I had no idea I was even doing this. I was having an adult sized tantrum in my head that no one else could see. Now it is important to understand that all of these thoughts are valid. It is a tough time and people are suffering, but the way I was saying it was definitely not validating. I approached this by turning back to what has been the foundation of my recovery, something I learned about 15 years ago. It is rooted in the principles of Buddhism and that is 'in life there is suffering. It is not the suffering that causes the pain. It is the resistance to the suffering that causes you the pain.' So for me in this situation, my resistance or my mental tantrum was actually what was causing me the most pain. Recognizing this and having compassion for myself is so important here. And asking myself is there a way that I can take off my stomping shoes and stop resisting the fact that this is a hard time? We really do have a choice. Do we meet hard times with tantrums and resistance or do we meet those hard times with compassion, validation, consideration and respect? In these moments now when I still find myself throwing that mental tantrum, I simply note it and say "Ok I see what's happening and how am I going to deal with it? Am I going to keep throwing this tantrum or am I going to hold space for the fact that this tantrum is representing how hard things are and how much I am still struggling?" This has been such a huge lesson for me during COVID-19. I hope it is helpful for you as well as we are all still navigating these difficult and challenging times. ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Sep 30, 2020

Today on Your Anxiety Toolkit, we are joined by Gelong Thubten, a Buddhist monk, meditation teacher and the author of A Monk's Guide to Happiness. He is here to discuss how mindfulness and meditation can help us understand the power of our own minds. This episode is not about religion, rather, it is a beautiful message of wisdom and compassion. In this beginning of this episode, Gelong Thubten spends some time discussing happiness and how this desire to be happy really drives everything we do in life. The search for happiness can get us caught in a loop where we ultimately end up feeling more and more dissatisfied. He points out that the goal is to learn that true happiness is already inside each one of us. He goes even further to say that we can actually learn to be happy. It is a skill that we can practice. He explains that meditation can help us learn to be kinder to ourselves by teaching us how to transform our relationship with our thoughts. We become an observer of our thoughts during meditation. This non-judgment of thoughts and letting our thoughts simply be, actually allows us to have compassion for the moment and compassion for ourselves. Gelong Thubten gives some suggestions on how to begin a practice of mindfulness and mediation if you are a beginner. He stresses that there is no perfect way to meditate and it truly is a practice that you must work on. You don't have to do it perfectly for it to be effective. He suggests getting some instruction on how to meditate whether that is a book or online resource or even an app on your phone. He also suggests starting in very short increments, such as, five minute sessions. You begin your meditation by focusing on your body and finding your breath. When your mind wanders, do not engage in self-criticism, simply come back to your breath. We learn in this episode that meditation is a time of total freedom. You simply are in the moment, without judgment. By practicing these moments of nonjudgmental acceptance throughout the day, you are learning compassion which eventually will become your natural state. Gelong Thubten explains that our bodies are not designed for anger and rage. When we are happy, generous, kind, and connecting with others, we feel good inside, we feel happy which suggests that is our natural state. In other words, who we are deep down before we get caught up in negative and toxic outside influences. Meditation, he explains, is about bringing us back to that natural state. A Monk's Guide to Happiness: Meditation in the 21st Century www.gelongthubten.com Instagram @Gelongthubten

Sep 23, 2020

Hello everyone!!! I am so grateful that I was able to take some time off, but I am so happy to be back and I am excited to talk to you today about a really important lesson that I have learned and that is this concept that self-respect is not optional. Let me share a little bit about what this means. So many times, especially during COVID, I have been faced with the question: am I going to be respectful or disrespectful to myself right now? We are all actually faced with this question everyday, multiple times per day. Your responsibility is to show yourself respect every moment of every single day. Why? Because you are a human being and you get to have respect simply for being human. It is not something you earn. It is unconditional. This can be really hard for a lot of us, but self-respect is not optional. You deserve self-respect no matter what simply for being you not because of something you have done. How do you go about showing yourself respect? First, start by setting boundaries. It is respectful to set kind, compassionate boundaries and to show up for yourself when someone crosses that boundary. Second, hold yourself accountable. In other words, do what you say you are going to do. If you say I am establishing boundaries then hold yourself to that. Third, listen to and honor your body. If your body is hungry the most respectful thing you can do is to feed it. If you are tired ask yourself what your body needs at that moment. Also acknowledge what you respect about yourself and even share that with those you love. You might say "I really respect how well I have handled this difficult time." I find it to be true that self-respect is really the first step towards self-compassion. Finally, do not apologize right away. Apologies are wonderful, but sometimes we move too quickly to apologize or find ourselves apologizing for every misstep. Sometimes it is better to take a step back and really have a conversation with the other person. It is more respectful to have that conversation about what happened and to understand the other person and have them understand you. The healing happens in the back and forth communication, in hearing each other's point of view. I want to leave you with the reminder that it's a beautiful day to do hard things and I hope you will let self-respect be one. ERP School is open for purchase! ERP School is jam packed with the same tools and information that Kimberley uses with her own clients to help them learn to manage their OCD. And now if you purchase ERP School between September 14-28, you will receive 2 FREE bonus materials that will be emailed directly to you! Please click here to purchase. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Sep 11, 2020

Hello everyone! We have some very EXCITING news today here at CBT School. We are so happy to announce that ERP School is being relaunched today, September 14, 2020! And we are so excited to say that it is now CEU approved!!!! This means that it is now an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. This is so special to us because it has long been a mission of CBT School to educate as many clinicians as possible about OCD and Exposure and Response Prevention. ERP School is jam packed with the same tools and information that Kimberley uses with her own clients to help them learn to manage their OCD. And now if you purchase ERP School between September 14-28, you will receive 2 FREE bonus materials that will be emailed directly to you! You will receive a free checklist of the important things you need to know as you practice ERP and a free audio training from Kimberley about things that may be getting in the way of your recovery. You will receive unlimited access to both of these bonus materials if you purchase before September 28th. So please head on over to cbtschool.com where you can purchase both the regular ERP School as well as the ERP School for CEU 's. Your Anxiety Toolkit Podcast will be back on September 25th! We have so many awesome topics to cover and some amazing guests lined up. We can't wait! See you all on the 25th!

Jul 8, 2020

Welcome back to another episode of Your Anxiety Toolkit. I wanted to take some time today to let you know that I am going to be taking a break. I am going to take a couple of months off to heal, to replenish, to restore and to rest. I want to share with you how I came to this decision about taking a break because I am wondering if you may be struggling with the same feelings. Over the past several months, I have found that I have not been slowing down enough to replenish. I haven't been listening to my body which has been saying to me "rest, please take some time." What has been so hard for me and may be hard for some of you as well, were the feelings I had that "I should be able to handle all of this and I'm weak if I can't." I was really judging myself for having those feelings. When I finally stopped and accepted that my body was trying to tell me something, I was able to recognize that now more than ever, my body, as wise as it always is, was telling me to slow down and take more time. So I want to ask you all to check-in with yourself and do a quick assessment to really connect with your needs. What your body is telling you? We are in such difficult times right now. There is so much uncertainty and anxiety which can take a tremendous toll on the body. Now more than ever it is so important to recognize the importance of taking care of ourselves. So what can we do to begin taking care of ourselves? We can take a deep breath. We can bring validation and recognition to all of our feelings and then we can give ourselves exactly what we need. If that means eating a brownie, or having a good cry or taking a break. I hope you will stop and honor your body and give it what it needs at this time. ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com While Kimberley is taking a break, we are not going to leave you hanging. Each week for the next 10 weeks we will send you a new anxiety management tool to help you stare fear right in the eyes. This 10 week series is FREE and we cannot wait to have you join us! Click here to get started.

Jul 2, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today on the podcast, we are so lucky to be able to talk with Dr. Dennis Tirch, the founder of The Center for Compassion Focused Therapy and the author of six amazing books including, The ACT Practitioner's Guide to the Science of Compassion and The Compassionate-Mind Guide to Overcoming Anxiety. Dr. Tirch is here to talk with us about learning to embody self-compassion. In the beginning of this interview, Dr. Tirch spends some time discussing the definition of self-compassion and why self-compassion is so important for our mental health, especially for those struggling with anxiety. Dr. Tirch says that learning to embody self-compassion involves "grounding ourselves in a sense of emotional safeness, meaning and purpose." By practicing self-compassion and mindfulness, Dr. Tirch says we can "gradually train the mind to rest in an awareness of compassion and care." He so beautifully tells us that if people can learn to embody this self-compassion and feeling of being grounded then they will be able to "turn towards the things they fear and walk through them." By learning to embody self-compassion and learning to speak to yourself in a compassionate voice, Dr. Tirch says your empathy will grow and your ability to tolerate distress will grow as well. Dr. Tirch spends some time talking to us about his own personal self-compassion exercises and he shares how important breathing and meditation can be when learning to embody self-compassion. Finally, Dr. Tirch spends some time explaining the importance of "finding your aim." When we ask ourselves "what is your aim?' it helps us become more self-aware and able to find our purpose. This is an amazing interview so full of beauty and wisdom. I hope you all enjoy. The Compassionate-Mind Guide to Overcoming Anxiety The ACT Practitioner's Guide to the Science of Compassion Dr. Tirch's website www.mindfulnesscompassion.com Ep: 134: Giving and Receiving Meditation ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

Jun 26, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today on the podcast we are talking about facing your fears with Dr. Patricia Zurita Ona, or Dr. Z for short. Dr. Z is a licensed clinical psychologist in California treating clients with OCD, anxiety and trauma. She has written several amazing books including Living Beyond OCD Using Acceptance and Commitment Therapy and The ACT Workbook for Teens with OCD. In our interview, Dr. Z discusses how to use Acceptance and Commitment Therapy to augment treatment of OCD, social anxiety, panic disorder , and phobias. Dr. Z shares with us WHY facing your fears is so important and something you should want to do! In this episode, Dr. Z talks about, 1. Ruling your thoughts and how to unpack them. 2. How to date your mind. 3. How to know which behaviors are working and which are not. 4. How to find values that energize you. 5. Create your own ERP menu that includes your own triggers and avoidant behaviors. 6. Learn how to react using wisdom. 7. Learn how to identify the ways your brain creates patterns. Dr. Z's websites www.actbeyondocd.com and www.thisisdoctorz.com Dr. Z's Instagram @dr.z.passionatebehaviorist Link to Dr. Z's books https://www.thisisdoctorz.com/books/ ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

Jun 18, 2020

Welcome back to another episode of Your Anxiety Toolkit. Recently we have talked a lot about self-compassion. If you go back to episodes 134, 146, and 147, you will see self-compassion mentioned a lot. Today we are going to expand on that discussion by learning how to write ourselves a self-compassion letter. I have actually been doing this with my clients for years and it really just involves putting your self-compassion into words which can actually be so helpful. There are several steps in writing your self-compassion letter. The first step is to show awareness of your struggle. You might say "I see that you are having a hard time." Whatever it is, just bring it to your awareness and write it down. The second step is bringing in some words of unconditional love. No matter how much you are suffering, you still get to be loved and cared for. The third step is to show yourself some empathy for the distress you are in. You might say "I see you. I see the pain you are going through. I can relate to that." The fourth step is recognizing your common humanity. In your letter, you want to bring in the common humanity of your struggle. You could say "Everybody knows what it is like to have anxiety . I am definitely not alone." Next you want to normalize the fact that when we suffer we all want to engage in safety behaviors. A safety behavior is anything you may do to try and take away your fear, or shame, or sadness. Safety behaviors usually have unintended consequences and they usually end up causing more problems. Instead you would want to explore some more helpful solutions. You are going to look at the situation and say "How might I help myself?" The last step is to say something really, really kind to yourself and finally you are going to read your self-compassion letter aloud. Below is an example of my own self-compassion letter. Kimberley, my dear one. It's okay that I'm having a hard time right now. I feel afraid and I really just want to jump out of my skin. This is really a difficult time for me. Now, what I am feeling is not wrong. I'm doing the best I can with what I have at this moment. My suffering, this discomfort I feel, it deserves to be met with kindness and tenderness. I deserve that. I am worthy of this kindness and tenderness I'm giving myself. And I wish for myself to have some peace of mind. I know it's a hard time, but I know I will find peace. Now I'm going to find this peace mostly by doing what I'm doing right now, which is changing the way I respond to my suffering. Every single pain that shows up inside me, I'm going to meet with kindness and I'm going to recognize that each moment of suffering is worthy of self-compassion. I'm strong and I can face fear and I can hold space for my emotions, no matter how hard it is. I deserve to be a safe place for fear, as it rises and falls in my body. I am my best ally and I have everything I need right here inside me to get through these hard times. Now I promise to be there for myself when things get hard. I'm sending you my love. Now Kimberley, go gently into this moment, my darling. ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

Jun 9, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today on the podcast we are talking with Christian Newman about managing health anxiety. Christian is an anxiety coach who has done a lot of work learning to manage his own health anxiety and today he is sharing with us the tools that he has used to help regain his life from health anxiety. In this interview, Christian shares his own struggle with health anxiety and how it impacted his daily life. He shares how a terrifying panic attack led him on a journey to discover how to deal with his health anxiety. He shares with us several important tools that he has used to help him effectively manage his health anxiety. The first tool is the contract that he made with himself. In this contract, Christian wrote down everything that he was going to do to overcome his anxiety. This included stress management, diet, exercise routine, and sleep habits. Once he made this contract, he committed to taking action in his own life. One of the first actions that he took involved addressing the compulsions that fueled his health anxiety. He asked himself what positive actions he could take instead of engaging in the compulsive behavior. This allowed him to teach his brain to engage in something more positive which would then allow him to move forward. He also discusses how mindfulness including journaling, setting intentions, and meditation have helped along with Acceptance and Commitment Therapy. He explains that at times he still has moments of uncomfortable symptoms or sensations, but he has learned how to recognize what is happening and not allow those feelings to derail his life. Christian's Instagram @healthanxiety.coach Christian's website www.healthanxiety.coach ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

May 28, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today I want to talk with you all about the feelings of uncertainty you may have coming out of COVID-19. As we slowly begin to move out of quarantine, a lot of my patients and clients have started to talk about how scary it is to go back into life because there are so many uncertainties. Coming out of a difficult time requires us to accept change while staying in the uncertainty. When we begin coming out of COVID-19, we must face this sort of uncertainty, not knowing whether it will stay or whether it will get better or if it will come back. What is it going to look like in six months? What is it going to look like in a year? These are the questions we are all asking and because we are asking those big, big questions, we are going to have big, big emotions about them. Having these big emotions does not mean that you are not handling this well. It doesn't mean that there is something wrong with you. My hope is to give you permission to have them. My second wish is to ask you to please not judge yourself for what you experience as you begin coming out of COVID-19. If those big emotions show up, before you judge yourself gently say, "It's okay. It's okay that I feel this. I'm allowed to feel these emotions." Remember, it is normal to feel anxiety . You might have anxiety about having to go back to seeing people in person. You might have anxiety about having to find a new rhythm to life. You may have been secretly benefiting from quarantine because it meant that you didn't have to be around the thing that scared you before COVID-19. If you have been lucky enough to not see the thing that frightens you, I really urge you to go right back into staring that fear in the face as soon as possible, because the longer you delay it, the harder it's going to get. The thing to remember about anticipation is that is ultimately just about the uncertainty. It's about leaning in and saying, "Okay, I radically accept that I don't know. I'm going to take one step at a time. I am not going to beat myself up. I'm going to do my best to be non-judgmental. And I'm going to try and find a glimpse of joy along the way." I'm going to look for those teeny tiny shimmers of joy that may be along the way. I still believe that when we open our eyes to joy, we can find it, even if it's once a day. So, I hope you go with intention and give yourself permission to have all the feels. ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

May 22, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today we are going to talk about a really important topic: learning to trust yourself. Trust is so important for our feelings of safety and security. So often I hear from people who are experiencing anxiety and depression that they do not trust themselves. Today I want to share with you all a metaphor about trust, that I love, and I think it will help you conceptualize how to look at trust. This is a metaphor that Brene Brown has talked about a lot. She said that when you meet somebody they have an empty jar (metaphorically) and overtime as they show you in little ways, it might be their consideration, their respect for you, maybe they remembered your birthday, perhaps they sent you a little care package, every time they do something nice for you one marble is placed in the jar. If they do another small thing, you put another marble in the jar and overtime that jar fills up. This is how we experience a sense of trust for that person. Trust is something that grows and it often doesn't come from the big things. It comes from the teeny tiny things. Maybe a little smile when you are having a hard time, or checking in with you, or holding a safe place for you when you are struggling. So, now that we have that conceptualization that trust is something we build over time, we also need to recognize that when somebody has let us down the marbles may come out. Maybe half the marbles. Maybe all the marbles. Perhaps just one. We can always grow trust back even if someone has betrayed us. If we want to build that trust back up, this involves giving the person a second chance. Often when someone has been very seriously betrayed, they make the choice, "I don't want to trust that person. I don't want to ever put myself in that position again." Whereas other people might say, "well I love this person. I'm willing to take the risk." Now, this applies to ourselves too. You begin learning to trust yourself based on the small acts that you do for yourself. It's about taking care of yourself, making sure you're well-fed, making sure you're listening to your body. When you're frightened, it's about doing the hard thing instead of the easy thing. Every time we do that we are saying, "I've got your back unconditionally even during the difficult times." Now, just like I said before if you betray yourself, you ignore your needs, and put yourself down, you take out some of those marbles. If I've let a friend down or my partner down or my child down, I will intentionally try to regain their trust, and I'll do it in very small ways. I will be there for them, be kind to them, show up for them. This is the case for myself as well. If I have let myself down, I will need to show up in small ways with the intention that I want to trust myself. A lot of the time, when I'm doing hard work in therapy with clients, they back down because they tell themselves, "I can't do this. I can't." I tell them this is a matter of trust. You think you can't because you haven't in the past. This is a part of the process of learning to trust yourself, and it's an intention that you need to work on every day. Through those small acts, you'll get there. There will be days when you lose marbles. We all make mistakes, but we can all stand up and make the intention to build trust again for ourselves. It has to be unconditional. That is where our long-term wellness can benefit. So, I'm going to challenge you to think about how full your jar is for the people around you and the one for yourself and then ask yourself how intentional you are about building up that jar of trust. ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

May 14, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today we have on the podcast an amazing guest, Heather Hansen. Heather is a trial attorney, television legal analyst, and author of The Elegant Warrior: How to Win Life's Trials Without Losing Yourself. Heather shares how we can learn to become a better advocate for ourselves using many of the same tools that she has used in the courtroom. In this episode, Heather details the "tools of an advocate" that you can use to help win over your own self jury, that critical voice in your head that may say "You're not good enough. Things aren't going to work out. It's time to be anxious ." One of the tools Heather discusses involves collecting evidence when faced with self-doubt or worry. She suggests writing down, at the end of the day, what has made you proud. By collecting evidence, you start to build credibility with yourself. You can't advocate for yourself unless you believe in yourself. Collecting evidence, building credibility and believing in yourself are the first steps in learning to become a better advocate. Another tool of the advocate involves the words that you use and particularly the words you say to yourself. Words can create your reality. If you are anxious and use the term 'I am freaking out' you likely will freak out. However, changing your words to 'I am concerned' can actually change how you view a situation. The next tool is perspective. If you view the world as dangerous and scary then the world is going to feel dangerous and scary. There are always many ways to view a situation, Heather challenges us to look at all of those different views and then choose the perspective that best serves you. Finally Heather spends some time discussing how presentation, body language, and tone are also important tools of an advocate. Heather provides such fascinating information and amazing insight. I was taking notes during the entire interview! I hope you find it as helpful. You can find more information on Heather Hansen's blog, podcast, books, and coaching services at heatherhansenpresents.com The Elegant Warrior: How to Win Life's Trials Without Losing Yourself Find Heather on Instagram @imheatherhansen ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

May 6, 2020

Welcome back to another episode of Your Anxiety Toolkit podcast. Today I want to talk to you about anger. I have talked about anger before, but this time is a little bit different. I want to tell you why anger is your friend. When I say that to people, they usually have a reaction and they say "No, it's not. Anger is horrible. Anger makes me uncomfortable." I think we have anger all wrong because society tells us it's wrong. We are told "You are not allowed to be angry. It is disrespectful to be angry. You're overreacting. You are so insecure." Those are the messages we so often receive about anger and they only direct us away from listening to our anger. Let's first discuss, what is anger? Anger is an emotion that you feel and it is usually a reaction to some kind of injustice or some kind of threat. If you have been wronged, you feel angry about it. If you feel like you are physically or emotionally in danger, anger is usually the emotion that arises. Anger is just one emotion in our toolkit and it is so important. The cool thing about anger is that anger propels us forward. While anxiety pulls us backward, anger pushes us forward into either protection or problem solving mode. Anger is your friend because it shows up with a message that we should listen to. If you feel anger, the trick is to see that underneath the anger is an emotion that has a lot of knowledge and something to tell you. Anger is your friend because it will help lead you to where you work is, whether that is fear, shame, guilt or any other underlying emotion. When you feel anger arise, the first thing I am going to encourage you to do is to just validate the feeling. You can say "I feel angry and that is OK or I am noticing anger in my body right now." Next I want you to meet yourself with compassion. Something has been activated, some kind of pain and all pain, no matter the source, deserves and requires compassion. Finally, once you've validated and practiced self-compassion, the next step is to ask yourself what is underneath this anger? What is it trying to tell me? So in this moment just get really quiet and listen. Are you angry because you are afraid? Are you angry because you feel shame? Are you angry because someone brought up a fault that you didn't really want to address? These are some reasons we all feel anger so remember you are not alone. Since anger is your friend you can use it to propel you forward into solutions. If you listen to the anger, validate it and ask it what it needs, it will usually led you to your suffering so that you can either tend to it or solve it. It is really THAT powerful! ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

Apr 30, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to share with you one of my favorite topics of all time: how to access your compassionate voice. You may be thinking what exactly does that mean? Well it means helping you to get in touch with the compassion that lives inside each of you. So often my clients and patients say to me "I don't know how to access compassion" or "I don't know what that even feels like." Here is the thing. Your compassionate voice has always been inside of you, but sometimes other messages are simply louder. If you learn to listen deeply for it than it becomes so much easier to pick up. That little voice inside of you is ready to speak up and it is ready to fill you with a loving sense of self-compassion. During this episode, I walk you through how to begin to access your compassionate voice. You start by closing your eyes, following your breath and asking yourself some questions. These questions help you to tap into your compassionate voice and to start to become familiar with it. First, what does your compassionate voice sound like? What tone does your compassionate voice speak in? How would you like your compassionate voice to show up for you? How do you relate to your compassionate voice? Finally, what do you need from your compassionate voice? I really hope you will be open and experiment with this practice. It is such a beautiful exercise and the more you do it, the more you will hear and feel your compassionate voice. Even if it seems unnatural at first, I hope you will still give it a try because it can be really helpful for your mental health . Try viewing it as a type of emotional training. You are giving yourself a tool that one day you may need and then you will have it with you and know how to use it. Remember compassion is not about making the pain go away; rather, it is about meeting your suffering with safety. It is about showing up for yourself during the hard times. ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com

Apr 24, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I want to talk with you about self-compassion and to give you a compassion tool to try if you are struggling with feeling worthy, deserving, or comfortable with self-compassion. In order to understand this tool, I want you to imagine a scenario. Let's imagine you are having a moment of fear. In that moment, you may naturally engage in a safety behavior, something that protects you from the fear. Safety behaviors are natural. We as humans have learned to protect ourselves by getting away from danger. However, a problem that often comes with safety behaviors is the unintended consequence. If you have social anxiety and your safety behavior is to avoid social interactions then the unintended consequence may be that you feel lonely. So if you have a fear and you engage in a safety behavior that leads to unintended consequences, you may then judge yourself for how poorly you handled a situation. Here is where the compassion tool comes in. Before you start judging, I want you to try and catch yourself. This takes a lot of mindfulness . Try and recognize that these safety behaviors are part of the human experience. Try telling yourself "all humans engage in safety behaviors because all humans have felt fear, sadness, guilt or shame. I am going to show myself some compassion." Another point to remember is that when we have an emotion whether it is fear or sadness or shame and we engage in a safety behavior another unintended consequence is that we are actually making that emotion feel much bigger. The more you don't want to feel fear, the stronger and scarier it actually feels. Again, I want you try meeting those emotions with compassion. When you notice fear you may try saying "OK I am having feelings of fear. All humans feel fear. This is a normal experience." Instead of engaging in a safety behavior you might say "Wow fear, thank you for showing up. Thank you for trying to protect me. I am going to send you well wishes because I want to create a relationship with fear that is positive instead of negative." I truly hope this compassion tool will be of help to you in those moments of struggle. I hope you will show yourself compassion for all of those emotions and feelings that are part of the human experience. ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com Did you know that we were listed in the top 10 OCD podcasts to follow in 2020? https://blog.feedspot.com/ocd_podcasts/

Apr 16, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today I want to share with you the five thoughts you need to watch out for during COVID-19. I know we are in a stage right now where we are all trying to adapt to our new normal. Over the past week, I have noticed a few thoughts that have come up with clients about our current situation that I want to share with you. Here we go. These are the 5 thoughts you need to watch out for during COVID-19. 1. "I cannot handle this." This is really important because if you are telling yourself that you cannot handle it then chances are you probably won't. What I would love for you to say instead is, "I can do hard things." You don't have to do it perfectly, but you absolutely can handle it. 2. "I am going crazy indoors." It is easy to start feeling claustrophobic if you are constantly reminding yourself that you are indoors or cooped up. Instead try switching this statement to "It's hard for me to be indoors." I also think it is really important if you are in a place where it is safe and you are able to try and get outdoors every day. Even if it means just standing outside your front door. Getting outdoors at least once a day is so important for our mental health. 3. "When will it end?" This one is really, really hard. If you are spending a lot of time trying to answer this question then you are probably going to end up frustrated, disappointed and more anxious because nobody has the answer. Instead, I would encourage you to try and stay in the present moment. Try focusing on the present day only, not what might happen next week or next month. 4. "Life will never be the same." Another one that is really hard because there is a lot of grieving happening right now. You may be grieving that your life looks and feels so different. If we keep telling ourselves that life will never be the same, we end up creating a lot more anxiety and ultimately a lot more grief. I think it is so important to give yourself a lot of compassion if this thought is coming up for you. 5. "I should" statements. These look like "I should be handling this better. I should be cleaning my house. I should be learning a new language." No, we are in the midst of a pandemic. You may not have the energy, bandwidth or mental space to be doing any of those things and that is absolutely OK. I would encourage you to shift your language from "I should" to "I could." Instead of saying "I should be handling this better." say "I could be handling this better, but I am doing the best I can with what I have." So these are the five thoughts I want you to watch out for during COVID-19. Some of them you may be thinking a lot, some not at all, but I really felt it was important to address these five because it can be so easy to fall into some of these traps! ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com Please join the IOCDF for a live Townhall discussion on COVID-19 & OCD Saturday April 18 at 2 PM EST. There will be a live Q&A session. Please click here for more information. Did you know that we were listed in the top 10 OCD podcasts to follow in 2020? https://blog.feedspot.com/ocd_podcasts/

Apr 8, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today we have Heather Lillico on the podcast. Heather is a registered holistic nutritionist, yoga instructor, as well as a delightful human being. Today she is going to discuss how nutrition can impact mental health . Heather shares a little bit about her own mental health journey and how that led her to explore the connection between nutrition and mental wellness. Heather discusses what it means to be a holistic nutritionist. She explains that she focuses a great deal on the whole person, not only how nutrition can impact mental health, but also how a person's sleep patterns and exercise can as well. Heather shares some really helpful and fascinating information about how nutrition can impact mental health along with some slights changes you can make in your day to day life to improve your mental health. She takes some time explaining the role that a variety of different nutrients play in our mental well being. Heather does a beautiful job explaining to us how we can be a little more intentional with what we put in our mouths and on our forks. She gives some really simple ways that we can incorporate different nutrients and foods into our daily life. Heather also takes some time to explain the connection between our gut health and our mental health. I am so excited to share this episode with you at this time. Food keeps us nourished. Food is also a huge source of pleasure. Meal time is when we can join as a family and communicate and have a connection. It's a huge piece of our mental health right now so I thought this was a really, really great time to have this conversation with Heather and talk about all things food! Heather's website www.heatherlillico.com Heather's Instagram @heather_lil ERP School, BFRB School, and Mindfulness School for OCD are all now open for purchase. If you feel you would benefit, please go to cbtschool.com Please join the IOCDF for a live Townhall discussion on COVID-19 & OCD Saturday April 11 at 2 PM EST. There will be a live Q&A session. Please click here for more information. Did you know that we were listed in the top 10 OCD podcasts to follow in 2020? https://blog.feedspot.com/ocd_podcasts/

Apr 2, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today I want to remind you that you can do hard things! In this episode, I spend some time talking with you about how important it is to validate all the feelings you are experiencing during this difficult time. With so much going on around the world, there are so many emotions, so many feelings. And I think that we sometimes forget to stop and say, "Wow, this is hard for me," or "Oh, this is a moment of real suffering and struggle for me," or "I'm noticing I'm having a lot of anxiety ." It is so important to make space for all those feelings. To acknowledge and validate those feelings and to create a safe place for those emotions to be there as this event rises and falls. In this episode, I share with you all a little bit about how I am working to validate my own emotions when I am having moments that are difficult. The most important thing I want you all to take away from this episode and to remember during this very, very difficult time is: "It's a beautiful day to do hard things," and you are doing hard things. You were already doing hard things before this happened, right? But every time it gets a little harder, you realize how much stronger you are. Sending so much love to you all! Did you know that we were listed in the top 10 OCD podcasts to follow in 2020? https://blog.feedspot.com/ocd_podcasts/

Mar 27, 2020

Welcome back to another episode of Your Anxiety Toolkit. You guys, you are going to love this episode with one of my favorite poets of all time, The Poetry Bandit. Jon Lupin, aka The Poetry Bandit joins us today to tell us his story about sobriety, OCD , relationships, mental health and how poetry has helped him through. This is a story about honesty, vulnerability, and commitment. The Poetry Bandit shares his story and together we talk about some of the hidden meanings of his poetry. Jon and I got to read a few of his poetry pieces and talk about how he manages his anxiety, OCD, and sobriety while being a father, employee, friend and poet. If you get a chance, check out The Poetry Bandit's books of poetry. The links are below. Encyclopedia of a Broken Heart: Poems You Only Love Me When I'm Suffering: Poems My Sober Little Moon Jon's Instagram @the_poetrybandit Please join the IOCDF for a COVID-19 & OCD Live Townhall. Saturday March 28th at 2 PM EST. Bring your questions for Kimberley, Ethan Smith, Jon Hershfield, and Stuart Ralph. https://www.facebook.com/IOCDF/ Kimberley did a FREE Self-Compassion webinar on The Peace of Mind Foundation's FB page. https://www.facebook.com/peaceofmindfoundation/ Did you know that we were listed in the top 10 OCD podcasts to follow in 2020? https://blog.feedspot.com/ocd_podcasts/

Mar 20, 2020

Welcome back to another episode of Your Anxiety Toolkit. In today's podcast, I want to provide you all with an easy mindfulness tool to help with coronavirus anxiety. These are tough times, I know. It is overwhelming and there is a lot of information out there. In this episode, I would like to encourage you to step away from the tools that everybody is giving you right now and hopefully provide you with an easy tool that will help you in the deepest, darkest, moments of struggling. Now I am still going to strongly encourage you to reduce your consumption of news and to receive your news from one reputable source for a limited amount of time per day. I also want to encourage you to get support right now. Reach out to your people, every single day. In this episode, I also want to give you this mindfulness tool to help with coronavirus anxiety that you may have heard me mention before. It is actually a four step mindfulness tool known by the acronym, RAIN. The R in RAIN is for RECOGNIZE. This tool is to get you to slow down or stop and be in the present. Ask yourself, "What is it that I am feeling? What is it that I am thinking right now? What is it that I am experiencing?" The A in RAIN is for ALLOW. You are going to allow what you have recognized and you are not going to judge it, just allow it to come and go. The I in RAIN is INVESTIGATE. I think this is really important right now. Investigate involves engaging with your deep sense of curiosity. It involves looking at things as if you have never seen them before. The N in RAIN is for NURTURE. You have recognized what you are feeling, you've allowed what you are feeling, and you have investigated it with a curious mind. What is left over, you nurture. You provide yourself with a huge dose of self-compassion. Help Manage COVID-19 anxiety and stress with this mindfulness and self-compassion tool. A FREE custom-made PDF worksheet to help you manage anxiety, doubt and uncertainty. https://www.cbtschool.com/RAIN Please read this helpful article that explains how OCD and anxiety disorders can be complicated by coronavirus fears. https://www.washingtonpost.com/health/ocd-and-anxiety-disorder-treatment-can-be-complicated-by-coronavirus-fears/2020/03/13/6b851d60-63ce-11ea-acca-80c22bbee96f_story.html

Mar 12, 2020

I cannot tell you how often I get asked about how anxiety impacts sex. Social media followers often ask questions that involve how anxiety decreases sex drive, how sexual arousal can occur at unwanted times and the impact medication has on sexual arousal and orgasm. In today's episode of Your Anxiety Toolkit, we have Dr. Lauren Fogel Mersy to speak about all things anxiety and sex. Dr. Lauren Fogel Mersy is a certified sex therapist, psychologist, and upcoming author and she answered all of my questions on how anxiety impacts sex. When discussing the topic, Dr. Lauren Fogel Mersy answered the following questions: How can we refocus on the present when anxious? Does anxiety impact orgasm? Can anxiety cause sex to be painful? How to handle arousal related to unwanted, intrusive thoughts? How to manage strong feelings about sex, such as desire but also repulsion? How to manage sex hygiene? Will medication impact sexual arousal? Instagram: @drlaurenfogelmersy Facebook: https://www.facebook.com/drlaurenfogelmersy/ Please join the IOCDF for a special addition of Just, Ethan this Saturday, March 14 at 2 PM EST. This live stream on Facebook and YouTube will be an OCD/Coronavirus Town Hall with special guests Kimberley Quinlan and Shala Nicely. Come and bring your questions! https://www.facebook.com/IOCDF/ Please check out this really helpful article on managing anxiety over the coronavirus.

Mar 5, 2020

Welcome back to another episode of Your Anxiety Toolkit. In today's podcast, I give an account of how I manage health anxiety, both when managing medical issues and during medical tests. With all of the fear related to the Coronavirus, health anxiety is becoming a very scary word. Many with OCD are impacted by this because doctors and authorities are telling them to be concerned. This is very much the same when you are dealing with a medical issue and it can be hard to differentiate what is appropriate and what is fear-related. In this episode, I address how to manage health anxiety from many different perspectives and I hope you find it helpful. Please check out this post about managing health anxiety over the coronavirus. https://www.shalanicely.com/aha-moments/managing-ocd-about-coronavirus/ ERP SCHOOL is HERE! ERP School is a complete online course that teaches you how to apply Exposure & Response Prevention (ERP) to your Obsessions and Compulsions. The cost is $197 and includes almost 6 hours of the same ERP information and skills that Kimberley teaches her face-to-face clients. ERP School is only offered two times per year. The last day to purchase is Monday March 9, 2020. https://www.cbtschool.com/erp-school-lp

Feb 27, 2020

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have the incredible Katy Marciniak talking about the "10 things I have learned about recovery". Katy is open and honest and vulnerable in this episode and I cannot respect her more. She has really shown us how possible recovery is, but she is also honest about the ups and the downs. Here are the main points Katy covers. * At first if you don't succeed, try, try again. * There is not set time frame for recovery or for therapy. Take your time and don't put unrealistic expectations on yourself. * Vulnerability is your friend! You might not think it is, but it will help you get through the ups and the downs of recovery. * Its okay! It's okay if you are anxious. It is okay if you are sad. It is okay if you are angry. It is okay if you are struggling. These feelings do not make you bad or wrong and it doesn't mean you are not moving in the right direction. Don't beat yourself up for having a mental disorder or for needing therapy. Therapy does not mean you are weak or faulty. * There is freedom in not knowing. Having uncertainty, while it feels bad, is a good thing and will make you stronger. * Do not isolate yourself. And you are not alone. Try to find a group of people who are just like you and are going through something similar. A great option would be to join our private Facebook group called CBT School campus! * Live in the moment. It might sound like a catch phrase, but you can actually learn how to stay present and not get caught up in the future and the past. * Don't knock self-compassion! It will help you in ways you cannot even imagine. * Going to therapy will not solve all of your problems. You must be willing to do the work at home, at work and in your relationships. * Give yourself the credit you deserve. You are going through a lot and you are so strong. Instagram @navigatinguncertainty Katy's Blog: https://navigatinguncertaintyblog.wordpress.com/about/ Today is the day!!!! ERP SCHOOL is HERE! ERP School is a complete online course that teaches you how to apply Exposure & Response Prevention (ERP) to your Obsessions and Compulsions. The cost is $197 and includes almost 5 hours of the same ERP information and skills that Kimberley teaches her face-to-face clients. https://www.cbtschool.com/erp-school-lp We are excited to share that we are offering our FREE webinar called The 10 things you absolutely need to know about OCD. During this webinar, Kimberley will address the most important science-based skills and concepts that you need to get your life back from Obsessive Compulsive Disorder. https://www.cbtschool.com/10things OCD Gamechangers – Annual Conference https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901 https://ocdgamechangers.com/events/ March 7 @ 10:00 am - 6:00 pm MST Denver Turnverein, 1570 N Clarkson St Denver, CO 80218 United States

Feb 24, 2020

FREE TRAINING: 10 Things You Absolutely Need To Know About OCD Available Today! February 24, 2020 If you have OCD, or you know someone who does, please join us each evening at 6 pm PST to learn about the 10 things you need to know about OCD.⁠ ⁠ Things to note: ⁠ It's free! ⁠ Its offered each evening this week. ⁠ The webinar is pre-recorded and will be sent directly to your inbox. ⁠ It's FREE! ⁠ You can watch it in your PJ's⁠ If you miss the training, a replay will be sent to your inbox the following day. ⁠ Did I mention that it is free? ⁠ I LOVE YOU ALL AND HOPE YOU ENJOY IT! ⁠ https://www.cbtschool.com/10things ERP SCHOOL is HERE! ERP School is a complete online course that teaches you how to apply Exposure & Response Prevention (ERP) to your Obsessions and Compulsions. Available February 27, 2020! ERP School is $197 and includes almost 5 hours of the same ERP information and skills that Kimberley teaches her face-to-face clients. https://www.cbtschool.com/erp-school-lp

Feb 20, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today we are talking about how travel is the best ERP and how you can use travel to help conquer your fears. Today we are joined by Gilad Gamliel from the popular blog, www.overthinkerspassport.com. In this episode, Gilad Gamliel discusses how travel can be the best ERP especially for those who struggle with anxiety, panic and obsessive compulsive disorder . Gilad is 27 years old and has health anxiety and OCD. He shares how OCD and anxiety tried to confine him and keep him living a small and "safe" life, but for some reason, he was pulled towards taking a leap and trying travel. Gilad shares that he originally thought "travel just isn't for me" because his anxiety was so bad. However, Gilad found there have been many positives to come out of his experience traveling. In this episode, he shares why someone should travel and the benefits of traveling with anxiety. He also shares many special tips for traveling with anxiety and OCD. Some of the tips he shares are: 1. Step back to get perspective. 2. Remember that this travel experience is temporary and not permanent. 3. Focus on the present and engage with your surroundings. 4. Take note that there are many things happening that you have never seen. 5. Use technology to help build a support system from home. 6. Ask other travelers for advice. You will find that they may want companionship also. 7. You can do this, even with anxiety. You can bring anxiety with you and learn that anxiety doesn't have to ruin everything for you as you travel and experience the world. Website: https://www.overthinkerspassport.com/ Instagram: www.instagram.com/gil.ad.ventures Facebook: https://www.facebook.com/overthinkerspassport OCD Gamechangers – Annual Conference https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901 https://ocdgamechangers.com/events/ March 7 @ 10:00 am - 6:00 pm MST Denver Turnverein, 1570 N Clarkson St Denver, CO 80218 United States We are excited to share that we are offering our FREE webinar called The 10 things you absolutely need to know about OCD. During this webinar, Kimberley will address the most important science-based skills and concepts that you need to get your life back from Obsessive Compulsive Disorder. https://www.cbtschool.com/10things ERP SCHOOL is HERE! ERP School is a complete online course that teaches you how to apply Exposure & Response Prevention (ERP) to your Obsessions and Compulsions. Available February 27, 2020! ERP School is $197 and includes almost 5 hours of the same ERP information and skills that Kimberley teaches her face-to-face clients. https://www.cbtschool.com/erp-school-lp

Feb 13, 2020

In today's episode of Your Anxiety Toolkit, I wanted to share with you the 8 things I want you to know. You might be wondering, "How does Kimberley know what I need?" You are correct. I really cannot be sure, but I can guess and I wondered if you needed to hear any of these 8 points. Here they are: 1) It's ok to feel what you are feeling. You are allowed to feel it all! The good. The bad. The uncomfortable. There is no "right" way to feel. 2) Your thoughts do not define your worth. Not today. Not tomorrow. This is true for every single person. If you are wondering, "If she only knew how bad my thoughts are." I mean you too. There is no thought that disqualifies you or depletes your worth. 3) There is nothing you need to change. Nope! You are perfect, even with all of your imperfections. Hey, you are perfect because of your imperfections. 4) You are supported. Lean on the CBT School Facebook group if you are feeling alone. 5) We will not give up on you. When I say "we" I actually mean YOU AND ME! I won't give up on you and you can't either. 6) You are enough. That is all I am going to say. It's a fact! 7) This moment is temporary. This moment might feel unbearable, I understand. However, please remember that this moment is only here for a moment....and then it passes. No anxiety lasts forever. 8) You deserve love and peace. You really do deserve love and peace. We all do. If you are having a hard time right now, I am sorry. I wish you love and peace in the little ways and the big. OCD Gamechangers – Annual Conference https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901 https://ocdgamechangers.com/events/ March 7 @ 10:00 am - 6:00 pm MST Denver Turnverein, 1570 N Clarkson St Denver, CO 80218 United States ERP School is coming soon! Mark your calendars for Feb 27th!

Feb 13, 2020

In today's episode of Your Anxiety Toolkit, I speak with the incredible Dr. Margaret Robinson Rutherford. I cannot tell you how happy I am that she reached out for this interview. In this episode, Dr. Margaret Robinson Rutherford talks to us about a term coined, perfectly hidden depression. She talks specifically about how it differs from classic depression and she describes for us the ten characteristics of perfectly hidden depression with number 8 being that it often accompanies mental health struggles such as OCD, eating disorders, addictions or anxiety disorders. The following are those 10 commonly shared characteristics that Dr. Margaret Robinson Rutherford discusses: You are highly perfectionistic, with a constant, critical inner voice of intense shame. You demonstrate a heightened or excessive sense of responsibility. You have difficulty accepting and expressing painful emotions. You worry a great deal and avoid situations where control isn't possible. You intensely focus on tasks, using accomplishment as a way to feel valuable. You have an active and sincere concern about the well-being of others while allowing few if any into your inner world. You discount or dismiss hurt or abuse from the past or the present. You have accompanying mental health issues, involving control or escape from anxiety. You hold a strong belief in "counting your blessings" as the foundation of well-being. You have emotional difficulty in personal relationships, but demonstrate significant professional success. Dr. Margaret Robinson Rutherford also addresses the Five C's in the healing process for perfectly hidden depression. I think you will really resonate with the words and concepts discussed in this episode. Thank you Dr. Margaret Robinson Rutherford for your wonderful work. https://drmargaretrutherford.com/perfectly-hidden-depression/ https://drmargaretrutherford.com/ https://drmargaretrutherford.com/selfwork/ OCD Gamechangers – Annual Conference https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901 https://ocdgamechangers.com/events/ March 7 @ 10:00 am - 6:00 pm MST Denver Turnverein, 1570 N Clarkson St Denver, CO 80218 United States

Feb 6, 2020

Welcome to another episode of Your Anxiety Toolkit. Today I have the pleasure of interviewing Jeff Goldman, a Hollywood executive and the Director of Development for OCD Southern California. In this interview, Jeff shares his very vulnerable story of being tormented by OCD and how it has impacted his family and his career. Jeff shares his highs and lows with us in his very inspirational and honest story. In this interview, Jeff Goldman shares his story of having "Just Right" OCD and how the fear of being a failure caused him to become paralyzed with anxiety. Jeff explains that he was diagnosed with OCD at 17 yrs old and has had a long, but inspirational journey to wellness. Jeff discusses his struggles with facing treatment and how he needed a lot of support and motivation to work on his mental health. He shares, "I was afraid of changing in spite of hating my life." What comes after that is a recovery story that includes medication, therapy, and family support. Some of the tools Jeff uses to help manage his OCD are "you have to name it to tame it", "feel the pain" and "let the anxiety flood through your body." Thank you so much to Jeff Goldman for sharing his amazing story! Jeff Goldman, Director of Development, OCD SoCal (an affiliate of the IOCDF) https://ocdsocal.org/ https://iocdf.org/ jeffgoldman.livingwithocd@gmail.com OCD Gamechangers – Annual Conference https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901 https://ocdgamechangers.com/events/ March 7 @ 10:00 am - 6:00 pm MST Denver Turnverein, 1570 N Clarkson St Denver, CO 80218 United States

Jan 31, 2020

Welcome back to another episode of Your Anxiety Toolkit. This week's episode was exactly what I needed and I wondered if it was what you needed too. In today's episode, I am going to share with you my favorite self-compassion tool, giving and receiving. This is a meditation that I learned from Christopher Germer himself. Christopher Germer is the co-founder of the Center for Mindful Self-Compassion and the genius behind many of my favorite self-compassion exercises. In today's episode, we are going to learn the art of giving and receiving. No, not gifts. We are going to learn the art of giving and receiving self-compassion. I often use this meditation after a long day in the office or after a hard day, so I hope it helps you too. This is the 3rd core meditation of the MSC course. Giving and Receiving Compassion builds on the previous two core meditations: Affectionate Breathing which focuses on the breath and Loving-Kindness for Ourselves which focuses on the layering of compassionate words or images onto the breath. The new element of breathing in for oneself and out for others helps the practitioner to practice compassion through connection by loving others without losing oneself. Students tend to find this meditation both easy and enjoyable. Thank you, Christopher Germer, for this wonderful meditation. Instructions for Giving and Receiving Meditation: Please sit comfortably, closing your eyes, and if you like, putting a hand over your heart or another soothing place as a reminder to bring not just awareness , but loving awareness, to your experience and to yourself. Taking a few deep, relaxing breaths, notice how your breath nourishes your body as you inhale and soothes your body as you exhale. Now, letting your breathing find its own natural rhythm, continue feeling the sensation of breathing in and breathing out. If you like, allow yourself to be gently rocked and caressed by the rhythm of your breathing. Now, focusing your attention on your in-breath, let yourself savor the sensation of breathing in, noticing how your in-breath nourishes your body, breath after breath….and then releasing your breath. As you breathe, breathing in something good for yourself…whatever you need. Perhaps a quality of warmth, kindness, compassion, or love? Just feel it, or you can use a word or image if you like. Now, shifting your focus to your out-breath, feeling your body breathe out, feeling the ease of exhalation. Please call to mind someone whom you love or someone who is struggling and needs compassion. Visualize that person clearly in your mind. Begin directing your out-breath to this person, offering the ease of breathing out. If you wish, intentionally send warmth and kindness - something good -to this person with each out-breath. Now letting go of what you or the other person may need, and just focusing on the sensation of breathing compassion in and out and sending something good. "In for me and out for you." "One for me and one for you." If you wish, you can focus a little more on yourself, or the other person, or just let it be an equal flow—whatever feels right in the moment. Or you can send something good to more than one person. Allowing your breath to flow in and out, like the gentle movement of the sea - a limitless, boundless flow - flowing in and flowing out. Letting yourself be a part of this limitless, boundless flow. An ocean of compassion. Gently opening your eyes. OCD Gamechangers – Annual Conference https://www.eventbrite.com/e/3rd-annual-ocd-gamechangers-tickets-82657196901 https://ocdgamechangers.com/events/ March 7 @ 10:00 am - 6:00 pm MST Denver Turnverein, 1570 N Clarkson St Denver, CO 80218 United States I strongly encourage you all to read Shala Nicely's amazing blog post about the misuse of the term, "I am so OCD." https://www.shalanicely.com/aha-moments/ocd-is-not-what-you-think/

Jan 16, 2020

In this beautiful episode of Your Anxiety Toolkit, I speak with the amazing Andrea Barber about her new book, Full Circle: From Hollywood to Real Life and Back Again . In this interview, Andrea shares her experience with anxiety, panic and mental wellness. She shares why she wrote this book and her hopes for this memoir. In her book, Andrea Barber shares, "To fans, I've always been synonymous with my character, since most people don't know me in any other role. But now, I want you to accept the real me . . . and the fact that I'm nothing like I appear on TV. To know me is to realize that I am very flawed, and I have many shortcomings and insecurities. By sharing them with you, you may recognize things in yourself, and discover that you and I are not so unalike after all. For once, it will be nice to share Andrea with the world." Andrea shared what it was like having a huge support system, but still feeling completely alone with her anxiety, panic and depression. Andrea spends some time talking about how her anxiety manifests in stomach related symptoms. She also tells us about the process of accepting the application of medication in her wellness journey and her experience with the side effects of medications. I just adored when Andrea shared what she learned about herself since going through her mental health journey and her new reflection on mental illness and mental wellness. One of my favorite lines from her book, she shared "It's actually very empowering to think about: I have the power to change my life". One of the coolest things about Andrea Barber is her passion for speaking about suicide prevention and awareness. You will just adore the advice she gives. And finally, her most impactful message is this: "The most important thing perspective has taught me, and what I want to tell anyone out there who has been made to feel too broken to love, is that your illness does not define you." Isn't she just incredible?! Andrea's book https://www.amazon.com/Full-Circle-Hollywood-Real-Life/dp/0806539887 Follow Andrea on social media @andreabarber If you would like to apply for the 3rd annual UK OCD Camp please visit theocdcamp.com • Applications close 19th January • Interviews (15 mins) – W/C 27th January • If selected payment due by 1st March

Jan 10, 2020

Welcome to another episode of Your Anxiety Toolkit Podcast. There has been a lot of talk lately in the OCD Community surrounding this big question "Does Khloe Kardashian have OCD?" I know a lot of you are really struggling with this topic, feeling unseen, unheard and misunderstood. In a recent episode of Keeping Up with the Kardashians, Khloe's mom, Kris Jenner discussed her daughter Khloe's overwhelming need to be organized. She shared, "Khloe is the most organized, cleanest, most obsessive person I know in her own home. But lately, she's on another level." In response, Khloe explained: "Being the control freak that I am, this experience is torture". However, she also has been known to explain her need to be organized as "a good thing" and something that "helps" her in her life. This brings us to the big question: Does Khloe Kardashian have OCD? Well, the most important thing to remember in this podcast episode is that we cannot diagnose someone we haven't met. Please keep this in mind as we address this very important topic. In an effort to do my due diligence, I consulted with an attorney on this and he confirmed that it is not appropriate to diagnose someone you haven't met. He reported that this is an ethical issue, not a legal issue. One of the big questions that arose after this recent Kardashian episode was, "Can you treat someone you haven't diagnosed?" Again, when consulting with an attorney, we revealed that a therapist technically can in situations where it is not necessary to diagnose someone. However, in order to implement a treatment tool, it is a good standard of care to do a full assessment to be sure the treatment modality and related tools are appropriate for the person we are meeting with. In an effort to discuss if Khloe Kardashian has OCD and if her description of symptoms and presentation of symptoms meets criteria to be OCD, we would first need to have a good understanding of what OCD is diagnostically. In the episode, we discuss in depth the Diagnostic Criteria for Obsessive Compulsive Disorder, in an effort to thoroughly educate and advocate for those who have OCD and who are struggling to ask for help. Diagnostic Criteria (Directly from the DMS 5) A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Compulsions are defined by (1) and (2): Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts. B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. It is important that we specify if the symptoms are accompanied by good, fair or poor insight, as this can help us differentiate between the diagnosis of OCD and other mental illnesses that may look the same. With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. D. The disturbance is not better explained by the symptoms of another mental disorder, differential diagnosis or set of symptoms In an effort to really give you a good understanding of other diagnostic possibilities for someone showing similar, but not exact symptoms, I wanted to address some symptoms and disorders that would need to be RULED OUT before treatment. The reason for this is that small differences in the symptoms may drastically change the course of correct treatment. This is a crucial part of the assessment process, done by a therapist, psychiatrist, medical doctor or psychiatric nurse. The first is perfectionism which can be divided into two categories, adaptive and maladaptive. Adaptive perfectionism is a type of perfectionism that improves the quality of someone's life while maladaptive perfectionism negatively impacts a person's life. Research has shown that both adaptive and maladaptive perfectionists have high personal standards, but failing to meet those standards can have a negative impact. Perfectionism can also be categorized by orientation. Self-oriented perfectionism is perfectionism that is pushed by the individual person. Self-oriented perfectionists are very hard on themselves, set very high standards for themselves and have rules and expectations that are often unreasonable. Socially prescribed perfectionism is perfectionism that occurs due to societal expectations. This might include the expectation to get good grades in order to have a good life or having to have the "perfect" body to be loved. It is also important that we address the similarities and differences between OCD and OCPD. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), OCPD is explained as "a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency." People with OCPD have an unhealthy expectation of achieving perfection and have an excessive devotion to work at the expense of leisure time and close personal relationships. They are often inflexible with issues related to ethics and morality and can be seen as judgmental and expect others to live to the same standard. So, when answering the question, "Does Khloe Kardashian have OCD?" I encourage us all to do our best to continue to educate others on the differences between OCD, levels of insight related to OCD, perfectionism, and OCPD. I strongly encourage you all to read Shala Nicely's amazing blog post about this exact issue, mostly addressing the misuse of the term, "I am so OCD" https://www.shalanicely.com/aha-moments/ocd-is-not-what-you-think/ References used in this podcast https://www.apa.org/monitor/nov03/manyfaces https://www.anxiety.org/what-is-the-difference-between-ocpd-and-ocd-and-how-are-they-treated

Jan 2, 2020

Welcome back to another episode of Your Anxiety Toolkit. Today I talk about how "you cannot skip the line." This podcast episode is about an event that happened to me a few weeks ago that blew my mind. It pretty much punched me in the gut. Yes, you read that right. It was a hard, hard day. In this episode, I speak about attending a meditation class and being given a very hard lesson. The lesson was, "You cannot skip the line". Let me tell you more. In this class, I asked what I thought was a simple question. Without expecting it, the teacher taught me a very important lesson that I think will impact me for quite some time. She responded with "There is a lesson for everyone here. It is important that you do not skip the line here. You must do the work. If you haven't wrestled with this practice over and over, do not come to me for the answers." I was embarrassed. I felt ashamed. I felt called out. I felt anger. But, after some time and contemplation, I asked myself, "Is there a pattern here?" And guess what?! There was. The lesson was that you cannot skip the line to the "know" the answer. When you "skip the line", you prevent yourself from learning the real process. Knowing will only help for the first time or two. After that, it takes practice and patience. In this episode, I will walk you through a 4 step process to help you lean in and do the work instead of just asking questions. These steps include being aware that you cannot skip the line and then catching yourself when you are doing such behavior. The steps also involve being honest with yourself when you are engaging in such behavior instead of staying in the unknown. The goal is to be as patient as you can along the way. And lastly, the most important step involves Compassion, Compassion, Compassion. I hope this helps you in some way to notice when you are "skipping the line." Sign up for our FREE weekly newsletter. Incredible tools, tips, and mental health resources! Click here for more information. Please check out this excellent blog post by the amazing Shala Nicely, LPC on the problem with saying "I'm so OCD."

Nov 29, 2019

Welcome to Your Anxiety Toolkit Podcast. In this week's podcast, I want to talk with you about how I failed 100 times this year. Wait, What?!?! Yes, you heard right! In 2019, I made the goal to fail on purpose 100 times. The goal was to set my goals so high that I was forced to fail. And guess what? I failed 100 times. I possibly failed 1000 times. I failed so many times I lost count. In this podcast, my hope is to share with you my personal experiment in changing the way that I feel and respond to the thought of failure. Here are examples of how I failed 100 times: • I asked a lot of people to come on the podcast. A lot of people said no. I knew they would, but I figured it was worth a try. But, do you know what I learned? I learned that a lot of people I didn't think would say yes did. • I took a course that was so hard and out of my line of skills and really struggled to complete it. • I started playing the ukulele even though I was so afraid of being terrible at it (which I am). • I pitched a book to a publishing company (more on this later). • I said yes to being Room Mum for both of my kids (knowing I would not be the best at it). • I aimed to increase registration for ERP School and we did it. We reached the highest registration yet. But here is the thing. I also failed 100 times at things I never set out to fail at. I had to accept in many ways that I cannot push my body to do things that I simply could not do. This was the hardest part about failing. I had to stare my fear of failing at the easy stuff over and over again. Here are examples of how I not only failed 100 times, but gave myself permission to fail, even though it hurt so much. ◆ Remember that course I told you about? I got so sick, I didn't finish it. I had to drop out and this made me face imperfection and failure head-on. ◆ I was a less than perfect therapist! I missed sessions with clients, and I double booked clients during times when I was so overwhelmed. ◆ I gave myself permission to share the struggles I have had with friends. I was so embarrassed to do this, but I am so glad I did. I learned that when you share your struggles, you actually feel more connected with the people around you. But finally, the most important example of how I failed 100 times is the decision I have made to take a month off of the podcast. After much consideration, I have decided to listen to my body and take the month of December to rest, rejuvenate and repair. I fought this decision for a long time, but I know it is what I need. With that being said, I want to thank you for being so loyal and kind to me. I adore your support. I wish you a very Happy 2019 Holiday! I will be back in January, ready to go. Ready to fail! FREE anxiety video training! Learn how to become more intentional with the words you use to describe yourself, your experiences and your future. Cbtschool.com/thinkwisely

Nov 21, 2019

Are you struggling with gratitude this holiday season? If so, this episode is exactly what you might need to hear. In today's episode of Your Anxiety Toolkit, I spoke with Shala Nicely about struggling with gratitude. Together, we address why some people might be struggling with gratitude or being grateful, especially if they are also struggling with mental health. In this episode, Shala Nicely addresses the personal struggles she has had in the past with gratitude and some incredible tools to manage this. Shala so beautifully articulates three common reasons why people struggle with gratitude. The first two struggles fall under the category, that Shala calls, gratitude by comparison. This often occurs when you are supposed to be doing "better" than someone else, but you do not feel very grateful. Shala explains that gratitude by comparison can fall into two separate categories: relief-induced gratitude and guilt-induced gratitude. The third common struggle is forced gratitude. An example of this might be, "I should be grateful and I'm not. What's wrong with me?" or, "You have everything going for you. Why can't you just be thankful for what you have instead of focusing on the negative?" I love that Shala addresses how forced gratitude quickly becomes what we know clinically as toxic positivity. Some great tips if you are struggling with gratitude might be: • Mindfulness • Practicing wonder, curiosity or beginners mind • Non-Judgment • Give yourself permission to not practice gratitude over the holidays BFRB SCHOOL is here! A COMPLETE ONLINE COURSE FOR BODY-FOCUSED REPETITIVE BEHAVIORS (BFRB's) Trichotillomania (Hair Pulling) Compulsive Skin Picking Compulsive Nail Biting https://www.cbtschool.com/bfrb-school-online-course-trichotillomania-skin-picking Free Video Training for Anxiety! Cbtschool.com/thinkwisely Check out these other fantastic episodes featuring Shala Nicely!

Nov 15, 2019

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have a very special guest, Giulia Suro, Ph.D., who is going to talk to us about Acceptance and Commitment Therapy and how we can use ACT tools in our everyday life. Giulia is a psychologist in private practice in the Washington, D.C. area. She is passionate about ACT and helping her clients develop a new way of looking at their thoughts and feelings. Giulia does such a beautiful job of bringing these ACT tools to us in a compassionate and articulate manner. Thank you, Giulia! In this episode, we address how Acceptance and Commitment Therapy centers on the concept of mindfulness. We learn that ACT is really quite unique because anyone can use the tools regardless of the struggles they are facing. Giulia discusses how fighting or resisting those struggles can impact us in the long term and we learn that ACT involves moving towards our values. We also address the core ACT tools that Giulia uses in her daily life and in her practice, such as, the Bullseye worksheet (link below). Giulia Suro beautifully addresses the following questions with grace, care, and expertise: What is ACT? Why do we use ACT In everyday life? How can it complement our recovery/wellness plan? What tools does she use with her clients? What tools does she personally use? What struggles does she see some of her clients go through when practicing ACT? Giulia's Website: www.giuliasuro.com Instagram @drgiuliasuro Workbook: Learning To Thrive Bullseye Worksheet file:///Users/kimberleyjquinlan/Downloads/Bulls%20Eye%20Values%20Exercise.pdf BFRB SCHOOL is here! A COMPLETE ONLINE COURSE FOR BODY-FOCUSED REPETITIVE BEHAVIORS (BFRB's) Trichotillomania (Hair Pulling) Compulsive Skin Picking Compulsive Nail Biting https://www.cbtschool.com/bfrb-school-online-course-trichotillomania-skin-picking

Nov 6, 2019

Welcome to another episode of Your Anxiety Toolkit Podcast. This topic has been a long time coming, and highly requested. This week's podcast is all about anxiety and sex. In this podcast, we talk about how anxiety and sex can become two peas in a pod and how anxiety can present itself in many different ways. While I am not a sex therapist, I do have a lot of experience talking with my clients about anxiety and sex. The truth is, there are many ways anxiety shows up during sex, or sex shows up in our anxiety. This is true for many people and this can become very confusing. People often report anxiety impacting sex in many ways. This might include loss of arousal, loss of libido or interest in sex, intrusive thoughts during sexual intercourse, hyper-awareness of sexual-related sensations and many more. In this week's episode, we address the following topics • Social Anxiety: In social anxiety, people are afraid of being judged by their sexual partner and will often avoid sexual interactions in fear of being judged. For people struggling with social anxiety and sex, they must accept the risk of being judged and work to find a partner who respects them and their fears. Finding safety in a partner can help immensely. • Performance anxiety: This involves the fear of not being able to perform well (or perfectly) in sexual interactions. This is very common and often involves setting realistic expectations for ourselves. • OCD: There are many ways that OCD can create anxiety around sexual intimacy. This is most common for those who have sexual orientation obsessions, relationship obsessions, or pedophilia obsessions • Panic Disorder: Symptoms of panic can often come on during all stages of intimacy, not just anticipatory anxiety • Trauma: Trauma is a very important component to address. We encourage people who have trauma in this area to seek professional mental health care and work through these issues with a safe and caring clinician. Find a Sex Therapist: https://www.aasect.org/aasect-requirements-sex-therapist-certification https://www.amazon.com/Passionate-Marriage/dp/B00159T73Q

Oct 29, 2019

Hello there everyone and welcome to another episode of Your Anxiety Toolkit Podcast. This week's episode is all about how to prevent Social Anxiety. I know that the title, "How to Prevent Social Anxiety" might sound a little fishy, but in this episode, we are going to look at some groundbreaking new research on social anxiety that might help us to understand the relationship between shyness and social phobia and how to prevent social anxiety in adolescence. In this incredible new finding, researchers found that there is a direct relationship between shyness and social anxiety in pre-adolescents. For the purpose of this episode, we will define shyness as the feeling of apprehension, lack of comfort, or awkwardness. These symptoms will increase, especially when a person is around other people and in new or unfamiliar situations. This research found that negative social self-cognitions mediate the shyness - social anxiety link, whereas, social interpretation bias does not. Social interpretation bias, by definition, is the tendency to interpret ambiguous situations in a positive or negative fashion. What does this mean in regard to how to prevent social anxiety, you may ask? Basically, if we can teach pre-teens how to interpret themselves in a more positive way, we might be able to reduce the impact of social anxiety in adulthood. This research showed that prevention should address the negative self-cognition of shy (pre-)adolescents. So examples such as the below statements might be corrected into more logical and objective statements. ◆"I am a fool" ◆"There is something wrong with me" ◆"I look like an idiot" More Objective Statements ◆I am not for everyone ◆Just because there was silence, doesn't mean I am incapable of being in social settings ◆It's ok that they didn't laugh at my jokes. One person's "funny" isn't everyone's version of funny. Link to research. https://www.sciencedirect.com/science/article/pii/S0193397318302818

Oct 25, 2019

Welcome back to another episode of Your Anxiety Toolkit Podcast! Do you know what POTS is? I didn't know either until earlier this year, and my life has not been the same ever since. Let me tell you one thing, we are NOT talking about something that holds plants and something you cook spaghetti in. This episode is all about Postural Orthostatic Tachycardia Syndrome, also called POTS for short. Why? Because October is Dysautonomia Awareness month and because I have recently been diagnosed with POTS. This episode is aimed at educating you about POTS and also addresses my own experience of being diagnosed with a chronic medical condition. It has been an emotional ride, and my hope is to share with you a few tools that have helped me to manage this news and the ongoing treatment that I will need to adhere to. Thank you so much for supporting me this year. Your messages and kindness has been overwhelmingly positive and I am so grateful for you all. So, what is POTS? Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects circulation (blood flow). Basically, for most people, our autonomic nervous system works to control and regulate our vital bodily functions and our sympathetic nervous system, which activates the fight or flight response. However, if you have POTS you have what is called orthostatic intolerance. What this means is that when standing up from a reclining position, blood pools in the legs causing lightheadedness, fainting, and an uncomfortable, rapid increase in heartbeat. People with POTS have trouble regulating the blood vessel squeeze and heart rate response causing blood pressure to be unsteady and unstable. Each case of POTS is different. Patients may see symptoms come and go over a period of years. In my case, I have probably had it my whole adult life, but it has worsened enough to need medical attention. In most cases, with proper adjustments in diet, medications and physical activity, a person with POTS will see an improvement in quality of life. People with POTS usually suffer from two or more of the many symptoms listed below. • High/low blood pressure • High/low heart rate; racing heart rate • Chest pain • Dizziness/lightheadedness especially in standing up, prolonged standing in one position, or long walks • Fainting or near-fainting • Exhaustion/fatigue • Abdominal pain and bloating, nausea • Temperature deregulation (hot or cold) • Nervous, jittery feeling • Forgetfulness and trouble focusing (brain fog) • Blurred vision • Headaches and body pain/aches (may feel flu-like); neck pain • Insomnia and frequent awakenings from sleep, chest pain and racing heart rate during sleep, excessive sweating • Shakiness/tremors especially with adrenaline surges • Discoloration of feet and hands • Exercise intolerance • Excessive or lack of sweating • Diarrhea and/or constipation Please go to the below website for more information on POTS https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

Oct 16, 2019

Welcome to Your Anxiety Toolkit Podcast! Today I am so thrilled to introduce to you this week's guest, Alegra Kastens, MA. Alegra is not just a guest on the podcast. Alegra is also a very important part of CBT School and has helped me so much since CBT School launched in 2018. Alegra Kastens has been a huge part of the creation of this podcast, uploading it each week, creating a lot of the technological support, creating images and supporting me when I am struggling with all the projects. Alegra is now moving forward with her career and is working as a therapist who specializes in OCD. In today's discussion, Alegra told us about the first moment she had her first intrusive thought and how these impacted her life. She also shared with us the process of her finally deciding to ask for help, even though she was petrified and so ashamed. Alegra shared what she found helpful and not helpful from her therapist and how she was supported and encouraged to seek specialized OCD treatment from her therapist who did not specialize in OCD. What I loved most about this episode is that Alegra Kastens so candidly talks about her experience of shame, guilt, and stigma related to having OCD. Alegra's main sub-type of OCD was pedophilia obsessions, which caused her to be stuck in self-doubt, self-criticism and complete panic for a very long time. Alegra Kastens shared what it was like to experience sexual obsessions such as pedophilia obsessions and what it was like to undergo Exposure and Response prevention for her OCD symptoms. Alegra shared some of the ERP exposures looked like and the importance of being given psycho-education about ERP before beginning. I loved how much education and inspiration Alegra Kastens brought to this conversation. To learn more about her story, click HERE to read an article she wrote for IntrusiveThoughts.org. For more information on Alegra Kastens, visit: Instagram: @ObsessivelyEverAfter Website: www.alegrakastens.com Psychology Today blog: https://www.psychologytoday.com/us/blog/all-things-anxiety

Oct 11, 2019

Welcome to another episode of Your Anxiety Toolkit podcast. This week's podcast was recorded from an RV on Pacific Coast Highway. It was the last day of my birthday celebration and I rented and drove a 35-foot RV to the beach so I could celebrate my new year with my dear friends and dear family. As I sat back, I reflected on what my biggest goal was for my 38th year. My goal for the upcoming year is NO MORE RUSHING. That's right! I have made a deal with myself. NO MORE RUSHING. No more rushing my kids. No more rushing my family. No more rushing my joy. No more rushing my anxiety . My hope for my 38th year is to slow down and really drop down into the present moment. My hope is to be present and absorb the joy that exists all around me. Since I made the goal of no more rushing, I have found that I am more aware of all of the beauty in my life and I am more present to really see the amazing people and places around me. On this birthday weekend, we sat on the beach and just absorbed the love that we all felt for each other. We looked up to the horizon instead of focusing on the road and the computer screens and the phones. We connected and I didn't rush a thing. My hope for this podcast is to inspire you to take on the goal of NO MORE RUSHING and just see how much beauty that comes from this. OCD Awareness Week , from October 13-19, is almost here! This year's awareness-raising campaign is focused on sharing videos of you and your friends facing your fears. The goal is to educate the public about the realities of living with OCD and the challenge of having to face your fears on the path to recovery. To participate, the IOCDF is asking everyone to create a video or photo of themselves doing something that makes them anxious and then to post on any and all social media platforms with the hashtags #FaceYourFear and #OCDWeek.

Oct 4, 2019

Do you ever wonder how to live in the present? Is this a question you ask yourself often? Or, have you already got a good mindfulness practice, but you wonder how to live in the present when it comes to intrusive thoughts, intrusive images and strong emotions and urges? If this sounds true for you, you are not alone. I, too, am constantly on a mission to figure out how to live in the present in a more authentic and mindful way. In this week's episode of Your Anxiety Toolkit, we take a CBT SCHOOL listener's question. A wonderful member of our CBT School community reached out and asked a very important question and instead of replying personally, I thought it would benefit everyone by addressing this question with you all. Considering that I am always on a mission to solve the question of how to live in the present, I thought we could all take a look at this issue together! The listener's question is: "I work hard to implement mindfulness in my life, and in many ways it makes sense and helps me. But sometimes I feel like I escape when I try to live in the present moment. It's like my OCD tells me 'wow, you have learned a new tool…great, but do you know what – if something is contaminated or dangerous it doesn't matter if you try to live in the present moment. You are just kidding yourself! You have to take care of the problems from yesterday and you have to make sure you have a future to live in. Don't be fooled into that mindfulness stuff…' My mind gets twisted. Do you have any thoughts that can bring some clarity?" Before we go, I want to remind you of two wonderful awareness weeks! BFRB Awareness week is happening NOW and ends on October 7. You can participate by attending local events, joining the conversation online, and more. Click HERE for more information. OCD Awareness Week , from October 13-19, is almost here! This year's awareness-raising campaign is focused on sharing videos of you and your friends facing your fears. The goal is to educate the public about the realities of living with OCD and the challenge of having to face your fears on the path to recovery. To participate, the IOCDF is asking everyone to create a video or photo of themselves doing something that makes them anxious and then to post on any and all social media platforms with the hashtags #FaceYourFear and #OCDWeek.

Sep 27, 2019

In today's episode, we are talking all about how to manage Perfectionism. I am so honored to have Monica Packer on the podcast as this week's guest, as she has such an inspirational story about how she was impacted by perfectionism and what steps she is taking each day to take her life back from Perfectionism. This episode is jam packed with tools and strategies to demonstrate how to manage perfectionism in your life. In this episode, Monica answered the below questions and delivered some incredible insight into how to manage perfectionism in areas I myself had never considered. What is perfectionism and how has it impacted your life? What did perfectionism look like for you personally? We often praise people who are "perfect." What are your thoughts on this? At what point in your life did you realize you were a perfectionist? What did perfectionism look like for you personally? How long had you experienced perfectionism? What was your experience with overcoming perfectionism? What advice do you have to those who experience perfectionism? Were there any roadblocks/setbacks etc to this journey for you? If you are early in the process of learning about perfectionism or you are well aware of your perfectionistic characteristics, I am sure you will benefit from this incredible interview. For more information on Monica, visit: Instagram: @aboutprogress Facebook: @aboutprogress Website: aboutprogress.com Before we go, I want to remind you that ERP School for Obsessive Compulsive Disorder is available for purchase until October 1, 2019! ERP School is a complete online course that teaches how to apply Exposure & Response Prevention (ERP) to your Obsessions and Compulsions. Click HERE for more information and to purchase.

Sep 20, 2019

This week's episode of Your Anxiety Toolkit is called "Watch your mouth" and I mean that in the kindest possible way. I know we usually hear the phrase "Watch your mouth" as a phrase of discipline and can often be shocked or intimidated by such a statement. In this episode, we talk all about the words we use in daily life. We address how we often say things that simply are not true, or are quite unkind. Because we often unconsciously believe what we tell ourselves, we have be careful not to address ourselves in ways that are unhelpful. Take a quick look at the below examples: • "I NEVER do anything right" • "I am so BAD for having this thought" • "You ALWAYS make me anxious" Here are a few examples of ways in which we say things that are untrue and unhelpful. When we do this, we not only feed ourselves stories that are unhelpful but we also create an environment where negativity exists. I can make the assumption that these negative statements are not helpful for you. In this episode, we hope to inspire you to "watch your mouth" carefully and take note when you are speaking in a way that might exacerbate your anxiety . ALSO, We also have fabulous news! Exposure & Response Prevention School is BACK! ERP School was carefully created to cover the most important components of Exposure & Response Prevention. The ERP School includes the following modules: 1. The Science behind Exposure & Response Prevention (ERP) 2. Identifying YOUR Obsessions and Compulsions 3. Different Approaches to Practicing Exposure & Response Prevention (ERP) 1. Gradual Exposure & Response Prevention 2. Scripting and Flooding. 3. Opposite Action Skills 4. Interoceptive ERP 5. Let's Get Creative with ERP 4. Managing Uncertainty and Discomfort with Mindfulness 5. Troubleshooting Common Issues and Concerns 6. BONUS Material: OCD Sub-types and Themes We like to keep the courses super affordable so that everyone gets a chance to learn the tools needed to manage anxiety, obsessions, and compulsions. Exposure & Response Prevention (ERP) School is $197. Exposure & Response Prevention (ERP) School includes 18 videos, supplemental PDF's and handouts to help you apply the content to your obsessions and compulsions, as well as a BONUS 7 videos on applying ERP to the common OCD Sub-types. In total, the course is almost 5 hours of the same ERP information and skills I teach my face-to-face clients. CBT School is committed to supporting you throughout this process. If you have any questions, Kimberley meets bi-monthly on Facebook and Instagram for her LIVE MAGIC MONDAY Q&A hour (every second and fourth Monday at 12 pm PST) where she answers questions and troubleshoots any concerns you may have. Once you have purchased the course, you will have unlimited access to the videos. Exposure & Response Prevention (ERP) School is available for purchase just a few times per year. The cart for ERP School will open again September 20th, 2019 so get excited! For more information on the course and to purchase, click HERE .

Sep 16, 2019

FREE TRAINING: 10 Things You Absolutely Need To Know About OCD Available September 16-20th, 2019 If you have OCD, or you know someone who does, please join us each evening at 6 pm PDT to learn about the 10 things you need to know about OCD.⁠ 🌸⁠ Things to note: ⁠ It's free! ⁠ Its offered each evening this week. ⁠ The webinar is pre-recorded and will be sent directly to your inbox. ⁠ It's FREE! ⁠ You can watch it in your PJ's⁠ If you miss the training, a replay will be sent to your inbox the following day. ⁠ Did I mention that it is free? ⁠ I LOVE YOU ALL AND HOPE YOU ENJOY IT! ⁠ https://www.cbtschool.com/10things ONLINE OCD VIDEO COURSE: ERP School was carefully created to cover the most important components of Exposure & Response Prevention. The ERP School includes the following modules: The Science behind Exposure & Response Prevention (ERP) Identifying YOUR Obsessions and Compulsions Different Approaches to Practicing Exposure & Response Prevention (ERP) Gradual Exposure & Response Prevention Scripting and Flooding. Opposite Action Skills Interoceptive ERP Let's Get Creative with ERP Managing Uncertainty and Discomfort with Mindfulness Troubleshooting Common Issues and Concerns BONUS Material: OCD Sub-types and Themes We like to keep the courses super affordable so that everyone gets a chance to learn the tools needed to manage anxiety, obsessions, and compulsions. Exposure & Response Prevention (ERP) School is usually $197 Exposure & Response Prevention (ERP) School includes 18 video's, supplemental PDF's and Handouts to help you apply the content to your obsessions and compulsions and a BONUS 7 videos on applying ERP to the common OCD Sub-types. In total, the course is almost 5 hours of the same ERP information and skills I teach my face-to-face clients. CBT School is committed to supporting you throughout this process. If you have any questions, Kimberley meets bi-monthly on Facebook and Instagram for her LIVE MAGIC MONDAY Q&A hour (every second and fourth Monday at 12 pm PDT) where she answers questions and troubleshoots any concerns you may have. Once you have purchased the course, you will have unlimited access to the videos. Exposure & Response Prevention (OCD) School is available for purchase just a few times per year. The cart for ERP School will open again September 20th, 2019 so get excited! LINK TO COURSE: https://www.cbtschool.com/erp-school-lp

Sep 13, 2019

I am honored to have Steven C. Hayes, author of A Liberated Mind: How to Pivot Towards What Matters , back on the Your Anxiety Toolkit Podcast. He was on Ep. 83 and is joining us again! There is nothing that makes me happier than to chat with Steven Hayes about the unbelievable work he is doing and I cannot tell you how much I adored his most recent book. In this week's podcast episode, Steven Hayes addressed how we can reach a liberated mind by improving psychological flexibility and moving away from psychological rigidity. Not only does Hayes address these important topics using a combination of science and reason, but he also discussed how we can access a liberated mind by practicing compassion and kindness, and by seeking out our own set of values. During this conversation, we touched on some really difficult topics including suicidal ideation, immigration, global warming and other issues that impact the state of the world. Steven Hayes does such a beautiful job teaching us how we can reach be more open to our suffering and be open and flexible with other people's suffering. Steven Hayes also addresses how we overuse problem-solving with our emotions. He talks about how we can create our own "hero's journey" by choosing a path that feels liberating and freeing, instead of one that is powerless and rigid. For more information on Steven Hayes, click below: Website: https://stevenchayes.com/ TedX: https://www.youtube.com/watch?v=o79_gmO5ppg To purchase his most recent book: https://www.amazon.com/Liberated-Mind-Pivot-Toward-Matters-ebook/dp/B07LDSPRYM A book freebie: https://stevenchayes.com/a-liberated-mind/ Steven Universe video - "Here Comes a Thought": https://www.youtube.com/watch?v=dHg50mdODFM

Sep 5, 2019

Welcome back to another episode of Your Anxiety Toolkit. Today we are talking all about Accepting our Common Humanity. You may remember that Kristin Neff was on the podcast ( Ep. 87 ) and she spoke about how Common Humanity is a core component of Mindful Self-Compassion. In that interview, Kristin Neff spoke about how we must notice that we are all in this together. Her description of Common Humanity is that we are never alone because all humans suffer and all humans feel emotions similar to what you are feeling, although it might not have the same content and be experienced from the same source of stress. Kristen Neff also addressed how we should not compare our suffering to that of another. When we do that, we minimize our own suffering and we reject the common humanity that we all experience. In this episode, my goal was to share with you some of the struggles I have had in accepting my own human-ness. As I have battled multiple medical issues this year, I have had to face my common humanity over and over again. I have had to stare my human-ness in the face, which has been both painful and freeing. I have had to reflect many times on how I am treating myself and how to create a more self-compassionate life that involves me setting realistic expectations for myself, treating myself with love and care when I am not feeling well and being honest with myself about what I can and cannot achieve or do. This journey of common humanity has been such a huge one for me and one that I hope brings you some awareness or hope. I often hear listeners and members of the CBT School community talk about how hard they are on themselves and how they hold themselves to standards that are impossible and outright cruel. If this resonates with you, this episode is for you.

Aug 30, 2019

Welcome back to another episode of Your Anxiety Toolkit. Today we are thrilled to introduce Dr. Laura Wetherill who will be talking about school anxiety. Dr Laura Wetherill is a Formal Research Scientist, turned full-time mom, who has a gift for doodling and supporting students with their studies and their mental health. Dr. Laura Wetherill now considers herself an online educator and has so much to share with us about managing school anxiety . During the interview, we address the below questions: What advice to you have for those who afraid of how stressful the year will be? How can students manage comparisons (with students who are "smarter" or "more popular" etc.)? Any tips for managing time during the school year? How can one manage the fear of failing a test or a class? How can one manage strong feelings of dread and hate towards school? Dr. Wetherill gathered information on how students are feeling about going back to school and learned a lot about school anxiety and fears: When asked, "How are you feeling about going back to school?" the vast majority reported fears based around friends, exams, time pressures, expectations, etc. We included them for your reference. Friends/relationships: • Nervous about not having friends in some of my classes. • Worried about losing friends. • Worried about making friends. • Unresolved conflict with friends. • Bullying. Exam Stress: • Many students worried about coping with stress, anxiety and the pressure around upcoming exam time. • One student is worried that she will panic in the exam room. • Students worrying that they've failed their exams and must go back to school with "bad" results (worried they've let parents, teachers and themselves down). General stress: • Scared the year will be too stressful. • Excited for subjects but not about the stress. Expectations/Not feeling smart enough: • Worried about not meeting entry requirements for A levels. • Worried about not being smart enough and finding it hard when everyone is competing and being compared against one another. • Worried about being unable to cope with the step up in difficulty. Time pressure: • Not having enough time to learn everything. • Not having enough time to finish resources. • Not having enough time to revise. • Feelings of time running out. • Having to miss the first week of school and then worried about catching up with work. Predicting Failure: • One student had failed her mocks and is worried that she will fail the real exams. • Students worried that they will fail the exams at the end of this new school year. Feeling unprepared: • Unprepared for exams. • Unprepared to leave school at the end of the year. • Unprepared for the year ahead. • Some are not sure how to prepare for the year ahead. • Revising hard but feel like it's not enough. Coping with ongoing medical conditions that disrupt school. • Having a medical condition that means they might not be able to attend school or sit the exams that they would like to sit. • One student was doing half days and they're worried that this year they won't be able to cope if they have to do full days. • Making the wrong choices: • Worried that they've chosen the wrong subjects or will not enjoy them. Strong feelings: • "I hate school, I don't want to go back." • "My friends p*** me off." • "I'm terrified". New beginnings: • Nervous about starting a new college/6th form/school. • Nervous about starting a new school, in a new country. For more information on Dr. Wetherill, visit: Instagram: @doctormeclever Website: doctormeclever.com Dr. Wetherill and I created a FREE 7-Step resource to help you bust your procrastination habit. Click HERE for the info.

Aug 23, 2019

Welcome back to another episode of Your Anxiety Toolkit. Today I was reflecting on what you might need to hear and it dawned on me that you might need a solid dose of compassion. So, today we are talking about finding your compassionate voice. In this podcast, I will lead you through a "Finding your compassionate voice" meditation, created originally by Kristin Neff and Christopher Germer . The script is below, but please note that I did change a few components to match the style of my voice and my ideas for what you needed to hear. Finding your compassionate voice involves us bringing what we need to hear to our awareness. Examples of finding your compassionate voice might sound like: "I love you" "I am here for you" "You are enough" "You are loved" "Everything is going to be ok" Finding your compassionate voice is an exercise or tool that might be able to offer you a skill to increase self-compassion, self-kindness, and self-respect. Finding your Compassionate Voice Meditation Please find a posture in which your body is comfortable and will feel supported for the length of the meditation. Then let your eyes gently close, partially or fully. Taking a few slow, easy breaths, releasing any unnecessary tension in your body. • If you'd like, placing a hand over your heart or another soothing place as a reminder that we're bringing not only awareness but affectionate awareness to our breathing and to ourselves. You can leave your hand there or let it rest at any time. • Now beginning to notice your breathing in your body, feeling your body breathe in and feeling your body breathe out. Now releasing the focus on your breathing, allowing the breath to slip into the background of your awareness, begin to offer yourself words or phrases that are meaningful to you. Whisper these words into your own ear. • Just letting your body breathe you. There is nothing you need to do. • Perhaps noticing how your body is nourished on the in-breath and relaxes with the out-breath. • Now noticing the rhythm of your breathing, flowing in and flowing out. (pause) Taking some time to feel the natural rhythm of your breathing. • Feeling your whole body subtly moving with the breath, like the movement of the sea. • Your mind will naturally wander like a curious child or a little puppy. When that happens, just gently returning to the rhythm of your breathing. This is mindfulness . • Allowing your whole body to be gently rocked and caressed – internally caressed - by your breathing. • If you like, even giving yourself over to your breathing, letting your breathing be all there is. Becoming the breath. • Just breathing. Being breathing. • And now, gently releasing your attention to the breath, sitting quietly in your own experience, and allowing yourself to feel whatever you're feeling and to be just as you are. • Slowly and gently open your eyes.

Aug 16, 2019

Welcome to another episode of Your Anxiety Toolkit Podcast. We are talking all about our bodies and addressing a very important topic called Health At Every Size in this episode. Today, I am honored to talk to Emily Cooper, a therapist who specializes and is so knowledgeable about health at every size, body positivity, body neutrality, and privilege. In this episode, we talk about whether there is a "right type of body" or a "wrong type of body" and how society and diet culture impact us and how we see our bodies. Emily Cooper addressed why Health At Every Size is an important concept that improves self-respect and self-love. Health At Every Size (HAES) is an inclusive movement that supports people of all sizes, weights, and body types in addressing health directly by adopting healthy behaviors. Health At Every Size does not focus on weight as the sole indicator of health. Being thinner does not necessarily make a person healthier or happier. A "healthy body" aligns with more than one body type and across a wide range of weights. During this episode, Emily Cooper also addresses how our perception of our body can impact our everyday lives, specifically related to work environments, social environments, relationships, intimacy and life in general. In her discussion about Health At Every Size, Emily Cooper also addressed the concept of thin privilege and diet culture and how they impact our relationship with our body and other peoples' bodies. The goal of this podcast episode is to introduce you to the idea that you can start to respect your body today, no matter what size or shape. Emily beautifully shared that her hope is to give us permission to not like our bodies but still learn to live our lives, not using weight or size to indicate your worth or ability to do the things you want to do. For more information on Emily, visit: Instagram: @heyemilycooper Blog: http://www.heyemilycooper.com/ Book References: Body Respect by Linda Bacon and Lucy Aprhamor Intuitive Eating by Linda Bacon

Aug 9, 2019

Welcome to Your Anxiety Toolkit Podcast. Today we are talking about a concept that I get asked about so often. Today we are talking all about how to manage intrusive thoughts. So often I am asked by clients and the CBT School community questions like, "What is an intrusive thought?" and, "How do I manage intrusive thoughts from becoming mental compulsions?" and, "Why is it so hard to manage intrusive thoughts?" These are all such good questions and I can totally resonate with why it is such a difficult and confusing topic. In today's episode of Your Anxiety Toolkit, I talk about why thought suppression doesn't work and why distraction is a tool that only works for a short period of time. In this episode, we review the practice of mindfulness in an attempt to manage intrusive thoughts and create an environment in your brain where fear and uncertainty doesn't run the show. A wonderful follower sent me the below question: "I have heard you talk about distraction and thought suppression. Does that mean I need to just focus on my thoughts and stay in my own head? While keeping myself busy with my job and other activities keeps me engaged and gets me out of my own head, does this count as a distraction? Also when you say distraction is bad, is it in the context of OCD or in general? I'm a bit confused, can you please provide some clarity on this." This is such a common question that I get asked and I wanted to take this time to address a concept called "Occupation," which is the practice of allowing thoughts WHILE you go about your day. Occupation is a practice of taking intrusive thoughts with you while you do the things you value in life. This is a very important concept and can help us to define how we manage intrusive thoughts and how we can reduce engaging in compulsive behaviors and mental compulsions. I hope this episode helps give you additional tools to help manage intrusive thoughts and mental compulsions.

Aug 2, 2019

This week's episode of Your Anxiety Toolkit Podcast will really change the way you look at and relate to Self-care. In this episode, we aren't talking about luxurious, expensive and unsustainable self-care. We are talking about affordable self-care. And, we are talking about self-care that costs NOTHING! If you struggle with self-care, this is the episode for you. If you struggle to even be aware of when you need self-care, this is the episode for you. In this episode, we talk with Psychologist Dr. Jenn Hardy about how marketing and media have made self-care into something that should look perfect, cost a lot of money and be luxurious. Dr. Jenn Hardy brings up the wonderful point that a self-care plan that is expensive and indulgent is not sustainable and won't fit into most people's daily lives. Dr. Jenn Hardy addresses a concept she coined, affordable self-care, which is taking care of your basic needs and making time each day to give your body and mind what it needs. Here are a few examples of affordable self-care that you can include into your life in simple and easy ways. Going pee when you need to pee Journaling Slowing down Taking a breath between activities Honoring what your body needs Saying no to things The thing I love the most about this episode is that we learn just how accessible affordable self-care is. We all have access to affordable self-care, no matter what your income is, where you live and what you do for a living. For more information on Dr. Jenn Hardy, visit: Instagram: @drjennhardy Website: Drjennhardy.com Before we go, I want to share a virtual conference with you that I will be speaking at (from August 5th-15th): Share Triumph Cancer Conference . I will be speaking at this free, virtual event in which women share how they made decisions about medical treatment and discuss how the emotional effects of diagnosis impact them today. Specifically, I will be talking about managing anxiety related to physical illness and cancer. This event brings together renowned doctors, therapists, nonprofits, fashion brands, comedians, podcasters, survivors and metavivors teaching you how to get through diagnosis, treatment and the aftermath to help keep your mind and spirit intact! Click HERE for more information and to register

Jul 26, 2019

Welcome to another episode of Your Anxiety Toolkit Podcast. Today I am sharing my takeaways from the 2019 International OCD Foundation (IOCDF) Conference. I just got back and it was possibly one of the most wonderful experiences. This year, the conference was in Austin, Texas, and I won't lie…it was HOT. I was super impressed with the people from Texas, as they were so kind, cheerful and helpful. In today's episode, I wanted to give you guys a quick peek at what I took away from the 2019 IOCDF conference this year. The 2019 IOCDF Conference is a conference that is held annually to help provide education, support, and advocacy for those who struggle with Obsessive Compulsive Disorder , Health Anxiety, Panic Disorder , Body-Focused Repetitive Behaviors, Tic Disorder or Tourette's Disorder and general anxiety. It is a wonderful opportunity for those who need extra support or want to learn the gold-standard treatment for OCD. Not only is it an educational weekend, but it is also a weekend filled with hope, love, and unconditional acceptance. Here is what I took away from this year's 2019 IOCDF Conference. First of all, you guys are so kind. I cannot tell you how overwhelmed and honored I was to meet so many of you. Thank you to each and every one of you who came and said hi, gave me hugs, thanked me for the work I am so honored to do and for those of you who showered me with the sweetest and most thoughtful gifts. Thank you from the bottom of my heart. Now, once again this year, I was honored to host the 2019 Compassion Collective support group for Self-Compassion with my dear friend Michelle Massi. Michelle and I met each morning at the very early hour of 7 am to sit with a group of beautiful humans who are invested in being kinder and more compassionate to themselves. It was a beautiful group and, once again, we got to peek inside their minds for an hour each morning and learn just how hard you all are on yourselves. Wowsers, you guys. Humans are FAR too hard on themselves. The main message we tried to share with y'all (We were in Texas hehe) was to drop the idea of getting A+ in life and to shoot for a B-. Be a B- human. Give life a B- effort. Give yourselves a little break here and there. In addition to running the Compassion Collective group, I also had the honor of running the Women's OCD Support Group with my dear friend, Beth Brawley. The one big takeaway from these amazing women was to be unapologetically yourself. As women, we need to stop apologizing for ourselves and just own the struggles and wins that we have. Another thing I heard from attendees over and over in the elevators and hotel halls is the strong urge and pressure to make themselves attend each and every presentation. If anyone has attended and IOCDF Conference, you will know that the schedule is JAM PACKED every single hour of the day. There is no way we can do it all. I figured you guys are hard on yourself in daily life also so my message to you is that you don't have to do it all. This one is SUPER important. You are alone! You really are not. Each year, thousands of people meet in a random city in the USA to learn about OCD. I know at home you may not know a single soul with OCD, but please know that people like you are out there and they are wonderful and kind and smart and funny and make my heart so full, just like YOU. The last takeaway from the 2019 IOCDF Conference is this. YOU ARE SUPPORTED! I was honored to attend the OCD Game Changers event at the conference and there I met a large number of OCD treatment providers and OCD Advocates who are on a mission to help you all and provide good treatment and to advocate for you and to fight for you. You may have had terrible experiences with some therapists, but please know that there are some incredible therapists out there who are such badasses and they are fighting for you.

Jul 18, 2019

In today's episode of Your Anxiety Toolkit podcast, we are discussing a compassion practice that will change your life. Today, we are talking about the Buddhist practice, Tonglen Meditation for anxiety. The ancient meditation practice of Tonglen is known as a practice of "taking and sending". Tonglen Meditation for anxiety is a practice that is similar to everything we talk about here on Your Anxiety Toolkit. Tonglen Meditation for anxiety reverses our usual logic of avoiding suffering and seeking pleasure. Commonly, people with anxiety want to learn how to eliminate their own suffering and pronouns such as "I", "Me" and "Mine" is the focus of their attention. The use of Tonglen is a practice of compassion for all humans, including ourselves, that allows us to visualize taking in the pain of others with every in-breath and sending out whatever will benefit them on the out-breath. In the process of Tonglen Meditation for anxiety , we let go of patterns of selfishness and we bring love to both ourselves and others. We create a practice where we take care of ourselves and others. Tonglen Meditation for anxiety awakens our compassion and introduces us to a view of reality that is wider and more realistic. Tonglen meditation for anxiety can be a formal meditation practice or can be used at any time for even brief periods of time. Tonglen Meditation for anxiety also allows us to send compassion to all humans and see that many other humans are just like ourselves. This Tonglen Meditation for anxiety will bring you to see that you are not alone in your suffering. The practice is to bring love and compassion to all living beings, as everyone is suffering in one way or another. Instead of beating ourselves up, we can use our personal struggles as a way to access common humanity (understanding what people are up against all over the world). As we breathe in the pain and suffering for all of us and breathe out love and compassion for all of us, we create a space where we can feel more deeply and honestly. We can use our personal suffering as the path to compassion for all beings. Please use this Tonglen Meditation for anxiety to remove the suffering of mankind, while also sending the relief. Breathe out while releasing out comfort and happiness. Radiate love as widely as you can, CBT School community!

Jul 12, 2019

This episode of Your Anxiety Toolkit was not an easy one to record. No one likes to have a conversation about suicide, but we need to. We need to have a conversation about suicide more than ever and we need to keep having these conversations until we break the stigma of suicide. Recently, one of our dear CBT School members died by suicide and our community was heartbroken. My heart was broken. Even as a therapist, I cannot prepare myself enough for the conversation about suicide. Thankfully, as we all grieve this sad loss, we are joined today by Joe Dennis to help us work through this difficult topic. Joe Dennis is the Clinical Director of Mindful Counseling in Utah with such a wonderful kind heart. In a flash, Joe agreed to join me for a conversation about suicide where he educated us about suicide and gave us some wonderful tools and resources for those who are struggling with thoughts of suicide. We also discussed tools and resources for those with a loved one who has died by suicide. Joe talked with us about why we now call it "Death by suicide" and the reasons for this terminology change. Joe also talked about the difference between passive suicidal ideation and active suicidal ideation and how to differentiate between the two. Joe and I talked about why we struggle to talk about Suicide and how Depression, anxiety , trauma, etc. play into suicidal ideation. Lastly, Joe talked about what is going through the mind of someone who is contemplating suicide and what tools/strategies/resources they can use when they are faced with this difficult time. I really hope that this podcast helps you to understand and approach suicide in a way that is less stigmatized, less shamed and less frightening. Thank you, Joe Dennis, for being on the show. For more information on Joe, visit: Instagram: @joedennis.counsels Website: https://mindfulcounselingutah.com For more information on suicide awareness and prevention, visit or call: Helpguide.org National Suicide Prevention Hotline: 1800-273-8255 Crisis Text line: 741741

Jul 5, 2019

Welcome back to another episode of Your Anxiety Toolkit Podcast. This week we are joined by the amazing Dan Furlong. Dan Furlong is the man behind @maleanxietydepression on Instagram and is an inspiration to many in the mental health field. In this episode, Dan Furlong talks about his recent experience with running the Jungle Ultra in Peru through the Amazing Jungle. Dan Furlong called it a "self-sufficient race" where he had to run for 5 days through the Amazon Jungle, 3 of which had torrential rain. Dan Furlong talked about his struggle with anxiety, Obsessive Compulsive Disorder (OCD) and depression. Dan also talked about his struggles with suicidal ideation. Dan said many inspiring things throughout this episode, but here are a few inspirational quotes that really got me thinking. When discussing his experiences with depression, Dan quoted, "You need to goal set your way out of depression. He talked about how he never lets himself give up and "only when you go through real pain do you find out who you are!" As Dan ran through the Amazon Jungle and faced many death-defying cliffs and traverses, he repeated to himself, "If you get through this, you can get through anything" and he referred to his OCD recovery in this discussion also. Dan reported only getting 2-3 hours sleep each night and how he chose to run ahead to be allowed to take the "long course" which was running up to 1.5 marathons per day. Just so inspiring, right?! Dan Furlong spoke extensively about his mindset during the run (and his OCD recovery) and how he has learned to "take the path of least resistance". Dan stated that "your brain will always talk you out of doing hard things" and because of this, he learned to "take the harder route". To donate and help those affected by OCD, click HERE . To learn more about Dan, visit: Instagram: @Maleanxietydepression Website: Mad.com To purchase Can't Hurt Me: Master Your Mind and Defy the Odds by David Goggins, click HERE

Jun 28, 2019

In today's episode of Your Anxiety Toolkit Podcast, we are talking about finding a middle path in our recovery. This is a very important topic to me, as it is what has helped me immensely in my own anxiety management. Finding a Middle path (or middle way) is about us seeing beyond our dualistic or black-and-white ways of thinking, behaving and being. Finding a middle path (or way) describes our journey of seeing the middle ground between attachment (where we cling and grasp onto things being a certain way) and aversion (where we run away from things that are not the way we want them to be). Finding a Middle Path is about stepping away from "good" and "bad" and seeing that there is no good and bad, and there is only neutral. In this episode, we talk about embracing the dialectics of change and stillness at the same time. We addressed how finding a middle path is being independent whilst also being a part of a larger community. It is where we embrace tension, paradox and change and discover a world that is workable in the middle, not just at the beginning or end. One of the reasons I love this concept so much is that instead of always seeking resolution and completion and perfection, we let ourselves open and relax in the middle stages of our process. We live in the reality of the present. The more we delve into the middle way, the more deeply we come to rest between the play of opposites. One of the hardest parts of this Buddhist practices is learning to trust in life itself. In this episode, we touch on this as an important part of finding a middle path. For more information on Finding a Middle Path, read this wonderful article by Jack Kornfield: https://jackkornfield.com/finding-the-middle-way/

Jun 20, 2019

Dr. Sarah Sarkis Talks About Anxiety Management and Your Relationship with Anxiety Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have Dr. Sarah Sarkis on to talk about Your Relationship with Anxiety. Dr. Sarah Sarkis is a psychologist, writer, and performance consultant with a private practice in Honolulu, Hawaii (though it won't take you long to discover she's a Boston girl at heart). Her integrated approach is big on science, low on bullshit, empowering us to achieve long-term change and growth through an eclectic blend of psychology, neurobiology, and functional medicine. Her blog, The Padded Room, is your virtual safe space to help you manage the jarring realities of life. There, you'll find a soft landing for life's harshest truths. You can find it at drsarahsarkis.com . Addressing your relationship with anxiety might be one of the most important steps you take when it comes to your anxiety management. Dr. Sarah Sarkis beautifully shares how she approaches fear and how your relationship with anxiety can determine the degree of suffering around anxiety. She also addressed people's conceptualization of "I cannot handle this" or "I cannot face this" when it comes to facing fears. During this interview, we also addressed concepts around Optimum Performance and Dr. Sarkis' experience in her practice with patients in this area. I am sure you will agree that changing your relationship with anxiety is a game changer when it comes to your mental health, and I am so excited to share this inspiring interview with you For more information on Dr. Sarah Sarkis, visit: Website: https://drsarahsarkis.com Facebook: https://www.facebook.com/drsarahsarkis Instagram: https://www.instagram.com/drsarahsarkis/ Lastly, the annual IOCDF conference is being coming up SO SOON! It will be held in Austin, TX, from July 19-21. This national meeting focuses solely on Obsessive Compulsive Disorder (OCD) and related disorders. I will be one of the presenters among over 100 presentations, workshops, and seminars. There will be support groups and evening events as well. Click HERE for more information and to buy tickets.

Jun 14, 2019

Do you remember podcast episode #92 where I talked about my new goal of Failing 100 times? At the beginning of this year, I set the goal to fail 100 times in my business, personally and in my life. The whole concept came from a podcast episode by Amy Porterfield ( EP# 247 ) where she set the goal to fail 100 times this year, not because she wanted to drop everything and mess up, but because she wanted to set goals that were so high that she was destined to "fail." The whole premise of failing 100 times was to reach for the stars instead of setting goals that held us back and limited us. Well, I decided that I was going to fail 100 times this year, but I was hit by a rude awakening that has completely changed the way I think about failure. As some of you may know, I have been struggling with some pretty serious medical and emotional issues this year. It has been a very scary and uncertain journey for me, but I have learned so much about myself. What ended up happening was that I ended up failing in ways I wasn't even expecting and I came to see just how hard I am on myself. I am scared to share this with you, but I have decided that it is a beautiful day to do hard things. So, this episode is about how I am failing at 100 things that I didn't set out to fail. I hope you find it helpful and that it inspires you to take a close look at how you conceptualize failure. And finally, I ask you, how are you doing at failing 100 times this year? There are a few things I want to remind you of before we go! The annual IOCDF conference is being held in Austin, TX, from July 19-21. This national meeting focuses solely on Obsessive Compulsive Disorder (OCD) and related disorders. I will be one of the presenters among over 100 presentations, workshops, and seminars. There will be support groups and evening events as well. Click HERE for more information and to buy tickets. Catherine DeMonte, who joined us in Ep. 95 of Your Anxiety Toolkit Podcast, is the author of a new self-help book that will be released on June 18, 2019. Beep! Beep! Get Out of My Way! Seven Tools for Living Your Unstoppable Life is a practical self-help book grounded in Psychotherapist Catherine DeMonte's 25 years of clinical psychotherapy practice. Based on the Abundance Circle groups she created and leads, this book contains the tools her clients used to realize their dreams. Written with nurturing warmth and humor, this book addresses both the inner and outer work necessary for creating lasting shifts. You can manifest your "one big thing"— even when circumstances make it seem impossible.Click HERE to order on Amazon.

Jun 7, 2019

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today is a little different. I was all ready to record a podcast and all of a sudden, I put that podcast episode on hold and just spoke from the heart. I just wanted to talk directly to you and remind you to honor your hard things. I know when things are hard and you are struggling, it feels like you have no choice but to give up, but again, always honor your hard thing. In this episode, I share about a recent "hard thing" I did with my daughter. I shared how surprised I was by how hard it was and emphasized that we do not honor the hard things we do enough. My goal was to address how we compare our struggles in mental health with others who do not have the same struggles. Because of this, we don't honor the hard things you are doing (which is a lot). In addition, we judge ourselves for struggling and we make it hard on ourselves when things are already hard. My hope with this episode is to help you along to honor every hard thing you do. My hope is that it gives you a moment to celebrate the work you are doing with Obsessive Compulsive Disorder (OCD) , Depression, Panic Disorder, Body Focused Repetitive Behaviors (BFRBs) and Eating Disorders. It is hard work and I honor your hard things. Before we go, I want to remind you about the upcoming IOCDF conference in Austin, TX, from July 19-21. This national meeting focuses solely on Obsessive Compulsive Disorder (OCD) and related disorders. I will be one of the presenters among over 100 presentations, workshops, and seminars. There will be support groups and evening events as well. Click HERE for more information and to buy tickets.

May 31, 2019

On today's episode of Your Anxiety Toolkit Podcast, we are talking all about a journey of self-compassion. Yep, that's right! This is one special episode. This week we are joined by previous guest, Ethan Smith, the national ambassador for the charity called the International Obsessive Compulsive Disorder Foundation (IOCDF) . Ethan talks all about his new experiences and journey of self-compassion and how he has learned a lot about himself in the past year. Consider this Chapter 2 of Ethan's story, as he shares his struggles with taking responsibility for what goes wrong in his life and not blaming Obsessive Compulsive Disorder for his struggles. Ethan also shares how he is learning how to cope with "bad" choices and making mistakes and how he was pushed into the practice of self-compassion when he realized he was still under the spell of internalized stigma of mental health. This is such an important issue and one I want to focus on in the future of Your Anxiety Toolkit. Ethan also shared his journey of self-compassion as he learns how he would internally compare and contrast the mistakes he has made before, during and after treatment. He talked about how recognizing this process has made him realize how hard he really was on himself. I think we can all resonate with this at times and Ethan beautifully shares his vulnerable and authentic experience. Ethan addressed how he is now learning to cope with unrealistic expectations and how self-compassion has taught him to accept himself as he is. He talked about how common humanity is a concept that he fought for so long in fear that it will make him complacent and careless. I am sure you will learn a lot from this episode and I hope that it helps you reflect on your journey of self-compassion. Before we go, I want to remind you about the upcoming IOCDF conference in Austin, TX, from July 19-21. This national meeting focuses solely on Obsessive Compulsive Disorder (OCD) and related disorders. I will be one of the presenters among over 100 presentations, workshops, and seminars. There will be support groups and evening events as well. Click HERE for more information and to buy tickets.

May 24, 2019

Welcome back to another episode of Your Anxiety Toolkit. Today, we are talking all about Managing Sleep Anxiety. It is very common for my clients to report significant anxiety at bed time and during sleep. They might report trouble getting to sleep, racing thoughts while trying to fall asleep, trouble staying asleep, waking up panicking, or ruminating on an event or worry. In this episode, we are not talking about the specific medical side of sleep disturbances. We are talking specifically about managing sleep anxiety. Did you know that more than 40 million Americans suffer from a sleep disorder? (according to the National Institutes of Health). And, did you know that 50% of those with GAD have a sleep disorder? These statistics blew me away and made me realize I need to be addressing this issue more often. I am sure you will agree that stress and anxiety may increase sleeping problems or make existing problems even worse. Many will report that their sleep quality is much reduced when they are going through a difficult time in their lives. But, the real question is, which one comes first? Sleep disorder or Anxiety Disorder? We will discuss this in this episode. In this episode, we also address sleep hygiene, caffeine intake, and the importance of exercise when it comes to managing anxiety. We also talk about the importance of reducing screen time, keeping naps to a minimum and the necessity of seeing a sleep specialist if you are really struggling. I really hope this episode helps you manage sleep anxiety just a little better. It's a beautiful day to do hard things, CBT School community! Before we go, I'd like to remind you about two amazing events coming up and a way for you to give back to the OCD community! International OCD Foundation 1 Million Steps 4 OCD Walk What: The IOCDF is hosting their 1 Million Steps 4 OCD Walk in Calabasas on Saturday, June 1, to increases awareness and raises funds for the IOCDF and its Local Affiliates so they can continue their mission. I will be walking at this one! There are many walks happening so be sure to check your area if you are interested. When: June 1 Where: Juan Bautista de Anza Park | Calabasas, CA Click HERE for more information and to register. International OCD Foundation Annual Conference What: Since 1993, the Annual OCD Conference has been the only national meeting focused solely on obsessive compulsive disorder (OCD) and related disorders. The unique event allows people with OCD and their loved ones to learn about the latest OCD treatment and information alongside the mental health professionals who care for them. The Conference features more than 100 presentations, workshops, and seminars as well as nearly two-dozen support groups and various evening events. Presenters include some of the most experienced and knowledgeable clinicians and researchers in the field, as well as people with OCD and family members sharing their stories about life with OCD. When: July 19-21 Where: JW Marriott Austin, Austin TX Click HERE for more information and to buy tickets. Giving Back During the month of May, Shala Nicely is giving 100% of her royalties from Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life to the International OCD Foundation for the conference scholarship fund. In celebration of the one-year anniversary of Fred 's publication, she hopes to raise enough money to send at least 5 people in need to the conference. And with your help, we can send even more! As Shala shares in the Fred chapter "Changing the OCD Mind," going to her first IOCDF conference was life-changing: she finally learned about exposure and response prevention therapy (ERP) for OCD and actually tried the therapy on her own, realizing with amazement that ERP gave her the power to reclaim her life. If you have OCD, know someone with OCD, treat OCD, or have ever been curious what OCD is really like, please purchase a copy of Fred . As I wrote in my endorsement of the book, " Is Fred in the Refrigerator? is a stunning story of growth, perseverance and hope. Shala beautifully details how mental illness shaped her life, taking us with her on her brave journey through perfectionism, shame and fear. This book is the perfect combination of entertainment, education and validation for those who are on their journey to recovery from OCD, but also for any human being who wants to live courageously and joyfully." 100% of the royalties from every book sold will directly support sending people with OCD to the IOCDF conference, where they will learn that they, too, can reclaim their lives. Thank you!

May 17, 2019

How To Be Uncertain In the Management of OCD Welcome to this week's episode of Your Anxiety Toolkit. When it comes to the management of anxiety, practicing being uncertain is the key to long-term recovery. We must face our fears and purposely not try to solve what will happen and what we would do if our fear came true. For anyone attempting this, we can all agree that being uncertain is a very difficult skill to practice. I have found that while my clients logically are on board with the idea of being uncertain, they still struggle with HOW to be uncertain. Cognitively, we know the importance of uncertainty, but the actual practice of it might not be something that we are fully on board for. Nearly every day, a client or a follower on social media ( Instagram , Facebook , Twitter ) will ask me HOW to be uncertain. They might say, "Kimberley, I get that I have to lean into the uncertainty, but HOW do I actually be uncertain?" In today's podcast episode, we talk all about how to be uncertain and what major roadblocks might be causing you to bypass uncertainty. We also talk about some key mindfulness tools to help with the practice of uncertainty when managing strong obsessions and compulsions. This is a very important concept when it comes to anxiety management, so I would love to hear your thoughts. There are a few very exciting events coming up! The IOCDF is hosting their 1 Million Steps 4 OCD Walk in Calabasas on Saturday, June 1, to increases awareness and raises funds for the IOCDF and its Local Affiliates so they can continue their mission. I will be walking at this one! Click HERE for more information and to register. Also, the IOCDF Annual Conference will be held in Austin, Texas, from July 19-21. I will be speaking at this event and love seeing you there! Click HERE for more information and to buy tickets.

May 10, 2019

100th Episode Virtual Party! Welcome to another episode of Your Anxiety Toolkit Podcast. This episode is a very special one for us. We are celebrating out 100th Episode and we are having a VIRTUAL PARTY! At this party, we want you to celebrate this wonderful community of brave and courageous people who stand by each other as we go through hard things and we do hard things. For this virtual party, we invited some of our favorite guests and asked them to share some wisdom, a funny story or dance the night away with us. First up, we have Ethan Smith who was on Ep. 53 (How Advocacy "Keeps Me Well": Interview with Ethan Smith OCD Advocate) and he starts the evening off in the most glamorous way. Sheva Rajaee who was Ep 45 (FIVE Roadblocks to Anxiety Recovery (w/ Sheva Rajaee) shares a wonderful story about Octopi and how adaptable they (and we) are. Chris Tronsdon who was on Ep 97 (The Emotional Stages of Recovery – Rebuilding Life After OCD with Chris Tronsdon) shared a wonderful and inspiring story of having Obsessive Compulsive Disorder (OCD) and then led us into a fabulous dance. Nathalie Maragoni from Ep 65 shared her love for our community and how proud she is of us all. Shala Nicely from Ep 16 (Guilt, Shame and being "SO OCD" with CBT ROCKSTAR Shala Nicely), Ep 36 (This EASY tool Might Change Your Way of Coping with Anxiety with Shala Nicely) and Ep 78 (Tips To Help You Share Your Mental Illness With Others) Shared her words of wisdom and also has a wonderful and generous gift she is sharing with the OCD community. Catherine DeMonte from Ep 95 (Love vs. Fear with Catherine DeMonte) shared a wonderful piece about how we must choose love over fear and allow love to lead us. Catherine always has beautiful things to share with us. Jon Hershfield from Ep 42 (Dispelling The Myths About Managing Anxiety and Obsessive Compulsive Disorder) And Ep 85 (Harm OCD with Jon Hershfield) as always brings humor and wit to our interactions. Michelle Massi from Ep 84 (How to Manage Social Anxiety (with guest, Michelle Massi, LMFT) Beautifully shares what she loved about being on Your Anxiety Toolkit Podcast and we 100% cannot wait to have you back on Michelle. Alegra Kastens, our fabulous and hard-working CBT School assistant gives us a huge dose of inspiration and support with her beautiful words of hope and faith. Thank you, Alegra! Of course, no party is complete without Jeremy Quinlan from Ep 99 (Making The Choice to Embrace Panic with Jeremy Quinlan) who shows us late and always causes trouble. Thank you, Jeremy, for showing your handsome face! The lovely and wise Zoe Gillis from Ep 19 (Nature just might be the ULTIMATE Mindfulness Tool with Zoe Gillis) shared how she experiences parties and brings a unique and thoughtful approach to our 100th episode (always making me think outside the box). And, true to form, Patrick McGrath from Ep 64 (Don't Try Harder, Try Different with Patrick McGrath) brings his hilarious jokes and firm direction for those who are working on anxiety and recovery. And, last but not least, Chrissie Hodges from Ep. 67 (Grieving the Losses of Mental Illness) shares a powerful message for those who are in the throes of anxiety and OCD recovery. I just adore her thoughts and wisdom. I cannot thank you all enough for all of your support and excitement. Thank you for joining us for this virtual party! I have loved every minute of this podcast...all the minutes of recording, editing, and preparing. Thank you so much, CBT School community! Here is to another 100!

May 3, 2019

Jeremy Quinlan Talks About Panic Disorder and Choosing to Embrace Panic Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have a very special guest. For me, this is THE most special guest, because this week I had the honor of interviewing my husband about Making the Choice to Embrace Panic. In this episode, Jeremy tells the story of his Panic Disorder , how panic took so much from him and how he made the choice to embrace panic, instead of run from it. I have wanted to record this episode for the longest time, but life, work, family and business always got in the way. But, on a beautiful spring day, we both sat down while the kids were at school in our lounge room and recorded his story. Together, we talked about the fear of flying and how this caused him to exit off many flights in a state of panic. We also talk about his fear of driving on the highway, fear of getting on elevators, fear of getting on a train or a trolley or a taxi cab, etc. We also got very deep into the experience of panic disorder and what it felt like to have a panic attack. Jeremy described his specific experience of panic and how it made him fear he would hurt someone or lose control of his body. What I loved the most was how he shared his bumpy journey to recovery. Jeremy carefully describes what that journey with panic felt like and how he made an intentional decision to "choose life" over running from anxiety, panic, and dread. He addressed how he came to a place where he could see that he had only two choices: choose to embrace panic or to keep running and let it take over his life. I am so excited to share this episode with you, CBT School community. I hope he inspires you as much as he inspires me.

Apr 26, 2019

Three Mindfulness Basics for Anxiety and Depression Welcome back to another episode of Your Anxiety Toolkit Podcast. Do you ever feel like you have to go back to basics? Maybe you feel overwhelmed with all the "tools" and strategies you need to practice to manage your anxiety , obsessions, compulsions, and emotions. Maybe you are feeling like you need to simplify your mental health practices so that you only have a few things to manage instead of many. If you are feeling this way, you are not alone. I recently realized that I had to return back to some mindfulness basics and review the tools that helped me many years ago. In today's episode of Your Anxiety Toolkit, I talked about the 3 mindfulness basics for anxiety and depression that you must return to when you are struggling with anxiety, stress, life events, depression, and grief. In this episode, we talk about how we sometimes refuse to go back to the basics because we are afraid it means we are "going backward." We dispel this myth and address how these 3 mindfulness basics for anxiety and depression can recharge our mental health plan and practice. If you'd like to learn more about mindfulness skills that I teach my face-to-face clients who struggle with Obsessive Compulsive Disorder (OCD), we have an online course available on CBTschool.com called Mindfulness School for OCD . Click HERE to learn more and sign up. Before we go, I want to remind you of two wonderful upcoming events! The TLC Foundation will host their annual conference on Body-Focused Repetitive Behaviors from May 2-4 in Virginia. Click HERE for more information and to buy tickets. Also, the IOCDF Annual Conference will be held in Austin, Texas, from July 19-21. I will be speaking at this event and love seeing you there! Click HERE for more information and to buy tickets.

Apr 19, 2019

Chris Trondsen Talks Rebuilding Life After OCD Do you ever wonder what life will look like after OCD Treatment? If so, this is the podcast episode for you! We are talking all about the common emotions involved with the recovery process from mental illnesses such as Obsessive Compulsive Disorder (OCD) , Anxiety, and depression in today's episode of Your Anxiety Toolkit Podcast. Many of you have asked for more episodes about the emotional side of Obsessive Compulsive Disorder (OCD), Anxiety , Depression, Eating Disorders, and Body Focused Repetitive Behaviors (BFRB's) , as well as what life is like after mental illness. In today's episode, we talk with Christopher Tronsden on Rebuilding Life After OCD. In this episode, Chris Tronsden talks about his childhood of "confusion" about his symptoms and thoughts and how he was claimed to be a "difficult child." Chris Tronsden also talks about how he moved towards isolation after being wrongly diagnosed with other mental illnesses, and resultantly survived a suicide attempt. Chris shares the emotions he experienced after this suicide attempt and how it led him to finding the correct treatment for OCD (Exposure and Response Prevention) and moving towards Rebuilding life after OCD Treatment. What I loved the most about Chris' story is how beautifully he explains and articulates the process of building up the courage to perform Exposure and Response Prevention and then having to manage the painful experience of anger and loss after his OCD treatment. Chris Trondsen explains how he had to have some difficult conversations with loved ones and himself before he could turn his battle into something that was meaningful. Chris ends the podcast episode with a beautiful message of hope for those who are at all stages of treatment and recovery. His message really does give hope to those who are embarking on the process of rebuilding life after OCD Treatment. Thank you, Christopher Trondsen, for a beautiful interview. For more information on Chris, visit: IOCDF SoCal: https://ocdsocal.org/about-us/board-of-directors/ Twitter: https://twitter.com/christrondsen?lang=en Instagram: https://www.instagram.com/christrondsen/?hl=en Facebook: https://www.facebook.com/ChrisTrondsen Email: christrondsen@gatewayocd.com

Apr 12, 2019

Dr. Jed Siev Talks Religious (scrupulosity) and Moral Obsessions Welcome back to another episode of Your Anxiety Toolkit Podcast. Today, I am so thrilled to talk with you about Religious and Moral Obsessions. In this episode, I was honored to talk with Dr. Jed Siev. Dr. Jed Siev is an Associate Professor in the Psychology Department at Swarthmore College and is skilled in treating Obsessive Compulsive Disorder (OCD) , specifically Religious and Moral Obsessions. Religious and Moral Obsessions are very common among OCD sufferers and I am so thrilled to share with you. I was able to take some questions from followers on Instagram ( @kimberleyquinlan ) for this episode and Jed Siev did such a great job of bringing compassion, skill, and research into the conversation. Here are some of the questions we addressed in the interview: What is scrupulosity? What are the common obsessions and compulsions for Religious (scrupulosity) and Moral Obsessions? How does Scrupulosity differ from Moral Obsessions? What does treatment for Religious (scrupulosity) and Moral Obsessions consist of? Does treatment for Religious and Moral Obsessions differ for different common religions? The below questions from listeners are addressed: Is it helpful to involve a member of clergy when treating religious OCD? Is it common to question whether you are a good person or just do a good thing to prove you are a good person? How do you practice acceptance of thoughts and obsessions even if it feels so against your morals? When you struggle with religious (scrupulosity) and Moral Obsessions, how do you teach your younger child to pray? Why is there such a strong feeling of guilt attached to Religious (scrupulosity) and Moral Obsessions? How do you address the fear of doing things that are disloyal? What to do if you keep judging your actions? What to do if you keep putting shame on yourself? Thank you for everyone who submitted these questions. I am sure you will find this episode very, very helpful, as I learned so much from Jed Seiv. For more information on Dr. Siev, visit: https://www.jedsiev.com/ https://www.swarthmore.edu/psychology/faculty-staff EXCITING NEWS...OCDeconstruct is THIS WEEKEND!! OCDeconstruct is a free online conference designed to give those with OCD , and their loved ones, the information needed to understand key concepts related to the disorder so they can get a productive start on treatment. During the conference, six therapists will present on topics including intrusive thoughts, ERP, family dynamics, medicine and more. OCDeconstruct happens on Saturday, April 13 and will run about 4 hours.

Apr 5, 2019

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have someone who is very dear to my heart: Catherine DeMonte. Over a year ago, I had the privilege of joining a women's group called an Abundance Group, run by Marriage and Family Therapist, Catherine DeMonte. Catherine was so inspiring to me and gave me some of the tools I needed to get me inspired and motivated to create CBTschool.com. That's right you guys! Catherine was one of the people who stood next to me as I cultivated the seed of CBTschool.com . For that, I am forever grateful. In Catherine DeMonte's abundant circles, I learned how to lead with love, not fear. While this was a concept I already knew, Catherine helped me to put this into play as I created CBTschool.com and created a life that lined up with my values. Catherine has such a beautiful heart and a beautiful way of speaking in a compassionate and gentle way. In this interview, she delivers tools that will help you tap into the wonderful beauty of your heart and create a life you really want. She talks about love vs. fear. Catherine talks about what it's like to lead with love vs. fear. In this episode of Your Anxiety Toolkit, Catherine talks to us about being open to receiving love and health and compassion and support. She shares with us some of her amazing tools that she has included in her upcoming book, Beep! Beep! Get Out Of My Way! Catherine De Monte also talks about involving deep desire to the hard work that you're doing with Exposure and Response Prevention and she teaches us how to practice grace and gratitude as we work towards our anxiety recovery. I very much love this episode and I hope you do too. Lastly, I want to remind you about an upcoming event that I am thrilled to be speaking at: OCDeconstruct! OCDeconstruct is a free online conference designed to give those with OCD , and their loved ones, the information needed to understand key concepts related to the disorder so they can get a productive start on treatment. During the conference, six therapists will present on topics including intrusive thoughts, ERP, family dynamics, medicine and more. OCDeconstruct happens on Saturday, April 13 and will run about 4 hours.

Mar 29, 2019

Life after OCD with Shawnté Johnson Welcome back to another episode of Your Anxiety Toolkit Podcast! Today, we talk about life after OCD. So often, my clients in my private practice have questions about what recovery for anxiety and Obsessive Compulsive Disorder looks like. Clients and social media followers are often asking me what "recovery" means and how can they get there. Understanding recovery is a crucial part of taking those first steps towards fear. Today, I am thrilled to share with you Shawnté Johnson, an OCD advocate and blogger who not only talks the talk on recovery but walks the walk too. Shawnté Johnson has a blog called Life After OCD and she talks so beautifully not just about life after her recovery from OCD and Anxiety, but also life before and during treatment. In this week's episode, Shawnté talks about how "doing hard things" is worth it and how she learned to embrace facing her fears and took on an approach where she commits to facing her fears every day. Shawnté shares her own story and how she chose her own values over fear. She talks about how she was "enslaved" to her OCD and how she "chose faith over fear." What I loved so much about what she talks about is how fear was motivating much of her decisions and how she found her own form of motivation to take her life back from anxiety, fear, and panic. Shawnté also talks about recovery being a long game and how she stays aligned with the core concept of her OCD and anxiety treatment. There is life after OCD! You can find Shawnté at: Instagram: https://www.instagram.com/lifeafterocd/ Before we go, I want to remind you about upcoming events that I am thrilled to be speaking at: the OCD SoCal Conference and OCDeconstruct! This Saturday, March 30, I will be speaking at the OCD Southern California 4th Annual Conference alongside other OCD specialists and advocates. I'll be speaking during the breakout session titled Managing OCD Roadblocks: Creative and Effective Tools to Tackle ERP . For registration information, visit ocdsocal.org or click HERE . OCDeconstruct is a free online conference designed to give those with OCD, and their loved ones, the information needed to understand key concepts related to the disorder so they can get a productive start on treatment. During the conference, six therapists will present on topics including intrusive thoughts, ERP, family dynamics, medicine and more. OCDeconstruct happens on Saturday, April 13 and will run about 4 hours. Do you want to get weekly free content from us, right to your inbox? SIGN UP HERE FOR OUR NEW WEEKLY NEWSLETTER! The weekly newsletter includes free mental health tips and tools, information about upcoming events with Kimberley. and free coupons for CBT School products.

Mar 22, 2019

Welcome back to another episode of Your Anxiety Toolkit. You are going to LOVE this week's podcast interview with Dr. Reid Wilson. For those who don't know Dr. Reid Wilson, he is a world-class specialist in the area of Anxiety Disorders. Dr. Reid Wilson is the Director of the Anxiety Disorders Treatment Center in Chapel Hill and Durham, NC, and is Adjunct Associate Professor of Psychiatry at the University of North Carolina School of Medicine. Dr. Reid Wilson is the author of the amazing book for Panic Disorder, called Don't Panic , and the co-author of wonderful books such as Anxious Kids, Anxious Parents , Stop Obsessing! and Playing with Anxiety . Dr. Reid Wilson is a Founding Clinical Fellow of the Anxiety and Depression Association of America and a Fellow of the Association for Behavioral and Cognitive Therapies. So, I am sure you are wowed already, but wait for it! This episode will blow your mind even more. In this week's episode, I talk with Dr. Reid Wilson about a perspective change and an attitude change from one where we do not want anxiety to one where we WANT anxiety. I know this may seem strange, but believe me, this will change your whole game when it comes to the treatment of anxiety, Obsessive Compulsive Disorder (OCD) and other anxiety disorders. In this episode, we address the following topics. Why do we want anxiety? What is going on in our brains when we have anxiety and when we face our fears How to get a client to do Exposure & Response Prevention How to Engage the Ambivalent or resistant OCD Client A different approach to the ERP hierarchy? How to have a complete Attitude change about fear and anxiety. Please consult Reid's other site, Anxieties.com , for additional information, videos, resources, and treatment options. Before we go, I have a few exciting events to tell you about! I'll be speaking at both the OCD SoCal Conference and OCDeconstruct. On Saturday, March 30, I will be speaking at the OCD Southern California 4thAnnual Conference alongside other OCD specialists and advocates. I'll be speaking during the breakout session titled Managing OCD Roadblocks: Creative and Effective Tools to Tackle ERP . For registration information, visit ocdsocal.org or click HERE . OCDeconstruct is a free online conference designed to give those with OCD, and their loved ones, the information needed to understand key concepts related to the disorder so they can get a productive start on treatment. During the conference, six therapists will present on topics including intrusive thoughts, ERP, family dynamics, medicine and more. OCDeconstruct happens on Saturday, April 13 and will run about 4 hours. Do you want to get weekly free content from us, right to your inbox? SIGN UP HERE FOR OUR NEW WEEKLY NEWSLETTER! The weekly newsletter includes free mental health tips and tools, information about upcoming events with Kimberley. and free coupons for CBT School products.

Mar 15, 2019

Welcome back to another episode of Your Anxiety Toolkit Podcast! Want to know four massive changes I have made in my life? Well, here you go! In today's episode, I will present to you four massive changes that I have made in my life that have changed the way I see myself, the way I spend my time and, lastly, the approach I have with perfectionism and mistakes. If you are someone who is hard on yourself, beats yourself up for not being perfect or productive or just for existing, this episode might be really helpful for you. If you are someone who lets fear stop you from pursuing your dreams or even doing a smaller task, this is the episode for you. In this podcast episode, we will address time management, setting intentions and surrounding yourself with people who will inspire you and hold you accountable to your big dreams and with the hard struggles you are going through. One of the points I am so excited about is my new plan to FAIL MORE! Yes, you heard and read correctly. I plan to fail more this year. More than I ever have. As Amy Porterfield says in this podcast episode , failing can get you closer to your goals. As I also plan to aim higher and be 100% intentional as I go. The massive changes I have made in my life have made me into a bolder, braver and more confident person. I hope they inspire you too.

Mar 8, 2019

Welcome to another episode of Your Anxiety Toolkit podcast. This week's podcast episode is very dear to my heart. My intention with this podcast is to give you all some direction with food and body, specifically if you struggle with immense fear around food. This week's episode has the most amazing guest, Evelyn Tribole, the author of Intuitive Eating: A Revolutionary Program That Works . In this week's interview, we break down some of the barriers between fear and food. Evelyn does a great job at identifying why there is so much fear surrounding food, addressing societal, cultural and familial rules around food. We discussed how, for many, food creates anxiety for us personally, or how our anxiety manifests a bad relationship with food. Evelyn Tribole discusses : What is Intuitive Eating? Why is Intuitive Eating so important? What is diet culture and why is it such an important concept to understand? What happens when you don't Intuitively Eat? Evelyn also answers some questions given specifically by the CBT School family. Here are a few questions she addressed: How can I introduce myself to Intuitive Eating? What are the steps of Intuitive Eating? How do I avoid the extremes of eating? I am either eating "too unhealthy and too healthy as a compulsion." How do I address Emotional Eating or "bad" eating because of a hard day? How do I attempt Intuitive Eating if I HAVE to lose weight because of health reasons? How do I manage the fear of gaining more weight? How do you make all foods neutral whilst also finding joy in food? How do I not get trapped in diet culture? How long does it take to get a good handle of Intuitive Eating? How do I begin to desire and have the persistence to intuitively eat while having an Eating Disorder? Due to mood changes, how can I eat when I don't want to? What is the best way to stick with Intuitive Eating? What is the best way to approach Nutrition for Anxiety Disorder ? How does Anxiety impact hunger cues. etc.? How do I address Avoidant and Restrictive Food Intake Disorder? For more information on Evelyn Tribole, visit: https://www.evelyntribole.com/ Do you want to get weekly free content from us, right to your inbox? SIGN UP HERE FOR OUR NEW WEEKLY NEWSLETTER! The weekly newsletter includes free mental health tips and tools, information about upcoming events with Kimberley. and free coupons for CBT School products.

Mar 1, 2019

Not Alone Notes (Morgan Rondinelli and Molly Fishback) Welcome back to another episode of Your Anxiety Toolkit. One of the most common statements I get from new clients when I meet them in my office is, "I feel so alone." After waiting and being so afraid to finally talk with someone about their mental illness and personal struggles, they are overwhelmed with isolation and loneliness. The experience of feeling alone and wondering if you are the only one on this planet that is suffering in this way is a common one. Given the stigma of mental illness, we are often shamed into keeping our mental illness and mental struggles private and suffering in the dark alone. If you have ever felt this way, or you know someone who feels this way, you are not alone. In this episode of Your Anxiety Toolkit, we talk with Morgan Rondinelli and Molly Fishback about their project called Not Alone Notes. In this episode, Morgan and Molly share their own stories of feeling alone and unseen in their struggles with Obsessive Compulsive Disorder (OCD) . Together, they joined hands from across the country to send personally painted and written notes to those with Obsessive Compulsive Disorder (OCD) and Body-Focused Repetitive Behaviors (BFRB's) . My hope after today's episode is the you begin to understand that you are not alone and there is a whole community out there who wants you to know that they are on your side. Here is a little blurb from their website: "The idea from this project stemmed from becoming pen pals with several friends from OCDcon. Morgan was writing back and forth with them and wanted to somehow reach out to strangers with OCD. Morgan loves snail mail because there is something special about receiving a handwritten letter, so she wanted to pass that on to others. In October of 2017, it started simply as a link to a Google Form on Morgan's blog. Shortly after, Molly reached out to Morgan with the idea of handmaking notecards for the project. Not Alone Notes has continued to grow as Molly and Morgan work together to send letters to individuals with OCD and related disorders." In this episode, Molly and Morgan get really vulnerable and showcase proof that you are not alone. They talk about their own recovery journey, what it was like to begin Exposure and Response Prevention treatment, and how it feels to be at different stages of recovery. In effort to ensure that you are not alone in this mental health journey, Morgan and Molly also share their specific steps of ERP and how they are getting creative with ERP. To learn more about Not Alone Notes, visit: https://www.notalonenotes.org/ Before we go, I want to talk about my upcoming exciting weekend in Colorado at the OCD Gamechangers event that Chrissie Hodges is putting on. I will be speaking alongside other licensed clinicians on important topics about OCD recovery. OCD advocates will take the stage to discuss the emotional impact that OCD has had on their recovery. The event takes place on Saturday, March 2. Click HERE for more information on the event or to get tickets.

Feb 22, 2019

In today's episode of Your Anxiety Toolkit, we are talking all about the 5 Mistakes We Make When Managing Anxiety, Obsessive Compulsive Disorder (OCD) , Depression, Body Focused Repetitive Behaviors (BFRB's) and any other mental health struggle. This podcast episode got me all fired up and I loved sharing with you bite-sized concepts to consider and marinate on. My hope with this episode of Your Anxiety Toolkit is to help you identify the specific areas where you might be falling into the anxiety trap, and then find ways to manage anxiety more effectively and purposely. We talk about Mindset, Mindfulness and strategic skills you can practice just about anywhere. As a Marriage and Family Therapist who specializes in the treatment of Anxiety Disorders such as Panic Disorder, Obsessive Compulsive Disorder (OCD), Social Anxiety, Health Anxiety, Eating Disorders and Body Focused Repetitive Behaviors (BFRB's), I often see my clients engage in behaviors that prevent them from properly managing their anxiety. It is common for us to get stuck in compulsive and compensatory behaviors that cause us to continue to live in fear. In today's podcast, I go through the 5 Common Mistakes We Make When Managing Anxiety. Some of these points might surprise you. Others may not. This is not a list of the only mistakes we make. There are lots of ways we can get stuck in the turmoil of anxiety, intrusive thoughts, sensations, panic, urges, obsessions, and compulsions. Please note, that these are 5 mistakes I make when managing anxiety also. I don't want anyone feeling like they are alone in this. I make these mistakes also. I think we all do, mostly because they are very easy traps to fall into when it comes to the management of anxiety, depression and other mental health issues. I hope you find this helpful. Thank you to everyone who has left a review for the podcast. This is super helpful and increases our chances of getting really wonderful guests on the show. Instagram: https://www.instagram.com/cbtschool/ Facebook: https://www.facebook.com/KimberleyQuinlanCBTschool/ Forward we go, Kimberley

Feb 15, 2019

The Flow of Recovery In today's episode of Your Anxiety Toolkit, we are talking all about Recovery. Yes, we know! This can be a controversial conversation, especially when talking about recovery for Obsessive Compulsive Disorder (OCD) , Eating Disorders, Anxiety Disorders and Body Focused Repetitive Behaviors (BFRB's) . The truth is, achieving this thing called "recovery" depends mostly on your definition of recovery. There can be a very big difference of opinion when it comes to what is considered "recovery." In today's podcast, we talk all about recovery and what I like to call, "The FLOW of recovery." Finding your own Flow of Recovery is what I think will help you so much with the speed and ease of your recovery, not matter what your definition is. I have seen this idea of FLOW of recovery to be a huge part of OCD and Anxiety recovery for many. As you may know, last week we had the amazing Kristin Neff on the podcast (Ep. 87) where she shared her brilliant research and practice of Mindful Self-Compassion. She shared about the importance of including self-compassion in our everyday lives and different compiments of self-compassion that can help us live a better life. Some people have the faulty belief that self-compassion is for sissys. Some hold onto the huge misconception that the practice of self-compassion will make us weak or lazy or fat or a loser. Many of my clients have told me that they are too afraid to practice (or even consider) practicing self-compassion because it might make them snap and turn lazy and never get out of bed again. So typical of anxiety, isn't it? Kristin Neff talked about the Yin and Yang of self-compassion (go to that episode to hear more). She believes that self-compassion must include both the Yin of self-compassion, which is like a mother tenderly comforting her crying child and the Yang of self-compassion, which is the mother bear that shows up for ourselves, ferociously protecting her cubs (and us) from harm. As we mentioned before, many of us struggle with fearing becoming too Yin, and some people do the opposite and are afraid to step into the Yang of self-compassion. As a result, they avoid getting their needs met. They avoid everything. So, when we talk about "The Flow of Recovery" we are talking about using both the Yin and the Yang of self-compassion to help you FLOW. The Flow of Recovery is moving from action to gentleness and rest. The Flow of Recovery involves slowing down sometimes and other times the flow of recovery involves speeding up. Sometimes, the flow of recovery involves moving back and forth between the Yin and Yang quite quickly. Today, in this podcast, I want to inspire you to begin using both the Yin and YANG of self-compassion. My use of the term the flow of recovery is all about doing the hard things (YANG) and then slowing down to be gentle (YIN). You are going to use these tools, not once, but over and over again. And you are going to find a flow where you swing back and forth and back and forth between action and rest, action and rest. The action could be ERP, setting a boundary with someone, starting therapy, sharing your struggles with a friend, and the rest is where you get really quiet and ask yourself what it is that you need and make sure you find a way to give that to yourself. The Flow of Recovery is also the gentle swing of saying really gentle and kind things to yourself and then speaking almost as a coach. "I can do this hard thing!" And "I will get through this" and "I have my own back, unconditionally." So, to sum it all up, the principle of Yin and Yang is that all things exist as inseparable and contradictory opposites, and this is so true for recovery. I urge you to check in and see if you have a Yin and a Yang. How can you add more Yang if you rely too much on Yin? How can you add some Yin if you are stuck in a cycle of all action and no self-care? And lastly, please note that ERP School is open until February 18th! Shhh…we kept the cart open a few more days. ERP School is our online course that teaches you all the most important components of ERP for Obsessive Compulsive Disorder. Exposure and Response Prevention School (ERP School) is an online course that teaches you the tools and skills I teach my clients in my office. Let me tell you a little bit about it. The course is a video based course that includes modules on The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP Mindfulness tools to help you manage anxiety, panic and uncertainty Troubleshoot common questions and concerns BONUS 6 videos of the most common subtypes of OCD The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to share ERP with you and would love to have you join us and the CBT School Community. It's a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the Facebook group and on Instagram to talk about questions you may have. Click HERE to sign up.

Feb 8, 2019

Kristin Neff Talks All Things Self-Compassion Hello there CBT School friends and family, This week we have a SUPER exciting episode of Your Anxiety Toolkit Podcast to share with you. If you are someone who is hard on yourself, this is THE episode for you. If you are someone who beats yourself up, this is the episode for you. If you need help being self-compassionate, THIS IS THE EPISODE FOR YOU! I am so thrilled to share with you this week's podcast guest, Kristin Neff. Kristin Neff is a pioneering self-compassion researcher, author of one of my favorite workbooks called The Mindful Self-Compassion Workbook, and is a wise and informative teacher of self-compassion. Kristin Neff developed an 8-week online program that teaches self-compassion skills to those who struggle in this area. The program, co-created with her colleague Chris Germer, affiliated with Harvard Medical School, is called Mindful Self-Compassion . In this episode of Your Anxiety Toolkit Podcast, Kristin Neff addresses what self-compassion is and what it is not. I found this to be incredibly informative, especially for those who struggle to differentiate between self-compassion and self-care. Kristin Neff also addresses why some people struggle with practicing self-compassion, and specifically addresses the cultural and political aspects of this topic. What I loved the most is how Kristin Neff explains whay self-compassion practices look like, feel like, and sound like. For those who need a most literal description of self-compassion, this conversation will be right up your alley. We also address the Yin & Yang of Self-Compassion and how we often forget the Yang component of Self-Compassion (listen to the full description). Lastly, for those who find that their negative self-talk increases when they practice self-compassion, Kristin Neff addresses a concept called Backdrafting, and how this is a normal (and even positive) part of Self Compassion. For more information on Kristin Neff, visit the links below: Website: https://self-compassion.org Workbook: https://self-compassion.org/mindful-self-compassion-workbook/ And lastly, please note that ERP School is available for one more week! ERP School, our online course that teaches you all the most important components of ERP for Obsessive Compulsive Disorder , is BACK. Act fast because it is only available until February 14th, 2019! Exposure and Response Prevention School (ERP School) is an online course that teaches you the tools and skills I teach my clients in my office. Let me tell you a little bit about it. The course is a video-based course that includes modules on The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP Mindfulness tools to help you manage anxiety, panic, and uncertainty Troubleshoot common questions and concerns BONUS 6 videos of the most common subtypes of OCD, including Harm OCD. The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to finally share ERP with you and would love to have you join us and the CBT School Community. It's a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the FB group and on Instagram to talk about questions you may have. Click here to sign up. https://www.cbtschool.com/p/erp-school-lp

Feb 1, 2019

The Science of Exposure and Response Prevention (ERP) Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we are talking about the science behind Exposure and Response Prevention. I know a lot of you have a lot of questions about why we would ever put ourselves in a position to be MORE anxious and MOST uncertain. But, there are many reasons why and today we are going to dive into The Science of Exposure and Response Prevention . To put it simply, we instinctually we run from fear. We go into fight, flight and freeze when we are faced with serious, dangerous events. In emergency situations, this is the most sophisticated human response. We are so lucky we have this response, as it keeps up alive and well. However, in our era, we are often bombarded by THOUGHTS of serious, dangerous events and this causes our brain to make mistakes about the imminence of danger. We experience the thought as if it were an imminent threat - right here, danger in close quarters, etc. The problem is that we react to this thought or sensation or urge as if it IS an imminent threat. We run away, we fight it or we freeze. What happens when we do this is that we reinforce that the thought IS dangerous and, because we responded in this way, a cycle that is created. Fear --> avoidance response --> fear….and the cycle continues. So, what can we do instead of fight, flight or freeze? We can stare our fear right in the face. We do this by performing Exposure and Response Prevention. Exposure and Response Prevention includes changing our behavior, or response, to the original thought or obsession and exposing ourselves to our feared consequence. Now, if you hate the idea of this, you are not alone. In this week's podcast, we address the science behind Exposure & Response Prevention to help motivate and inform you of WHY ERP is so important and HOW it changes our brains. If you need help with this, now is the time to act. ERP School, our online course that teaches you all the most important components of ERP for Obsessive Compulsive Disorder , is BACK, but act fast because it is only available until February 14th, 2019! Exposure and Response Prevention School (ERP School) is an online course that teaches you the tools and skills I teach my clients in my office. Let me tell you a little bit about it. The course is a video-based course that includes modules on The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP Mindfulness tools to help you manage anxiety, panic, and uncertainty Troubleshoot common questions and concerns BONUS 6 videos of the most common subtypes of OCD The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to finally share ERP with you and would love to have you join us and the CBT School Community. It's a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the FB group and on IG to talk about questions you may have. Click HERE to sign up.

Jan 25, 2019

Overcoming Harm OCD with Jon Hershfield Welcome back to another episode of Your Anxiety Toolkit Podcast. Today we have a special guest, Jon Hershfield, LMFT. Jon has been on the show already and is a favorite among the CBT School-ers. Today, Jon and I talk about how to manage specific obsessions related to violence and physical harm. In OCD terms, we call it Harm Obsessions or Harm OCD (if you meet the requirements for a diagnosis of Obsessive Compulsive Disorder or OCD). In this episode, Jon answers some important questions such as: Does everyone have Harm Obsessions, thoughts, impulses or images? Why do these Harm Obsessions bother some people and not others? What is the difference between a Harm OCD and having thoughts about harm? Are people with Harm OCD any different than those who have other types of OCD? How do we treat Harm OCD? This was such a fun episode and I really hope it helps those with harm obsessions, thoughts, images, impulses, and urges (Harm OCD). Fore more information on Jon's latest book, Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts , click HERE . For more information on Jon Hershfield, visit: Website: Ocdbaltimore.com Twitter: @cbtocd IG: @ocdbaltimore FB: @JonHershfield GOOD NEWS!……WE HAVE A HUGE SURPRISE! On January 28th, 2019, we are offering our FREE webinar called "10 THINGS YOU NEED TO KNOW ABOUT OCD." This is a FREE online video course explaining exactly what OCD is, how to treat it and what complicating factors can occur during the process. This free webinar will run daily at 6pm PST for one week ONLY. If you are not able to attend the free webinar, no stress! There will be a free replay sent to your inbox the day after signing up. I cannot wait to share this FREE educational resource with you. CLICK HERE TO SIGN UP! ALSO, ERP School is COMING BACK! Exposure and Response Prevention School is an online course that teaches you the tools and skills I teach my clients in my office. Let me tell you a little bit about it. The course is a video-based course that includes modules on: The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP Mindfulness tools to help you manage anxiety, panic and uncertainty Troubleshoot common questions and concerns BONUS 6 videos of the most common subtypes of OCD, including Harm OCD. The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to finally share ERP with you and would love to have you join us and the CBT School Community. It's a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the Facebook group and on Instagram to talk about questions you may have. Click HERE to sign up.

Jan 22, 2019

Michelle Massi, LMFT, Talks To Us About Managing Social Anxiety Welcome back to Your Anxiety Toolkit. After multiple suggestions and requests, we are so excited to share with you an episode that focuses entirely on managing Social Anxiety . I am so excited to share with you the amazing, Michelle Massi (formally known as Michelle Otelsberg). Michelle Massi, LMFT, is an OCD and Anxiety Specialist who has both a private practice in Encino and Westwood and also works at the UCLA OCD Intensive Treatment Program. Michelle works one-on-one and runs group therapy, and has a ton of experience treating Obsessive Compulsive Disorder (OCD) , Social Anxiety, Panic Disorder , TICS, Body-Focused Repetitive Behavior's (BFRBs) and other anxiety-related disorders. In this episode of Your Anxiety Toolkit, we talk about all things Social Anxiety. Michelle and I talk about the presentation of Social Anxiety and different symptoms that can present when ones struggles with Social Anxiety. Michelle talks about different themes and fears related to social anxiety and how there is no one-size-fits-all approach to social anxiety presentation. Michelle and I also discuss different approaches to Social Anxiety treatment and some fun ways to practice facing your fears and tolerating the fear of judgment from others. We discuss the use of Cognitive Therapy, Behavioral therapy, and Exposure and Response Prevention (ERP), as well as the use of Mindfulness and Acceptance and Commitment Therapy (ACT). Also, please get super excited! ERP School is BACK! Exposure and Response Prevention School is an online course that teaches you the tools and skills I teach my clients in my office. Let me tell you a little bit about it. The course is a video-based course that includes modules on The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP Mindfulness tools to help you manage anxiety, panic, and uncertainty Troubleshoot common questions and concerns BONUS 6 videos of the most common subtypes of OCD The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to finally share ERP with you and would love to have you join us and the CBT School Community. It's a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the FB group and on Instagram to talk about questions you may have. Click HERE to sign up. For more information about Michelle, Anxiety Therapy LA, and the UCLA OCD Intensive Outpatient Program: Anxiety Therapy LA: Anxietytherapyla.com Instagram: @anxietytherapyla UCLA OCD Program: https://www.semel.ucla.edu/ocd-itp

Jan 11, 2019

Steven Hayes Talks Acceptance & Commitment Therapy (ACT) Welcome back to another INCREDIBLE episode of Your Anxiety Toolkit Podcast! Today we have an amazing guest, Steven Hayes. Steven Hayes is a clinical psychologist and professor at the University of Nevada. Steven Hayes has done so much for the psychology field, writing a whopping 44 books (wow, right?!) and many research articles. Steven Hayes also developed the evidence-based therapeutic modality that I use in my therapy office every day: Acceptance & Commitment Therapy (also known as ACT). ACT is a wonderful compliment to Exposure & Response Prevention (ERP), as it relies heavily on Mindfulness, positive reinforcement and using Value-Based Behaviors. In this interview, Steven Hayes and I discuss what Acceptance & Commitment Therapy (ACT) involves and how we can learn to diffuse from our thoughts. You will find this especially helpful with you have anxiety, Obsessive Compulsive Disorder (OCD) , Panic Disorder, Social Anxiety , and Depression, mostly because we tend to fuse a lot with our thoughts when we struggle with these disorders. However, the truth is, we all could learn the skill of diffusion and Steven Hayes does an amazing job of expelling why. Steven Hayes also teaches us useful ACT tools to stay present, and the practice of living a life that is based on values, not fear or anxiety. My favorite part of the interview is where Steven Hayes discussed why our thoughts sometimes link together and how it is completely a waste of time trying to block, suppress or avoid thoughts. I am sure you will agree that Steven Hayes is a genius and that he has so much to teach us about our brain, our psyche and how we can react batter to our thoughts. AND…..WE HAVE A HUGE SURPRISE! ERP School is BACK! Exposure and Response Prevention School is an online course that teaches you the tools and skills I teach my clients in my office. Let me tell you a little bit about it. The course is a video based course that includes modules on: The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, and interoceptive exposures, as well as how to get creative with ERP Mindfulness tools to help you manage anxiety, panic and uncertainty Troubleshoot common questions and concerns BONUS 6 videos of the most common subtypes of OCD. The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to finally share ERP with you and would love to have you join us and the CBT School Community. It's a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the FB group and on Instagram to talk about questions you may have. Click HERE to sign up. If you would like further information on Steven Hayes and access to his FREE mini course, visit http://www.stevenchayes.com/ . Click HERE for more info on Steven Hayes' workbook Get Out of Your Mind and Into Your Life , as well as his other books.

Jan 4, 2019

Staring Fear In The Face With Four Powerful Statements Hello there CBT School Rockstars! Happy New Year! In this week's episode of Your Anxiety Toolkit, I want to give you the 4 Powerful Statements you need in 2019. Even though this is directed at you for the new year, this episode is created in hope to get you ready for any circumstance and any time in your life. So here they are! The #1 Powerful Statement you need in 2019 is……. "There is nothing wrong with me" The #2 Powerful Statement you need in 2019 is……."I radically accept this situation" The #3 Powerful Statement you need in 2019 is………."I am making the decisions around here from now on" The #4 Powerful Statement you need in 2019 is……"It is a beautiful day to do hard things" The whole purpose of this podcast episode is to help you move away from a life where fear makes all of your decisions and towards a life where we stare fear in the face and live the life we want to live as if fear wasn't there at all. We want to ask ourselves what we would do if fear never showed up and then go live that life while only bringing fear along for the ride. CBTschool.com has many ways we want to help you "do hard things" in 2019 and we hope that these 4 Powerful Statements will help you move in that direction. We are excited to announce that ERP School is coming back in January. Click HERE for more info. ERP School is an online course that teaches all the Exposure & Response Prevention Tools you will need to manage Obsessive Compulsive Disorder , Panic Disorder, Health Anxiety, and Social Anxiety . We are also excited to announce that BFRB School is also coming back in January. Click HERE for more info. BFRB School is a course that teaches those with Compulsive Skin Picking (Dermatillomania & Excoriation Disorder), Hair Pulling (Trichotillomania) and Compulsive Nail Biting the science-based tools they need to manage their symptoms and live a full life. Sending you much love and healing vibes, Kimberley

Dec 28, 2018

"You WILL get through this!" Interview with Fashion Blogger and OCD Advocate Jemma MrDak Hello there CBT School Community! Welcome back to another episode of Your Anxiety Toolkit Podcast. Today, we are so excited to share with you Jemma Mrdak. Jemma is a well-known Australian Fashion and Lifestyle Blogger and an avid Mental Health advocate. I first heard about Jemma on social media after she bravely came out and talked about her experience with Obsessive Compulsive Disorder (OCD) on the Today show. As soon as I saw her interview, I knew she would be such an inspiration to you all. In this episode, Jemma talks about her struggles with Obsessive Compulsive Disorder (OCD) , specifically checking and tapping compulsions. Jemma talks about being so overwhelmed with anxiety that she was unable to get to school on time and fell behind in her studies. Jemma also talks about her success with seeking treatment from a Cognitive Behavioral Therapist (CBT) and how she used her tools to help her get her life back from OCD. Jemma also shared her love for nature and exercise and how that helped her get in touch with the practice of Mindfulness. If you are feeling hopeless about your future and questioning if you are able to get better at managing your anxiety and OCD, this episode is for you. Jemma is so great at sharing what was easy, what was really hard and what roadblocks she came across in her treatment journey. She is truly an inspiration and will give you some amazing words of wisdom to help with on your journey to mental wellness. For more info on Jemma, visit the below: Website: astylishmoment.com IG: @astylishmoment Before we go, GET EXCITED! ERP School is almost here again. ERP School will be re-released in late January. Click HERE to be the first one alerted by signing up to be on the waitlist.

Dec 20, 2018

How Practicing Self-Respect Can Lead to Self-Compassion Hello there CBT School Family! I am so thrilled to share another episode of Your Anxiety Toolkit Podcast with you. You guys know me well enough to know that I am a huge fan and advocate for the practice of self-compassion. I love sharing the benefits of self-compassion and helpful ways to put it into practice. However, over the past few months, I have heard the hopelessness in some of your voices when you share with me that self-compassion just feels too hard and too triggering. Maybe you feel like you don't deserve to be kind to yourself, which is common in Anxiety , Depression and Obsessive Compulsive Disorder (OCD) , or you are afraid that practicing self-compassion will mean you lose control and become a lazy, useless bum (none of this is true, BTW). For those of you who are struggles with self-compassion, this podcast is for you. Today we are talking all about how practicing self-respect can lead to self-compassion. Self-respect is all about honoring your right to be treated fairly and kindly. It is all about not treating yourself in a way that is disrespectful and hurtful. We all deserve to be treated equally and fairly, and this is a practice that is crucial if you ever want to master the practice of self-compassion. In this episode of Your Anxiety Toolkit Podcast, we will discuss effective ways to practice self-respect and learn how self-respect leads us towards the beneficial practice of self-compassion. During the podcast episode, we take a look at how you can improve self-respect by addressing these important questions. 1) Do my behaviors represent and reflect self-respect? 2) Do my behaviors respect my values? 3) Do my behaviors respect my beliefs? 4) Do my behaviors allow me to achieve my goals and values? 5) What are some times I have felt a true sense of self-respect? 6) Does my behavior lead me towards a sense of mastery (of a skill or a situation)? 7) What behaviors am I doing that damage my sense of self-respect? I hope this podcast episode brings you closer to the practice of self-respect and self-compassion. These are two concepts I am very invested in and I hope you find them helpful.

Dec 14, 2018

How to Thrive and Survive The Holidays Happy Holidays Everyone! Well, the holiday season is here and if you're anything like me, you're feeling slightly overwhelmed and stressed because of all you have to do, and all of the emotions that go along with the holidays. This is a common time of the year where we can experience very high emotions such as joy, happiness and excitement, but we also experience a lot of difficult emotions such as fear, panic , depression, hopelessness, grief and loneliness. Given that this is such a universal experience during the holiday period, we thought it was a great opportunity to bring on Alison Seponara who is a Licensed Professional Counselor in the state of Pennsylvania to talk about How to Thrive and Survive the Holidays. This episode is particularly important if you are also managing a mental illness or other psychological stressors. It is not uncommon for anxiety and depression to worsen during the holiday period, so we wanted to be sure to bring you multiple tools to help you Thrive and Survive the Holidays. In this interview Alison and I talk about important topics that can really impact our mental wellness during the Holiday season. In this podcast, we address the following: Grief and how the holidays can bring up grief you were not expecting Anxiety and how it is often increased due to the stress of the holiday period and the presence of triggering family members Social anxiety and how it can cause us to dread the holiday period The fear of saying no to family members and events that you don't think are healthy for you to attend The financial struggles that go along with the holidays The overwhelming expectation to feel nothing but joy and celebration The most important point Alison and I made during this episode of Your Anxiety Toolkit is that YOU DO NOT HAVE TO FEEL BAD IF YOU ARE NOT ENJOYING THE HOLIDAYS. Alison made some great points in reassuring you that it is ok and totally normal to struggle instead of feeling festive. I hope you find this podcast helpful and you now feel ready to thrive and survive the holidays. IG: @therapywithali FB: Alison Seponara https://www.alisonseponara.com/

Dec 7, 2018

Tips To Help You Share Your Mental Illness With Others Welcome back to Your Anxiety Toolkit podcast! Recently on the podcast , I shared my own personal journey of struggling (and now managing) significant anxiety, disordered eating and life stressors. It was a scary, yet brave thing for me to do and I am so glad I did. Because I am constantly telling others that "It is a beautiful day to do hard things," I figured I have to walk the walk, not just talk the talk. It was such an amazing experience to hear many of your reflections and own personal stories on these difficult issues. What surprised me was that one of the most common questions I heard from you guys (my lovely CBT School community and YAY Podcast listeners) was, "HOW do I share my story?" So many people reached out and shared that they wish they had the courage and "know-how" to start telling others about their journey with mental illness. Maybe you want to empower others? Maybe you want to get it off your chest? Maybe you want to reduce the stigma around your own disorder and mental health struggles? So, you know what I did? I called the person I most respect when it comes to sharing her story, Shala Nicely . Together we recorded a podcast episode and talked about what you might want to consider when making the decision to share your story. Shala shared many beautiful personal examples of her own process of writing a memoir about her journey with Obsessive Compulsive Disorder (OCD) and how she handled the ups and downs of this process. Shala and I also talked about HOW to share what you are struggling with a friend or loved one. Shala gives some wonderful tips to decide who to share with and why it might not be who you would have first considered. What no one can prepare you for is your own mental roller coaster that occurs when you share information about yourself. We also address self-criticism and dealing with what I call "sharing remorse" or what Brene Brown calls a "vulnerability hangover" after telling someone your deep dark secrets. One of the things I love the most about Shala is that she is honest and open about the ups AND the downs of sharing. She shares what it is like for her to handle negative feedback and how she manages that through Exposure and Response Prevention (ERP). I hope this helps you come to a decision for yourself.

Nov 30, 2018

Managing Perfectionism and Learning To Be Good Enough (with Kim Foster Carlson) Welcome to another episode of Your Anxiety Toolkit Podcast! This week, we talk about all things anxiety and mental health. Today, I am excited to share with you our guest, Kim Foster Carlson. Kim Foster Carlson is an award-winning broadcast journalist in San Francisco Bay and the author of the book Good Enough: How to Overcome Fear of Failure and Perfectionism To Live Your Best Life . There is not a day in my office where I don't see the debilitating anxiety that is caused by perfectionism. Perfectionism can prevent us from trying new things, paralyze us when we have to perform, and can cause us to be very hard on ourselves. In today's podcast, Kim addressed many of the factors that might cause perfectionism, as well as some super helpful tools to manage it. The difficult part is that we are constantly being bombarded by unrealistic expectations from our family, our social media accounts, from magazines and from our society's expectations. In this interview, Kim and I talk about perfectionism, fear of failure, anxiety and procrastination. Kim shares her history of being an athlete and how perfectionism and the fear of failure caused her to be very hard on herself. Kim also shares her story of going to therapy and realizing that perfectionism was the cause of her anger, anxiety and poor coping strategies. She shared how this was triggered by stressors related to parenting and she was so open about how she got through some very difficult times. Kim details many mindfulness skills that helped her along the road to becoming a "recovered perfectionist." One tip that I loved from today's episode of Your Anxiety Toolkit was Kim's example of Steph Curry, a professional basketball player. Kim emphasized the importance of "finding the joy" (Steph Curry's phrase) in everything we do by practicing gratitude and by verbally thanking someone every day. I just loved this idea and this is a tool I am going to adopt myself. I hope you enjoy this week's episode.

Nov 23, 2018

This is me...doing a hard thing Hello there lovely CBT School Community, You all know how much I adore coming on here every week and sharing cool Cognitive Behavioral Therapy (CBT) tips or fun Mindfulness tools with you all!? As I often say, "these are skills for life" and sometimes we have to stare the dark place of mental illness in the face before we get introduced (and practice) these wonderful tools. Sometimes, we have to hit rock bottom before we ask for help. We have to be struggling so much that we have no choice but to double down and learn the tools we need to live a more mindful and healthy life. This was definitely the case for me. In today's episode of Your Anxiety Toolkit podcast, I share with you my story with Mental Illness. I am not going to lie. I have felt many emotions about sharing my own story. This week's episode is one that has challenged me to be as brave as I can be. I have been thinking about telling my own story of mental illness/health for some time and it has taken me many conversations with trusted colleagues and family members to come to a place where I felt ready. So, today, I bravely share with you my story. This is me….doing a hard thing. In the episode, I talk about how I moved away from my small hometown to go to university. Immediately, I was riddled with anxiety and panic. I felt so painfully alone and I was plagued with the repetitive thought that "something bad will happen." I felt out of control and I had no tools to manage these terrifying feelings. In this episode, I share how I responded to these thoughts in the only way I knew how. I used what some would consider very positive behaviors and use them in a way that became very problematic. Before too long, I was restricting my food, compulsively exercising and binge-eating to manage my emotions. I spent hours planning and calculating my calorie intake and I kept it all a secret, in fear that someone would find out how much I was struggling. I was so afraid of being seen as weak or over-dramatic. These behaviors stripped me of my joy, comfort and my life. My hope with sharing my own personal story is to remind you that you can get better. I also hope that it helps us all feel more connected and a part of the same community. We all have our own story and struggles, and I wanted to share mine with you so you felt I understood what you might be going through. While I might not have exactly the same story (or circumstances), we all get to the place where we have to ask for help. We all get to the place where were feel so out of control that we have to make a change. That was me. And this is me….doing a hard thing. I hope you find it helpful, or comforting. Please know that you can get better and you can get your life back.

Nov 16, 2018

Dr. David Burns Helps Us Learn the Art of Feeling Good Hello! My name is Kimberley Quinlan and welcome back to Your Anxiety Toolkit Podcast. For those of you who are new, welcome! Your Anxiety Toolkit is brought to you by CBTschool.com . CBTschool.com is an online resource that provides evidence-based tools and resources for those who are experiencing anxiety, depression, or other mental health struggles. CBT is an acronym for Cognitive Behavioral Therapy. CBT is made up of Cognitive Therapy and Behavioral Therapy. Today, I am so excited to share with you one of the masters in our field of Cognitive Behavioral Therapy, Dr. David Burns. Dr. Burns has been a legend in my mind for many years. He wrote the book Feeling Good , which I consider one of the most valuable books for the management of faulty and unhelpful thoughts. Dr. David Burns is an adjunct professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine . David Burns is also the author of the best-selling books Feeling Good: The New Mood Therapy , The Feeling Good Handbook , When Panic Attacks , and has a new book being written called Feeling Great (I cannot wait to read this one!). Dr. David Burns brings Cognitive Therapy, Buddhist foundations and principals, and Behavioral Concepts into this amazing work. Dr. Burns also created and copyrighted The Burns Depression Checklist, which is a rating scale for depression that I use very often in my office. In our interview today, David Burns helps us by teaching how to better approach our faulty cognitions that cause depression. Burns states that 50% of anxious people will be depressed and 100% of depressed people will be anxious. He strongly believes that much of our depression is directly related to our faulty thoughts, which I am sure you will all find very interesting and inspiring. What David Burns teaches us is how to correct our depressive thoughts and come up with strong, powerful statements to counter their incorrect content. We talk about themes such as hopelessness, helplessness and worthlessness. Please note, there are points made by Mr. Burns regarding medication, but I really encourage you to speak with your doctor to make sure your medical and medication plans are best for you. Every person is different and needs specific care. Dr. David Burns also addresses these topics during the interview: Thoughts are the cause for depression. If you can change the way you think, you will change the way you feel. Recent studies researched Feeling Good , to test if it clinically helps those who are experiencing depression, and results showed it is highly effective for those who suffer from depression. How he conceptualizes recovery as either 100% recovery (where all symptoms are gone) and 200% recovery (a stage and experience of enlightenment).

Nov 10, 2018

ONE Day Non-Judgment Challenge Hello and welcome back to Your Anxiety Toolkit Podcast. Today we are talking about an interesting challenge. You see, recently I was dared to take an entire day to just listen to my body and feel my feelings and sit in peace. I thought this was a fabulous idea so I shipped my kids and husband away for one day (I never do this BTW) What quickly arose was one thing that was taking the joy out of what could have been a lovely day. That thing was Self-judgment. Self-judgment is the thing that kept bringing me out of simply spending the day with myself. "I should be doing this instead" "You are being lazy" "Why did you choose that activity?" "You have to do it this way because that way is a waste of money" "You shouldn't be feeling this way" "You don't deserve this" "Why did you do it that way?" "Why are you the way you are? Here are just a few of the self-judgment statements we say to ourselves during the day. When you see it on paper, it sounds so awful. Yet, these are things we say to ourselves without hesitation or even awareness sometimes. So, I decided to change the focus of the day away from it being a day of freedom and pleasure and towards a day where I practiced non-judgment. I called it the NON-JUDGMENT CHALLENGE DATE DAY (or #nonjudgmentdateday on social media). So, here is the challenge. Non-Judgment Challenge Day is a day where you go out on your own for a whole day (or an hour or two) and you practice doing things you enjoy doing. Do something pleasurable or exciting or new. As you do this, be very aware of the thoughts in your mind. During this date with yourself, observe your thoughts, both positive and negative, about yourself and the activity you are engaging in. Non-Judgment Challenge Day was a complete eye opener for me and I strongly encourage you to try it. Listen in to this episode of Your Anxiety Toolkit Podcast to hear about my reflections and struggles with my very own Non-Judgment Challenge Day. Also, I just wanted to let you know about "What if?", a collaborative film project by Robin Roblee-Strauss for his senior thesis project at Hampshire College. "What if?" Is a movie that documents the experiences of living with OCD . The film focuses on the voices of those struggling with OCD as the experts on their own internal experiences and recovery processes. And guess what....you can be involved in its creation! Go to www.whatifocdmovie.com to learn how you can be a part of the project by sharing your story, contributing cinematic or artistic expertise, or donating. By creating a movie with the help of individuals with OCD, Robin hopes to empower sufferers to speak out and show the world a brave and honest look into the struggle with uncertainty and anxiety.

Nov 2, 2018

Tips To Manage Anxiety At Work Welcome back to another episode of Your Anxiety Toolkit. Today's topic was a suggested topic be one of the members of our online FB group, CBT School Campus . One of the members asked for tips to manage anxiety at work. This is a very important topic, as it is common for some to appear to be highly functioning, but underneath, they are riddled with anxiety and feel like they have no tools to manage their anxiety. The hard part about managing anxiety at work is that it is a practice of multi-tasking. Not only are you fulfilling requirements of your job description, but you are also trying to manage intrusive thoughts, uncomfortable feelings and (sometimes) terrifying urges. These are common symptoms of Generalized Anxiety Disorder (GAD) , Obsessive Compulsive Disorder (OCD) , Social Anxiety, Health Anxiety (hypochondria) and Panic Disorder . So, this week we are addressing 10 tips to manage anxiety at work, school, volunteering or other activities that you might do. Don't get me wrong. There are many other tools that could be used, but these are some of the ones I thought might be the most helpful. Here is a quick overview of the 10 tips to manage anxiety at work: Don't aim for no anxiety. Accept that it will be there Don't judge yourself for having anxiety There is nothing "wrong" with you for having anxiety. You are not "bad" for having anxiety Your worth doesn't change because of anxiety's presence Do a Door check (listen to the episode for more information on this) Pull your shoulders back Create a strength-based statement to get you through the hard times "We can do hard things" "This too will pass" "I am stronger than I think I am" "I have done hard things before and I survived" Set small, realistic goals Focus on only one client at a time Do one job or one assignment at a time Have rewards for work well done Implement a consistent and strong self-care plan: Getting exercise and sleep, as well as reducing caffeine and alcohol, is a good start. Begin a Self-Compassion practice You have to name emotions to tame emotions. Bring on that Anxiety, baby! Try to stare your fear in the face as much as you can. I hope that has been helpful! Have a wonderful day and don't forget to leave us a review on iTunes or Stitcher or wherever you tune in.

Oct 25, 2018

The Best FREE Mindful Tool Is... Clients and the CBT School community are often asking me for tools and tricks to manage anxiety . Thankfully, we are so blessed there are so many scientifically proven tools and treatment modalities to help those with anxiety, depression, and other struggles. However, I feel the need to bring us back to a mindful tool that we can use any time we want. The great thing about this tool is that it is THE BEST FREE MINDFUL TOOL! That's right! It is the best, and it is free. Before we do that, I want to look at things abstractly for a second. I promise it will make sense once I tell it so hear me out. Let's say I want to be a great mom. I want my daughter to think I am the freaking best mom ever. Here is the thing! Just because I am her mother, that doesn't automatically mean she and I will be good friends and have a great relationship. Or, that she will even like me. To be a freaking rockstar mom, and to make a lasting impact on her heart and well-being, I am going to have to nurture her and our relationship. I am going to have to hear her pains. I will need to sit with her when things are hard. She will need me to hold her hand and be compassionate when she makes mistakes. And wipe her tears when she cries. And most of all, she will need me to not deny her of her anger and sadness and brattiness. I am going to need to really be with her. To have a nurturing and healing relationship, I can't cheat and do it the fastest way. She is not going to think I am an amazing mom just because I buy her the newest iPad and get her the best clothes and hire the best nanny to take care of her all the time. Those things are great and will make her happy for the short term, but they won't result in a good relationship with my daughter in the long term. She won't feel deeply loved by me and she won't feel deeply seen. If I want to have a lasting and healthy relationship, I have to actually sit with her. Be with her. Not disown her because she is angry or being naughty. I can't just leave it to the nanny to fix her when she is sad or angry or not cleaning her room. I can't buy her a trip to Disneyland and send her off with the nanny and expect that she will feel loved by me just because I arranged it and paid for it. If I do that, she will understand that I will only be there when she is good, or when it is easy, and she will not feel worthy when she is having tough emotions. Here is where the healing and growth occurs. So, here is this week's lesson. When it comes to your mindfulness practice, you can't cheat. You too have to do the actual "being with." Our relationship with ourselves is no different. We all want to be deeply understood. We all want to feel worthy of being sat with. We all know that feeling deeply seen is one of the most healing experiences we can be given. Here's the big question for this podcast episode. Do you try to cheat when it comes to actually spending time with yourself and deeply sitting with your experience? My guess is you are saying Yes. We cheat ourselves on self-care and just "being" all the time. So, let's talk about how we befriend ourselves. This is the best FREE mindful Tool I am talking about. The best free Mindful tool is your breath. We disregard breath as one of the best mindful tools and we push forward wanting more supercharged, easier tools. During this podcast, we do a short breathing meditation, in hope to simply honor our "being" and "spend time with" ourselves. Returning to our breath really is the best free mindful tool. Before we go, here is a reminder to check out our swag! WE ARE SO THRILLED TO FINALLY BE OFFERING IT! We have an array of t-shirts and tanks for men, women, and children. Each product has our very own CBT SCHOOL motto, "It is a beautiful day to do hard things." Check it out at the following link! https://www.etsy.com/shop/CBTschool

Oct 19, 2018

How To Talk To Others About Mental Illness (with Representative Michael Schlossberg) Hello there and welcome back to another episode of Your Anxiety Toolkit podcast. Today we have the final episode of the "We can do hard things" series; a series of episodes where we have inspirational and courageous guests who talk about hard and life-changing things. I have enjoyed this series so much and hope to start it back up again early next year. I just loved having all of the wonderful guests, who inspired me to be better and brave and more courageous. Today we are discussing how to talk to others about mental illness. I often get asked questions about how to share your story of having Obsessive Compulsive Disorder or Eating Disorder or Panic Disorder or depression with loved ones. If you are wondering how to talk to others about mental illness, this is the episode for you. In this week's episode, we have State Representative of Pennsylvania, Michael Schlossberg. Michael Schlossberg is not only a State Representative. He is a mental health advocate and the author of the fiction book Redemption . Redemption is a science fiction book about a character who defeats depression and anxiety. If you are interested in reading this book (the first of a three-part series), click HERE . During this episode of Your Anxiety Toolkit podcast, Schlossberg talks about his response to Robin Williams' death by suicide and how that propelled him to be more open about his own depression and anxiety. We talk about the experience of depression and how it can keep you feeling alone and isolated. Schlossberg has many pieces of helpful information on how to talk to others about mental illness. He talked about how talking to others about his mental illness made him feel closer to others and how it helped him to be more accepting and kind to himself. The best advice I took from this episode was "There are more people in their rooms crying than you would ever notice. 1/5 Americans have depression. You are not alone." Click HERE to learn more about Michael's story and his focus on mental health in his governmental work. Find him on Facebook HERE and Twitter HERE .

Oct 12, 2018

How To Let Go of the Past This week's episode of Your Anxiety Toolkit Podcast is my response to a question that came directly from the online Facebook group CBT School Campus . It is based upon the following: how to let go of the past. This question was one that the online group agreed was incredibly painful and one that was very difficult to approach. If you aren't familiar with CBT School Campus, go check it out. CBT School Campus is an online group of wonderful people who support each other as they do hard things! The group includes people who are struggling with anxiety , depression and other mental health issues. Each member is kind, supportive and helpful. Here is the question: "One of my obsessive regulars is about things from the past that my mind twisted and has blown way out of proportion (at least that's what my non-OCD support people tell me. Ha!), but the memories cause me immense guilt/shame because I question my motives and wish I hadn't done it. I do my exposures to try and accept that I may have had the wrong motive, it may have been inappropriate, I may be bothered by it forever, etc. My struggle lies in the yucky, depressed, guilty feeling it gives me as it looms and sucks the joy. That often leads to the worry of suicide if I can never get over it. I try to welcome the yuck, keep moving, etc. Anything specific that has helped you?" What a great question! During this podcast, I talk about how we misinterpret events from the past and use past events to calculate or define ourselves, our worth and our value. This miscalculation (or rating game) can become a compulsion and as you might already know, the more you review yourself, the more you find to be upset about and the worse you feel. DON'T FORGET, THIS WEEK IS OCD AWARENESS WEEK! CLICK HERE FOR INFORMATION. WE ARE SO THRILLED TO FINALLY BE OFFERING SWAG! We have an array of t-shirts and tanks for men, women, and children. Each product has our very own CBT SCHOOL motto, "It is a beautiful day to do hard things." Check it out at the following link! https://www.etsy.com/shop/CBTschool

Oct 5, 2018

Everything You Need To Know About Self-Compassion (Interview with Paul Gilbert) This week's episode of Your Anxiety Toolkit is going to blow your mind! Yes! You better believe it! If you have been thinking you should start a self-compassion practice for yourself, THIS is the episode for you. Today we are going to discuss everything you need to know about self-compassion. This week I am so honored to talk with Paul Gilbert, Professor of Clinical Psychology at the University of Derby and Consultant Clinical Psychologist at the Derbyshire Health Care Foundation Trust. Paul Gilbert is what I consider a Self-Compassion and Shame "Guru." We all know shame and we all know how difficult shame can be when it comes to Anxiety Disorders, such as Obsessive Compulsive Disorder (OCD) , Social Anxiety, Specific Phobias , Panic Disorder, Generalized Anxiety Disorder (GAD), and Body Focused Repetitive Behaviors (BFRB's) , such as Trichotillomania (hair pulling) and Dermatillomania (compulsive skin picking) . Paul shares with us his beautiful insight and understanding of the human brain and how to apply self-compassion in our daily living. So much of what Paul has to say compliments the discussions we have had on the podcast already. Professor Gilbert performed psychopathology research for over 35 years with a special focus on shame and the treatment of shame-based difficulties. Paul Gilbert was the founder of Compassion-Focused Therapy (CFT) and I am certain you are going to LOVE what he has to say. Paul Gilbert has written and edited 20 books and established the Compassionate Mind Foundation in 2006. He was awarded an OBE in March 2011. During this interview, Paul shares everything you need to know about self-compassion. Paul explains his work and research on self-compassion and how he came to practice and develop Compassion-Focused Therapy. Paul addresses why he thinks we are so hostile or self-critical towards oneself and what he considers the most important tools for practicing self-compassion The most beautiful part of this podcast episode is that we ALL need to be better at practicing self-compassion. As a reminder, it's BFRB Awareness Week (October 1-7)! Click here for more information on BFRB School, which is a complete online course for Body-Focused Repetitive Behaviors (BFRB's). Lastly, OCD Awareness Week is coming up from October 7-13! OCD SoCal will celebration OCD Awareness Week on October 7 from 1:00 pm-5:00 pm in Los Angeles, Orange County, and San Diego. Go to IOCDF.org or search your local area for events.

Sep 27, 2018

How To Do HARD THINGS...It's A Beautiful Day For It!! Welcome back to another Your Anxiety Toolkit Podcast episode! This week's episode of Your Anxiety Toolkit is all about How to do Hard Things. I know I say "Its a beautiful day to do hard things" all the time, and sometimes people message me or email and ask me, "How do I do hard things?" Even friends and loved ones might call to ask, "Can you teach me how to do hard things?" These hard things might be doing Exposure & Response Prevention (doing something that scares you), taking a test, going to a doctor visit, traveling long distances, feeling intense feelings such as sadness or grief, delivering a speech, experiencing pain or any other event that scares the pants off you. :) A little note on this before we move on; Doing a Hard Thing is doing the thing that scares YOU, even if it doesn't scare others. If it is hard for you, it is hard. Try not to judge yourself or compare yourself to what is hard for you vs. others. After talking with a dear, loved one this week about an upcoming "hard thing" they were preparing to do, I decided to write them a letter. My hope was they could read it as they prepared to stare their hard thing in the face (take that hard thing!). After sending it, I wondered if maybe you needed a similar letter. So, here we go. Here is the letter I sent my friend. I hope you find it helpful in understanding how to do hard things. "Hi my love, Here are the most important things to remember when dealing with fear, dread, and panic. Just because your brain is telling you there is "danger," doesn't make it true or real or correct. Our brain misfires (and make mistakes) ALL the time and it is our job to help direct it back to more reasonable reactions. If we react with resistance, we keep training it to misfire. Our job is to just allow the anxiety, without reacting to it. We gently allow it to be present and allow it to rise and fall on its own. With this practice, we not only re-train our brain, but we learn that beyond this moment of discomfort is freedom. Just a few minutes beyond this discomfort is our opportunity to do whatever the fuck we want with our lives. Fear doesn't get to make our decisions. Our values and hopes and dreams do. You are strong, but you don't have to be stronger than fear. It's not a fight, so don't fight it. Slow everything down and gently say to it, "its ok, fear. I am just going to allow you to be here while I do the thing I love to do. You don't get to control me. Love, Kimberley" Also, CBT School is also excited to share that our lovely friend Stuart Ralph is offering The OCD Summit, an online summit specifically for OCD therapists. The OCD Summit will be a 6-week webinar series where Stuart Ralph, host of The OCD Stories podcast, will interview some incredible scientists and clinicians in the OCD field, with you the therapist as the audience. Kimberley is honored to be selected to be one of the panelists for this exciting event. Registration will include 6 topics curated for your continued development as an OCD therapist, where you can ask questions and network with other therapists in the private FB group community. Click here to join. Lastly, OCD Awareness Week is coming up: October 7-13! OCD SoCal will celebration OCD Awareness Week on October 7 from 1:00 pm-5:00 pm in Los Angeles, Orange County, and San Diego. Go to IOCDF.org or search your local area for events.

Sep 20, 2018

Grieving the Losses of Mental Illness Psst! This wasn't planned, but we decided to keep ERP SCHOOL open for ONE MORE DAY! If you are still interested in purchasing the online course for Exposure & Response Prevention (ERP) SCHOOL , it is available until midnight tonight (9/21/18). It didn't feel right to release a podcast the day after the cart was closing and risk you missing out by only one day. So, this is the last day, I promise (for 2018). I am so grateful to everyone who supported me and sent me information about their successes since signing up and taking the course. This week's episode of Your Anxiety Toolkit Podcast is possibly one of my most favorites. The reason for this is that this episode will give you so much validation for the pain you are going through. In this week's episode, we have Chrissie Hodges , a Peer Support Counselor for mental health. In this episode, Chrissie talks with us about the importance of Peer Support and how she offered her own experience of recovery as a way to help guide and lead those who are also managing Obsessive Compulsive Disorder , Depression, Anxiety and many other mental illnesses or struggles. Chrissie also addresses a topic I have been wanting to talk about for the longest time, which is life AFTER treatment. It is such a common question I get asked. How do we survive when life looks so different? How to get past how difficult that experience was? What can I do to grieve the losses of mental illness? The truth is, grieving the losses of mental illness is brave and courageous work. It requires us to honor our experiences and allow ourselves to feel some pretty hard and uncomfortable feelings. Grieving the losses of mental illness allows us to forgive ourselves for the hard times and the time lost. This episode of Your Anxiety Toolkit was quite a powerful one for me. Chrissie got real about her own process of grieving the losses of mental illness (specifically Obsessive Compulsive Disorder, Anxiety, and Depression). Chrissie also shares her experience with suicidal ideation and a suicide attempt that has traumatized her since. She also shares how difficult it has been on her body and how it has caused her to disown parts of her body and soul. If you are someone who is also grieving or feeling hopeless about all that you have lost in managing your mental illness, then this is the podcast episode for you. Links: Coffee with Chrissie Podcast Chrissie Hodges Website Chrissie Hodges Youtube

Sep 14, 2018

Seasonal Affective Disorder (SAD) is REAL and TREATABLE! This podcast episode of Your Anxiety Toolkit is all about the Seasons. I have received a lot of requests to talk about changing seasons as we move from Summer to Autumn (here in the Northern Hemisphere). It isn't just here. I am sure it is all around the world right now, as the seasons change from Winter to Spring for the Southern Hemisphere (Love you Australia!). There is no doubt that the seasons impact out mental health. In this week's podcast, I look at a few important things to consider when managing anxiety , depression, OCD and other mental health issues. First let's look at how the change in temperature impacts us on a Medical level. Seasonal Affective Disorder, also known as SAD, is understood to be a seasonal depression, affecting 5% of the population of US residents. Yes! It's that high. If you are someone who is highly impacted by the temperature changes, you are definitely not alone. Seasonal Affective Disorder (SAD) can be treated with light therapy, outdoor activity and medication. Seasonal Affective Disorder isn't just due to changes in seasons. It often occurs when daylight saving times changes and we "fall back," meaning we have less light during the day. When days get shorter, we have less time to get outdoors and move our bodies and soak up that glorious sunlight, which is linked to Seasonal Affective Disorder symptoms. We also know that colder weather can affect our circadian rhythms, causing us to have more depressive symptoms. When we are tired, we have less energy, causing us to feel down or sad or, in some cases, depressed. We also know that the season changes impact us on a Psychological level. We can also see changes in our thoughts. Negative thoughts can create depressive symptoms such as hopelessness, helplessness and worthlessness. Our job is to correct any negative or faulty thoughts so we are not so impacted by the weather or time changes. We can also be more mindful when these thoughts arise. In this episode, we also can look at the seasons from a metaphorical stand point. We need to be careful how we approach the seasons, similar to how we approach our emotions. We could consider some emotions as winter (like sadness and shame and guilt) and some emotions as summer (like happiness and joy and arousal). We could consider autumn being patience and letting go and shedding what doesn't serve us. We could also consider spring a time where we feel free and hopeful and alive. Metaphorically, if we treat one season (environmentally or emotionally) like it is less than or worse than, we will in turn start to have aversion to it. In this episode, we talk about how to be open to all of the seasons, whether you enjoy them or not. Lastly, Exposure & Response Prevention (ERP) School for Obsessive Compulsive Disorder (OCD) is HERE ! Exposure and Response Prevention School is an online, video-based course that teaches you the tools and skills I teach my clients in my office. The doors are only open to purchase ERP School from September 6th, 2018 until September 20th, 2018. Six more days!! We are so excited to share ERP with you and would love to have you join us and the CBT School community. Its a beautiful day to do hard things!

Sep 6, 2018

ERP Is the Coolest Thing! If you have Obsessive Compulsive Disorder or any other mental health struggle, you are going to LOVE this episode of Your Anxiety Toolkit. This week we have Nathalie Maragoni , an Associate Marriage and Family Therapist who not only treats Obsessive Compulsive Disorder (OCD) and other anxiety disorders , but also knows exactly what it is like the experience the terror of intrusive thoughts, panic attacks and brutal compulsions. She said it best herself: "ERP is the coolest thing!" In this episode of Your Anxiety Toolkit, Nathalie talks with us about how she struggles finding the correct therapy for her Obsessive Compulsive Disorder (OCD) and how she drove for over 1.5 hours to get a treatment specialist who used Exposure & Response Prevention (ERP). Nathalie also talks about her struggle with different types of obsessions and compulsions. She says, "Willingness is the key to managing OCD" and she could not be more correct about this. We just loved how she shared her love for Exposure & Response Prevention and how "ERP is the coolest thing!" Nathalie shares the importance of continuing ERP after treatment. She found that getting the proper treatment alone (ERP) was not enough to help her live a full and thriving life with OCD. She discusses the importance of applying Acceptance and Commitment Therapy (ACT) and how this helps her live a value-based life where she can just allow thoughts to be there, instead of fusing with them. For more information about Acceptance & Commitment Therapy, click HERE . Nathalie talks about how she is using the book The Happiness Trap to help her understand that "Every experience comes with a good feeling and a bad feeling." In other news, Exposure & Response Prevention (ERP) school is HERE . Exposure and Response Prevention School is an online course that teaches you the tools and skills I teach my clients in my office. Just like Nathalie says, ERP is the coolest thing! Let me tell you a little bit about it. The course is a video-based course that includes modules on: The science behind ERP Identifying YOUR obsessions and your compulsions The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP Mindfulness tools to help you manage anxiety, panic and uncertainty Troubleshooting common questions and concerns BONUS videos explaining the most common subtypes of OCD and how to apply ERP to these obsessions and compulsions. The course also includes many downloadable PDF's and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions. We are so excited to finally share ERP with you and would love to have you join us and the CBT School community. Its a beautiful day to do hard things! If you are worried about doing it alone, please don't fear. We meet bi-monthly on the FB group and on IG to talk about questions you may have. Nathalie Maragoni is an Associate Marriage and Family Therapist at OCDSpecialists.com . They now have offices in Bakersfeild and Los Angeles under Supervisor, Stacey Kuhl Wochner. Nathalie can be found on Instagram at @mindonfire_ocd .

Aug 30, 2018

Don't Try Harder, Try Different with Patrick McGrath Welcome back to YOUR ANXIETY TOOLKIT PODCAST! We have some SUPER exciting news this week. We are offering a NEW and FREE training called "The 10 Things you absolutely need to know about Obsessive Compulsive Disorder (OCD)." This webinar will be great if you are new to OCD and looking for some direction. It will also be a fantastic refresher into the key concepts of OCD treatment, if you are already on your road to recovery. If you are interested, click HERE to check it out. Next piece of exciting news! ERP school will be here in less than ONE WEEK! Heck yes!! Exposure & Response Prevention (ERP) School is an online course for those who don't have access to a therapist who practices ERP and science-based skills for OCD. I will be talking a lot about this in the next few weeks, as the doors are only open to purchase ERP School from September 6th, 2018 until September 20th, 2018. Keep it in mind that this course will only be available to purchase during that time. ONE WEEK!! It is right around the corner and I could not be happier and more excited. Do you ever feel like you are doing the same thing, over and over, with no change in result? You realize your fruitless outcomes and you decide you are going to try harder this time. You might even make a pact with yourself that you will NEVER do that one thing again and you promise yourself that this is the time it will be successful. But, just like last time, you get the same result and you are left feeling overwhelmed and hopeless. Well, if this is you, this episode is going to change some things for you. This week we have a wonderful interview with Patrick McGrath, Ph.D., who is a psychologist based out of Illinois specializing in the treatment of anxiety disorders. In addition to being the president of a private practice group called Anxiety Centers of Illinois, Patrick McGrath is also the Clinical Director of the AMITA Health Alexian Brothers Behavioral Health Hospital's Center for Anxiety and Obsessive-Compulsive Disorder Program and President of OCD-Midwest, an affiliate of the International OCD Foundation . I met Patrick at the IOCDF Conference and we immediately hit it off and agreed to do an impromptu interview. It was so much fun! You might even notice it was more of a conversation than an interview, but I loved it and was so thrilled to hear Patrick's wisdom. If you are at all interested in taking the Exposure & Response Prevention School (ERP SCHOOL) course, Patrick's talk today might help motivate you towards that goal. He beautifully talks about how to DON'T TRY HARDER, TRY DIFFERENT and this is definitely a concept you have to consider when starting ERP. Patrick also discusses the steps his clients need to know to move towards a "Don't try harder, try different" approach. Click HERE for more information on his stress management workbook titled Don't Try Harder, Try Different and HERE for more information on his book titled The OCD Answer Book: Professional Answers to More Than 250 Top Questions about Obsessive-Compulsive Disorder . I hope you enjoy this interview as much as I did! If you are at all interested in taking the Exposure & Response Prevention School (ERP SCHOOL) online course for Obsessive Compulsive Disorder (OCD), click HERE .

Aug 25, 2018

Addressing Fear Like A Scientist In this episode of Your Anxiety Toolkit, we talk about Addressing Fear like Scientists. Not the scary white haired kind! In this week's episode, we talk about becoming scientists who run studies that are rational, evidence-based, and experienced-based. Each time we have a thought, we have an opportunity to be a scientist. Don't worry about those white coats. You don't need them for these experiments. And you don't need to have a fully fledged scientist degree either. The human brain has up to 70,000 thoughts per day. That is a LOT of thoughts. When it comes to managing anxiety , much of the work is being able to identify which thoughts that are distorted (or errors) and which are not, so we can respond skillfully and mindfully. This is not an easy feat and takes ongoing work and courage. The other day, I started thinking about all the lovely people who are being tormented by scary intrusive thoughts, unwanted emotions, and sensations that make them think and feel like there is something wrong with them. Sometimes these intrusive thoughts make us believe that something bad will happen, or that terror is on its way. Often when we have these unwanted, intrusive thoughts, we go into a pattern of trying to disprove these possibilities. We start to shift our day, just to prove that this is in no way possible. We try to make the uncertain, certain. The problem with this is that we are not actually resolving the issues in REALITY. What we do when we have these obsessions is we create a new reality where the fear is less likely to occur. We do this by avoiding events or people or places. We also try to ensure that our fear won't come true by mentally reviewing all of the possible scenarios and how they might play out. Once we have mentally exhausted ourselves with identifying what specific scenarios might cause troublesome outcomes, we promise ourselves to never put ourselves in those situations. How To Address Fear Like A Scientist Addressing Fear like a scientist involves asking yourself a few very hard questions. Take a look at these questions and do a quick review on how you are responding to your anxiety and depression. What hypothesis (theory) is my depression, anxiety, obsessive compulsive disorder (OCD) trying to prove? Is this hypothesis true and based in reality and reason? Can I test the evidence in a non-biased way? Can I look at it from every angle without running away from fear? Or trying to solve it? Or steer the outcomes? Can I sit with the results of the experiment? Am I spending my time trying to prove my hypothesis or am I open to actually doing the work of a scientist, who is unbiased and accepting of the outcomes? I invite you this week to be more vigilant about addressing fear like a scientist who tests the hypothesis in a non-biased, rational and reality-based way. I know this is hard, but you know what I am going to say here. It is a beautiful day to do hard things. Also, CBT School is also excited to share that our lovely friend Stuart Ralph is offering The OCD Summit, an online summit specifically for OCD therapists. The OCD Summit will be a 6-week webinar series where Stuart Ralph, host of The OCD Stories podcast, will interview some incredible scientists and clinicians in the OCD field, with you the therapist as the audience. Kimberley is honored to be selected to be one of the panelists for this exciting event. Registration will include 6 topics curated for your continued development as an OCD therapist, where you can ask questions and network with other therapists in the private FB group community. Click here to join.

Aug 16, 2018

The Anxiety of Decision Making Is REAL and EXHAUSTING! Experiencing and managing anxiety is a hard and courageous task. And you guys know what I am going to say next. It is a beautiful day to do hard things! One activity that is made difficult by anxiety is the process of making decisions. Making decisions can be exhausting and brings up a lot for us. When making decisions, we might be faced with anxiety about making the "right" decision. We might also be faced with the anxiety of making the decision that won't hurt others or impact others negatively. We might also be faced with anxiety that our decision will cause us to miss out on something better or more beneficial to our long term goals. This constitutes the anxiety of decision making. Basically, making decisions is the ULTIMATE exposure to uncertainty and tolerating discomfort. There is no way to make a decision without acknowledging and facing uncertainty. Here is a teaser from the episode. Even when you put the decision making aside, you are actually making a decision. Not making a decision is technically making a decision you didn't even know existed. This weeks podcast is all about The Anxiety of Decision Making. We go over some of the themes that come up surrounding decision making such as Hyper-responsibility, Fear of Missing Out (FOMO) and Perfectionism. We also talk about how we must embrace uncertainty in our lives and accept that life doesn't need to be perfect. This can be easier said than done, so we discuss some important mindfulness tools which can help us manage perfectionism, hyper-responsibility and Fear Of Missing Out (FOMO) when it comes to decision making. We hope you enjoy this week's podcast episode or Your Anxiety Toolkit. Also guys, we are excited to share that ERP SCHOOL is going to be released VERY soon, so keep your eyes out. CBT School is also excited to share that our lovely friend Stuart Ralph is offering The OCD Summit, an online summit specifically for OCD therapists. The OCD Summit will be a 6-week webinar series where Stuart Ralph, host of The OCD Stories podcast, will interview some incredible scientists and clinicians in the OCD field, with you the therapist as the audience. Kimberley is honored to be selected to be one of the panelists for this exciting event. Registration will include 6 topics curated for your continued development as an OCD therapist, where you can ask questions and network with other therapists in the private FB group community. Click here to join.

Aug 9, 2018

"Trust your capacity to change" - Tara Brach Interview I am thrilled and honored to share with you an interview I did with my absolute idol, Tara Brach. If you don't know who Tara Brach is, let me introduce to you an amazing and inspirational human. Tara Brach is a leading Western teacher of Buddhist Meditation, emotional healing and spiritual awakening. Tara is a Clinical Psychologist, meditation teacher and Author of Radical Acceptance and True Refuge , two of my favorite books. In addition, Tara Brach, along side Jack Kornfield, co-founded the Awareness Training Institute (ATI) and the Mindfulness Meditation Teacher Certification Program (MMTCP) . For me, Tara's podcast ( tarabrach.com ) was (and is) one of the most important parts of my own personal development and growth. For hours I would (and still do) walk the neighborhood while listening to her podcast. Tara helped me through some of the hardest times in my life and allowed me to access her tools and wisdom through a freely offered podcast and streaming service that inspired me to create CBTschool.com . Tara taught me to be a fearless mental health advocate, so you may see that much of CBT School follows her goal of offering skillful and generous work. While I was in Washington, DC for the International OCD Foundation conference , I was lucky enough to meet with Tara in person before her Wednesdays with Tara Meditation Talk and ask her some questions about anxiety and mindfulness. I am still freaking out with excitement that I had the opportunity to meet her in person and then get to interview her for the Your Anxiety Toolkit Podcast. My goal for this podcast episode was to zero in to the questions I often get asked and see what Tara's response would be. True to form, Tara gives us some BEAUTIFUL responses that are easy to understand and apply. In this interview, we talk specifically about how uncertainty can be one of the hardest and most challenging parts of anxiety, Obsessive Compulsive Disorder (OCD) , panic attacks and depression. Tara gives some amazing mindfulness tools to help us approach uncertainty. We also talked about her book, Radical Acceptance and what some of the road blocks are to radically accepting our discomforts or fears. If you haven't read her books, I strongly encourage you to. Tara has a way of bringing compassion into the room, even if she isn't physically there. Tara gives us tips on how to implement Mindfulness practices into our everyday life and normalizes the struggles we all have with this. One of the questions I was most interested in asking Tara was her advice for those who are deeply suffering with mental health right now. She so beautifully responded with compassion and deep knowledge of mindfulness practice. This answer brought me to tears and I am so grateful for having this experience with her. And, last of all, I just had to ask Tara about why she uses humor in her meditation talks and Tara kindly shared with us one of her favorite jokes. Tara used humor a lot to help us understand our own reactivity or idiosyncrasies and I just loved having a little chuckle with her. So, as you can see, I am just a teeny bit in love with Tara (wink, wink). I really hope you get as much as I did out of this episode. Thank you so much Tara for your kindness and generosity. Ok folks! DO NOT FORGET to stay til the end of the episode because Tara so kindly gives an AMAZING GIFT at the end of the interview for our wonderful CBT School community.

Aug 2, 2018

My IOCDF Conference Key Takeaways One of the biggest honors I have as a therapist who treats anxiety disorders is to present at the International OCD Foundation (IOCDF) annual conference. I just adore these conferences, mostly because they provide a mix of both treatment presentations and support groups for those who struggle with Obsessive Compulsive Disorder (OCD) and for therapist who provide evidence based treatment for those who have OCD. Another amazing thing about these conferences is that they also provide support groups and presentations on Body-Focused Repetitive Behaviors (BFRB's) such as Trichotillomania (Hail Pulling) and Excoriation Disorder (Skin Picking) and Body Dysmorphic Disorder (BDD) and also co-occuring Eating Disorders and Substance Abuse. In this episode of Your Anxiety Toolkit, I wanted to share with you some of my reflections from running several support groups and attending some amazing presentations by some of the top treatment providers in the world. The IOCDF.org put on such an amazing event and I have to admit, this one was by far my favorite. At this years conference, I was honored to co-facilitate a new support group called the Compassion Collective with a dear friend and colleague, Michelle Massi. Michelle and I gathered every morning at 7AM (yes, it was VERY early) to meet with attendees who wanted support with self-compassion. Each morning we provided a new compassion tool to help those who are struggling with Obsessive Compulsive Disorder (OCD) . This was such an beautiful experience, as we got to really see inside the minds of the attendees and hear what is getting the way of them practicing self-compassion. Interestingly, perfectionism and fear of failure were two of the key components or self-compassion sabotage (which I speak a lot about in this weeks podcast episode). I was also honored to be a part of a presentation called "Let's Talk about Sex Baby!" This presentation was a question and answer formatted presentation where attendees asked very intimate questions about how OCD and anxiety can impact sex. One of the most interesting themes of these presentation was just how uncomfortable people were about discussing sex with their therapist. We had a very OPEN and HONEST dialog with attendees about sex and normalized it. Finally, I was lucky enough to get to run the Co-existing OCD and Eating Disorder group this year with Beth Brawly. Beth and I have ran this group several times and I love it SOOOO much. There is a fine line where OCD and Eating Disorders combine and we met to help attendees break down faulty views of body, health, body size, food and body image. It was so wonderful to see some very brave families join together to support their family members who are struggling. Fore more information on the IOCDF, click here . Lastly, this is a friendly reminder that ERP School (our online course for Exposure & Response Prevention for Obsessive Compulsive Disorder and other Anxiety Disorders) is COMING SOON, so stay tuned. Sign up HERE to be on the waitlist and be alerted as soon as it is available.

Jul 27, 2018

"You are right where you need to be" with Cami Julaine Well folks! Welcome back to another episode of Your Anxiety Toolkit. Today, we have another amazing guest interview as a part of our "We can do hard things" series. I am so excited to share with you an amazing interview with Cami Julaine, an avid mental health advocate, blogger, singer, actor and all-around wonderful person. In this week's episode, Cami shares her journey through Obsessive Compulsive Disorder, an Eating Disorder, Trichotillomania, Panic Attacks and Trauma. One of the things I love the most about Cami is that she is so authentic and open. I know we all struggle with finding the motivation to keep moving forward sometimes, as managing Anxiety Disorders such as Panic Disorder, Obsessive Compulsive Disorder (OCD), Social Anxiety, Phobias, Health Anxiety can be very difficult. Cami shares with us a inspiring story of how she went from rock bottom to taking bold steps towards her recovery. Cami shares her story of being supported by family members and close friends (ahem, Paula Abdul) who urged her to get help. This is an incredibly interesting and informative interview, as Cami shares how she had to blend many types of tools (and therapy) to get her to where she is today. Cami shares some wonderful mindfulness tools to help manage Panic Disorder and Panic Attacks. You will really love these tools, as they are very similar to ones we have discussed in previous episodes of Your Anxiety Toolkit, with a little Cami Juliane-twist. :) Cami also talks about her experience with Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). Finally, Cami shares with us how she has integrated spirituality with her recovery and how she practices self-care and self-compassion as a part of that practice. This is a topic that I have't touched upon much at all and I am sure you will find it inspirational and validating. You can find Cami Julaine on Instagram @camijulaine and more information on her website here . One thing before we say goodbye. GET READY...because ERP School (our online course for Exposure & Response Prevention for Obsessive Compulsive Disorder and other Anxiety Disorders) is COMING SOON, so stay tuned. Sign up HERE to be on the waitlist and be alerted as soon as it is available. PS: The first 20 people to sign up get a free, exclusive "We Can Do Hard Things Meditation" that you can download and use as often as you like. YES!

Jul 19, 2018

You Can Be Anxious AND Have Courage! Courage. Where do we find it? How do we get it? And, once we get it, how do we keep it? In this era, being courageous or brave comes with great expectations. Men are expected to show their "brave face" ALL the time, or they run the risk of being called a "sissy." That is a lot of pressure! Women (and many times men too) are expected to multi-task multiple difficult things at once, but also must look pretty and be smiling while doing it. But, to top it all off, we humans (men, women and children) with anxiety are often expected to meet all of the above criteria AND keep our anxiety to ourselves. Where did we get this from?! I cannot tell you how many times I have heard stories about family members or partners or parents who have told someone struggling with anxiety or depression (or another mental health struggle) to "be braver" or "toughen up" or "you gotta be stronger through this." While I do understand what they are trying to convey, today's podcast episode is all about approaching courage and bravery with a new (more reasonable) perspective. You see, I like to think of bravery and courage as something you can experience WITH anxiety. I actually think they go beautifully together. We can feel dreadful fear AND be courageous. We can feel overwhelming sadness AND be strong. What we have been told about bravery and courage is all off. It limits us and makes us feel like we must not try things until we have no fear and we can "hold it together." I like to believe that the person who decided to go to the party, despite their tremendous social anxiety , is the brave one. I believe that the person who does that really hard thing (even if it happens to be easy for other people) is the courageous one. I believe the one who has a tear running down their face as they face their fear is a brave rock star! I hope you enjoy this podcast episode and begin to challenge your view of what bravery and courage looks like. As always, thank you for supporting me with this podcast and with CBT School's online courses. Enjoy!

Jul 13, 2018

Value-Based Living Hello there CBT School Family Welcome to another episode of Your Anxiety Toolkit Podcast. As you may know, each week I do my best to bring you a new tool or idea for you to put in your toolkit, in hope that it will give you some skills to manage anxiety, panic and other difficult thoughts, feelings and sensations. I always envision that I am slowly handing you one tool after another and that you are carefully packing those tools into your toolkit or tool belt, so that you feel ready to face your day, with or without anxiety. This week, I want to discuss with you your metaphorical toolkit; the box or belt in which you hold dear to your heart and use daily to help you live your best life. The most important thing to understand in today's podcast is that carrying a tool belt/toolbox/toolkit is a choice. Every week, you freely join me for a weekly discussion about recovery and living a great life, while having anxiety. You don't have to carry your toolkit and all the tools around. Many choose not to carry a tool belt or any tools. But you, you do. It's pretty cool if you ask me. You see, the tools your put in your toolkit are your mindfulness skills. Your toolkit, the place you hold these tools, is your values. If you are on a mission to be a better human, you obviously value your wellbeing. It is a value that you stand by. You value your recovery. You value your quality of life. Using these tools of yours contributes to value-based living. Values are very important to our recovery. The only problem is, that sometimes fear can come in and stomp all over our values. Sometimes fear can lead us away from our values and away from our toolkit. Sometimes fear can lead us towards other problematic behaviors, such as compulsions including checking, counting, avoidance, reassurance seeking and mental rumination. Fear can also lead us towards anger and saying mean things to ourselves. Today, we talk about identifying our values and ways to use the tools you have to help you lead with values. We use concepts from Acceptance & Commitment Therapy, also knows as ACT. ACT is a very helpful treatment modality that beautifully compliments Cognitive Behavioral Therapy (CBT) and Exposure & Response Prevention (ERP). I hope you find it helpful! Forward we go, Kimberley

Jul 5, 2018

Surfing the Worry Imp's Wave In this week's episode of Your Anxiety Toolkit, I had the pleasure of talking to Sharon Selby, Marriage and Family Therapist and Author. Sharon has written an amazing children's book called Surfing the Worry Imp's Wave and this book is simply amazing. Before you turn away thinking, "This doesn't apply to me. This is about kids stuff!", wait up! Since reading Surfing the Worry Imp's Wave, I have been using these techniques with some of my adult clients and they LOVE them too. This episode brings some helpful tools and tricks to manage anxiety and perfectionism (at any age). Surfing the Worry Imp's Wave is a science-based book using the same mindfulness tools and Cognitive Behavioral Therapy (CBT) tools I use with some of my clients and members of the CBT School Campus with Obsessive Compulsive Disorder (OCD) , Generalized Anxiety Disorder (GAD), Panic Disorder, Health Anxiety, Social Anxiety and Phobias. During the episode, Sharon discusses her inspiration behind the book, her work with young children who have anxiety and what tools she has found to be super helpful. As I mentioned about, I have found that these tools are helpful for us BIG kids too (adults). Sharon also tells us about some of the games involved in the books and some helpful tools to manage fear, perfectionism, separation anxiety, and panic. You guys know how much I LOVE a good story or metaphor, and there are plenty in this book. Here is one I want you to think about. In the book, Sharon talks about how our brains need to make mistakes to grow. If we make a mistake, it is like water on a plant. Mistakes help our brains grow into smarter and kinder people. I just adore this part of the book and it is something I have implemented with my young (and old) clients (and me too!). When I make as mistake, I now close my eyes and imagine my brain neurons growing and thriving. This is just one of the wonderful tools that Sharon talks about. I cannot wait for you to listen to this week's podcast, and read this book. Surfing the Worry Imp's Wave is a bookshelf must have, if you have kids with anxiety. But don't forget, THIS big kid loves it too!!! See the link below to get your hands on Surfing the Worry Imp's Wave: https://www.sharonselby.com/product/surfing-worry-imps-wave-reducing-childrens-anxiety Sharon Selby's free e-book 8 Common Mistakes to Avoid When Your Child Is Anxious is available at: sharonselby.com/free-ebook You can also hear more about Sharon on her Website HERE

Jun 28, 2018

Thought Suppression Doesn't Work!! You may have heard it multiple times, but consider this a little reminder. THOUGHT SUPPRESSION NEVER WORKS! This short but hefty statement is considered one of the golden rules when it comes to the management of anxiety disorders, specifically Generalized Anxiety Disorder (GAD) , Obsessive Compulsive Disorder (OCD), Panic Disorder, Social Anxiety , Healthy Anxiety and Phobias. However, the truth is, we all attempt to make our "bad" or anxiety-provoking thoughts away. We try to push them down so they won't hurt us anymore. We try to make them go away, so we don't have to feel the related shame, guilt, irritation, and annoyance of these thoughts. Does this sound anything like you? Let me tell you, you are in the right place. You see, this is a very common reaction to intrusive, anxiety-producing thoughts. For those with Obsessive Compulsive Disorder (OCD) , Generalized Anxiety Disorder (GAD), Health Anxiety (hypochondria), Social Anxiety, Panic Disorder or Specific Phobias, thought suppression can be involuntary and we often do not even know we are doing it. Intuitively, our brains will fight or run away from almost anything that creates discomfort for us. We are biologically set up for fight, flight or freeze. In today's episode, we talk about why thought suppression never works. We talk about how thought suppression can actually increase our anxiety over time and how thought suppression teaches us to intuitively judge our thoughts as bad. If this sounds counter-intuitive to you, you are not alone. My clients and the members of the CBT School Campus are commonly asking some pretty great questions about this, so I wondered if this was a topic that might benefit you. In this week's episode of Your Anxiety Toolkit Podcast, we talk about how Mindfulness can help us to accept and allow thoughts, non-judgmentally. We address how it can change the dynamic between you and your thoughts to a more peaceful and coexisting relationship. Remember, allowing thoughts is the key. Allow them to come and go. Accept them and see what happens. Listen to hear more!

Jun 22, 2018

Anxiety-Related Exhaustion is NO JOKE! One of the most common struggles I hear from my clients and the members of the CBT School Campus is how EXHAUSTING anxiety and depression can be. If you are barraged daily by exhaustion resulting from Anxiety (or any other mental health issue), you are NOT ALONE! Experiencing Anxiety is a full-time job. No one can argue with that. Anxiety can drain us of our physical energy, our emotional energy and can cause us to have nothing left to give at the end of the day. It can make us too tired to be social and make us want to sleep the day away. Anxiety-Related Exhaustion can make us feel alone and like there is no hope for us. If this is you, this is the episode for you. Because you know what?! There IS hope for US! In this podcast, we talk about some mindfulness tools to manage anxiety-related exhaustion. We talk about learning to observe your thoughts and correct them to thoughts that are more helpful and less draining. We also address a few very important mindset shifts you may need to make. You see, when we are overwhelmed with tiredness and anxiety-related exhaustion, we often will begin to feel hopeless and start to believe that there is no end in sight. Everyone tells us, "Just keep going", but we can sometimes feel like we barely have the energy or faith that we need to "just keep going". In this episode, we talk about specific mindset tools that I use with my clients who struggle with Obsessive Compulsive Disorder (OCD), Anxiety, Depression and Body-Focused Repetitive Behaviors (BFRB's). And last of all, I use one of my favorite metaphors for managing Anxiety-Related Exhaustion. You guys know me! I love to use silly metaphors. That being said, I really believe in it and it works. I promise you that it will make you take better care of yourself if you put it in place and prioritize it. Please don't hesitate to let me know what you think and if this is helpful. Also, if you listen on iTunes, please do leave a review. Good reviews help me reach more people and help me get the really important (and inspirational) people on the show. Forward we go, Kimberley

Jun 14, 2018

How Advocacy "Keeps Me Well": Interview with Ethan Smith OCD Advocate Do you ever wish you had someone to inspire you and give you hope about your recovery? Maybe you wish there was a story about OCD or anxiety or mental health that looks similar to yours and you wish you knew how the story turns out? Well, today I give you Ethan Smith OCD Advocate. Ethan Smith (OCD Advocate) was the keynote speaker at the 2014 Annual International Obsessive Compulsive Disorder ( IOCDF.org ) Conference, the International OCD Foundation National Ambassador, a writer, director, producer and OCD Advocate. Amongst these incredible talents and accolades, Ethan is hilarious and kind and VERY informed about the ins and outs of OCD and the treatment of Obsessive Compulsive Disorder (OCD) . During this interview, Ethan talks about his struggles to find correct therapy, his experience with finding evidence-based treatment such as Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP) and Dialectical Behavioral Therapy (DBT). Ethan also opens up about his draw towards advocacy work, stating that advocacy "keeps him well" and how being honest and open is considered advocacy work. I think we often feel that we have to write a book or start a campaign or a fundraiser to be mental health advocates, but Ethan shares his belief that we ultimately just have to share our story and use our story to help others not feel alone. One of the things I love the most about Ethan is his ability to express compassion and humor in the same sentence. Discussions around Mental Health can feel very heavy, and Ethan has a way of making light of a very heavy topic. Thank you, Ethan, for all that you do. If you feel like sharing your mental health struggles with others is too big of a step right now, consider joining our Facebook Group, CBT School Campus. This group is filled with brave, supportive and compassionate people and was created so you could feel support and connected to others who are working tirelessly on their mental health in a safe and supportive platform. Click here to be taken to the FB group. Click here for Ethan's Keynote Speaker Video DO YOU WANT TO REALLY IMPROVE ON YOUR MINDFULNESS SKILLS FOR OCD? CHECK OUT CBT SCHOOL'S ONLINE COURSE, MINDFULNESS FOR OCD .

Jun 8, 2018

Are you Superhuman or Human? It's an interesting question, isn't it? Are you a Superhuman or Human? I think in order to answer this question, we need to address how we perceive a superhuman and how we view ourselves, as humans. We need to address how we "rate" ourselves as a whole. You see, sometimes society and our community will send us the message that those of us who struggle with anxiety or depression (or with a mental health issue) are humans that are missing something. In some circles, us anxious humans get seen as being "less than" or weak because we struggle. Most media outlets portray superhuman as those who have beyond average muscles and their stories usually end in glory and power and victory. Let me pose a new idea for you. Maybe it isn't a new idea to you, but I am guessing it is an idea that you need to be reminded of. I don't believe for one teeny tiny microsecond that those who experience anxiety are "less than" humans. I don't for a second believe that those who have mental health struggles are "weak". Let me tell you a little fact. The definition of superhuman is "having or showing exceptional ability or power". Handling Anxiety and Depression or any other mental health issue takes exceptional abilities and a LOT of power and strength. Let's take a look here. If being superhuman requires you to have an exceptional ability, I would be very comfortable saying that managing anxiety classifies as an "exceptional ability". Do you agree? I think that if anyone knew just how hard you were working, they too would say that managing anxiety and depression (or other mental health issues) is superhuman. We don't give ourselves enough credit. This podcast is all about how much of a SUPERHUMAN YOU ARE! Click HERE For Online Course for OCD

Jun 1, 2018

Is Fred In The Refridgerator? Interview with Shala Nicely Well, this episode is one of my favorites. Do I say that every week (hehe)? But this week I am not joking! In today's episode, I have the honor of interviewing the AMAZING Shala Nicely. Shala has written the most amazing, Is Fred In The Refridgerator?: Taming OCD and Reclaiming My Life. If you have Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD) or Depression or another mental health struggle, Shala has written THE book for you. In the book, Is Fred in the Refridgerator, Shala talks about her recovery with OCD, BDD, depression, substance abuse and much more. The book is an amazing and fun read, but also walks us through her struggles to find correct therapy for OCD, the rules her OCD held her to and the key components of her mental health recovery. Why is this one of my favorite episodes? Well, Shala walks the walk and talks the talk and she gets very vulnerable and transparent about her struggles with OCD. I love anyone who shares their truth, and Shala did just that. It was truly inspiring and my heart pretty much exploded during the recording of this episode. I asked Shala a lot of really deep questions and she was so honest and open with us, and for that, I am so grateful. I hope you enjoy this book as much as I did. See the link below toget your hands on Is Fred In The Refridgerator? Links: BUY IT ON AMAZON: Is Fred In The Refridgerator shalanicely.com If you missed last weeks episode 50 5 Lessons Learned from Hosting Your Anxiety Toolkit Thank you again for supporting me with this podcast and with CBT Schools online courses. Please click here to find out more about Mindfulness School for OCD .

May 25, 2018

FIVE LESSONS LEARNED FROM HOSTING THIS PODCAST Today is a special day. Today I share the FIVE LESSONS LEARNED FROM HOSTING THIS PODCAST! Today marks the 50th episode of Your Anxiety Toolkit Podcast. I get a little sentimental during this one, but please stick with me. Let me start by saying that I am so grateful for reaching 50 episodes. When I started this podcast, in my pjs in my kitchen with my sleeping baby next to me as I recorded my first episode, never in my wildest dreams could imagine what it would become. From this podcast came CBTSchool.com, and from CBT school came a community that I could never have imagined. So Today, on this 50th episode, I celebrate YOU! And, today I want to talk to you about what I have learned and a few of my favorite quotes that I live by (and I promise this will apply to you). In this episode, I share 5 lessons learned by hosting this podcast and I have lived by as I hosted this podcast. I have to be honest. I have learned SO much and I cannot wait to share the lessons with you. I won't pretend it has all been easy. It hasn't. There was a couple of time that this podcast nearly didn't get made. And, there were quite a few times it was made OVER AND OVER! All I can say is that I am so grateful for your support and compassion as I bumped along. If you missed last weeks episode 49 The Content of Your Thoughts Are Not Important Thank you again for supporting me with this podcast and with CBT Schools online courses. Please click here to find out more about Mindfulness School for OCD .

May 18, 2018

The Content Of Your Thoughts Are Not Important One of the biggest struggles my clients have is when they get caught up in the belief that their specific intrusive thoughts or fears warrant LOTS of attention and moral weight. This is one of the most difficult things to manage when you are struggling with significant anxiety. We can see that other peoples fears are irrational, but when it comes to our specific fear, we become unglued, confused and reactive. Here are a few questions that I want you to ask yourself before listening to this podcast. Have you caught yourself saying any of the following? 1. "It's easy for you to say to, "just accept the thoughts". You don't have thoughts about hurting someone all day like I do (insert here whatever thought you are obsessing or ruminating on). This thought is WAY worse than other thoughts." 2. "This isn't any old thought. This would destroy my life if this thought came true." 3. "I know I have to accept the uncertainty, but this isn't just a thought" These are all examples of getting caught up in our thoughts content. When we get caught up in the CONTENT of our thoughts we can get stuck in a cycle of anxiety. When we give our thoughts all of this attention and value, our brains become hypervigilent and get even more worked up about the presence of these thoughts, feelings, and sensations. Please note here, I am in NO WAY telling you this is your fault. This is just the way our brains work. We also have be to careful about our narrative about this thought. If we tell ourselves the thought is "bad", that triggers self-judgment, shame and self-doubt. Then we are off and running, judging ourselves more and putting ourselves down. Listen to the podcast to hear my FIVE STEPS to help when you are getting caught in the content of your thoughts. At the end of the podcast, I offer a little Challenge for you. Observe your thoughts and ask yourself if you could start to make any of these changes in your life. If you do notice that you are giving too much weight to a thought, try to practice Non-judgment (Ep 1) or Beginners Mind (ep 6) or What you say to yourself Matters (ep 17). Thank you again for supporting me with this podcast and with CBT Schools online courses. Please click here to find out more about Mindfulness School for OCD .

May 11, 2018

Ep. 48: 4 Steps to Doing Hard Things! Welcome back! This week's episode is a celebration of last weeks guest interview with Dennis A. Aguilar. Last weeks episode was the first of the series called, We Can Do Hard Things Series. In this series, I will interview people who have fought through the thickness of mental health struggles and have relentlessly worked on themselves. These will be inspiring and motivating stories that will help you see that you are not alone in your recovery process. One question I have been getting from listeners, in response to last weeks podcast, was the question, "But, How do I do hard things when doing even the smallest things seem so hard for me?" This podcast will outline the FOUR steps I use to doing the hard things. These steps are mostly tools that will help you understand and appreciate your personal journey. I often gently say to myself, "It is a beautiful day to do hard things!" and I really believe this to be a core part of my own mental health toolkit. I hope you enjoy this episode of Your Anxiety Toolkit. Resources: Episode The Skill of Non-Judgment Click HERE for My Free PDF Printout: My FOUR Favorite Mindfulness Tools for OCD CBT SChool Campus Facebook Group

May 4, 2018

If you know me at all, you know that I 100% believe that WE CAN DO HARD THINGS! If you are on Instagram or Facebook, you will often hear me repeat, "We can do hard things!" "We can do hard things!" "We can do hard things!" I am also a strong believer in Progressive Mastery. Progressive Mastering is the systematic and step-by-step approach to learning new things. Basically, we incredible humans can learn just about anything if we break it down into small steps and take one step at a time. I cannot stress this approach enough when it comes to mental wellness. We must not look up at the mountain, tell ourselves how we will NEVER be able to make it up there and then give up. We must take on emotion at a time. One thought at a time. One sensation at a time. One urge at a time. When we do this, we move forward. We move upward. We soar! This week's podcast is the first of a series I am doing called "We can do hard things". During this series, I will interview people who have taken the hard, but rewarding route of working through their emotions, mental health disorders, trauma and difficult childhoods. I could not be more excited to share this weeks episode with you. Dennis A. Aguilar joins us today to share the inspiring story of his life journey through mental illness. Dennis talks about trauma, depression, suicidal ideation, OCD, anxiety, Bipolar Disorder, ADD, social anxiet y and other struggles he manages. I found this interview to be incredibly inspiring and I am sure you will to0. Dennis also gives TONs of amazing advice to those who feel like recovery is not an option for them. He talks about how he would go through stages of hopelessness and how to fought himself to just keep going. About Dennis A. Aguilar and Resources He Suggests Instagram Books: Mind Programming: From Persuasion to Brain Washing The Siva Mind Control Method What Every Body is Saying The Heart Of The Buddha Psychology Fifth Edition The Norton Psychology Reader How Pleasure Works How The Mind Works Emotions Revealed Taking Charge of ADHD The Lazy Mans Way To Riches Other: Luminosity

Apr 27, 2018

In This Episode, We Are Going To Get Creative Are you guys friends? You know. You, and Anxiety. Do you guys yell at each other? Or, do you talk between yourselves in a respectful and considerate manner? This episode is all about your relationship with anxiety. Does Anxiety manipulate you into behaviors you don't want to engage in? Or, do you hold your ground when anxiety is trying to get its way? These questions might help you to determine what kind of relationship you have with the anxiety in your life. This is a really important question and a conversation that we must continually have with ourselves. Do you have a good relationship with anxiety? In today's podcast episode, we talk about How to Improve Your Relationship with Anxiety . This includes how you talk with yourself, how you react to your anxiety and what your expectations are about its presence in your life. You guys know how much I LOVE a good metaphor. Well, this week's podcast is one BIG metaphor on how to build a better relationship with your anxiety, depression, emotions, and sensations. My goal is to give you a visual for managing and tolerating discomfort. In this episode, I also address setting boundaries with anxiety and depression but creating a relationship with anxiety AND depression. I can't wait to hear whether this is helpful for you. I find it incredibly helpful. Enjoy! Click HERE to join our free FACEBOOK GROUP, CBT SCHOOL CAMPUS Click HERE to learn more about CBT Schools Mindfulness for OCD E-course Click HERE to learn more about CBT Schools e-course for Hair Pulling and Skin Picking, BFRB School

Apr 20, 2018

Do you sometimes wonder what the secret sauce is to Anxiety Recovery? Well, today, we have an INCREDIBLE interview with Sheva Rajaee discussing the FIVE ROADBLOCKS TO ANXIETY RECOVERY! Sheva Rajaee (forgive me for the error with her maiden name in the podcast) is a lovely friend of mine and I was lucky enough to get to work alongside her at the center where we were trained. Sheva is an OCD Advocate rockstar and was a speaker at last years UCLA TEDx Talk event, presenting the talk titled, "Addicted to the answer – anxiety in the age of information". In this interview, Sheva comes very well prepared (as she always is) and she details what she calls the FIVE ROADBLOCKS TO ANXIETY RECOVERY, including tools to help manage Anxiety Disorders, Obsessive Compulsive Disorder (OCD) and Body-Focused Repetitive Behaviors (BFRB's). Sheva details ways you can compliment Cognitive Behavioral Therapy tools and she uses a wonderful metaphor that we discussed in such depth that we ended up in hysterics! We talk about doing the hard work, staying committed and some mindset shifts that can help with recovery success. Sheva and I also talk about those who are not currently in therapy and how they can utilize their own resources to keep them going. Sheva has her own private practice in Irvine, CA called the Center for Anxiety and OCD . You can find Sheva on Instagram @theshrinkwrap.

Apr 13, 2018

Anxiety + Anxiety + Anxiety = Anger Do you feel ever notice that your overwhelming fear turns into overwhelming anger? Yes? Well, you are not alone. Anger is a very common bi-product of anxiety. Today, I share a little bit more about my experience of listening to Clint Malarchuk, who was a National Hockey League player and was the keynote speaker at the most recent So Cal IOCDF Conference. Click here for last weeks podcast episode on YOU ARE NOT ALONE Clint and his wife told their beautiful story about Clint's struggles with OCD and Trauma. Clint shared all about his journey of managing obsessions and compulsions while excelling as a professional hockey player. There was SO much about Clint and his wife presentation that I loved, but one thing stood out to me as being REALLY important. Clint shared about his Anger. Clint and his wife shared how he was overwhelmed with rage. Clint was angry at himself. Angry with his wife for demanding her get help. Angry at his disorder, for taking so much away from him. It made me wonder, I am sure some of you would love to know that they are not alone in their anger. This podcast is for you if you commonly feel angry about what you are going through and angry at those who just don't get it. Anger is a normal human emotion, but we need to work on making space for it. We cannot push it down and we cannot transfer it onto other people by yelling, throwing, punching and/or saying mean things. If you want to learn more about anger and how to manage it, listen to this podcast. I detail FOUR KEYS ways you can manage your experience of anger (and NO, punching a pillow is not one of them). You will learn that you have to honor and respect your anger and create a better relationship with it. Click HERE to read about CBT School's Mindfulness for OCD Online course Click HERE to read about CBT School's online Course, BFRB School: Joyful living with Body-Focused Repetitive Behaviors (Hair pulling and Skin Picking)

Apr 5, 2018

In Case You Didn't know, You are not Alone Just a couple of weeks ago, I attended and was honored to present at the Southern California OCD Conference ran by socalocd.com. It was such an incredible event and I left with my heart feeling full and mind inspired. The thing about these conferences is that the energy of the attendees is so infectious. At the beginning of the day, the room is filled with anticipation and hope. These conferences are held in hope to give tools and support to those in the community with Obsessive Compulsive Disorder. After listening to the keynote speakers and breaking into group sessions where attendees learn tools to manage their OCD (I spoke on Mindfulness and Acceptance and Commitment Therapy for OCD), we meet at the end of the day for a final Q&A with the panelists. The room was filled with togetherness. There was a sense of community and cohesion that warmed my heart (and it lasted for days). The next day, I posted on Instagram how honored I was to attend such a beautiful conference and I sent out the message that YOU ARE NOT ALONE. I knew a lot of people were not able to attend such a wonderful event and I wanted to spread the love and connection that I was feeling. The response flawed me. Direct Messages and emails came in from those who are struggling with OCD and Anxiety and Depression, reporting how alone they feel. It got me wondering. Do you feel ALONE in your suffering? Do you feel like no one understands just how hard it is for you? Do you feel like no one could possibly understand what is it like to experience such anxiety and fear and panic? I am also wondering, Do you feel alone in your bravery? Do you feel like no one understands or appreciates how incredibly brave you are? You get up every day and do your best to get through the day with anxiety and depression and dread. You face your fears, not because you want to, but because you HAVE to. Do you feel so alone that you feel angry? Maybe you are so angry and hurt because no one else you know has to face their fears every single day, day in and day out. Do you feel alone because everyone else seems to do the thing that you fear so easily? If any of this describes you, this episode is for you. You are NOT alone! Click the below link to be added to the group. I would LOVE to have you join us. CBT School Campus Private Facebook Group Link to OCD So Cal Below: OCD SoCal is an affiliate of the International Obsessive Compulsive Disorder Foundation (IOCDF)

Mar 30, 2018

Ep.42 Dispelling The Myths About Managing Anxiety and Obsessive Compulsive Disorder Jon Hershfield Shares How To Have A Wise Relationship With Thoughts, Feelings, and Sensations You guys know how much I LOVE breaking down ALL THINGS ANXIETY and then deliver it in easy and helpful ways. In today's episode, I am THRILLED to share Jon Hershfield's wisdom with you. He is a genius at breaking things down into easy-to-understand ways. For this episode, I reached out to some trusted and respected Mental Health Professionals for input. I asked if they could share some of the unskilled advice that some of their clients have received from their previous therapists or medical professionals. During our time together, Jon addressed how some advice for anxiety can be problematic and Jon shared his INCREDIBLE knowledge and wisdom on how to manage anxiety and obsessions in a mindful and rational way. We discuss topics such as: Why can't I just distract myself from the thoughts? Can I just Listen to music to drown out the thoughts? Can I imagine a Stop Sign when having intrusive thoughts or worrying? What about squashing thoughts like a bug? If I think it, is it my unconscious mind trying to tell me something? My Doctor told me that I just need one really heavy period for this anxiety to pass My Doctor told me my Anxiety is due to not being breastfed I understand I can get these scary thoughts to go away by thinking positive and using The Law of Attraction. About Jon: Jon is the author of When a Family Member Has OCD: Mindfulness and Cognitive Behavioral Skills to Help Families Affected by Obsessive-Compulsive Disorder . Hershfield is also the Co-Author of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully with Shala Nicely and The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy with Tom Corboy. Jon has a private Practice in Baltimore and uses Cognitive Behavioral Therapy (CBT) for the treatment of Anxiety and Obsessive Compulsive Disorder (OCD) OCDbaltimore.com The OCD and Anxiety Center of Greater Baltimore Twitter: CBTOCD Facebook: @JonHershfield Click here to read about how Mindfulness can help you.

Mar 23, 2018

So often, when we are anxious, we forget to stay present. Instead, we worry about what could possibly happen in the future. "What if something bad happens?" "What if I panic?" "What if...?" The more I observe my thoughts, the more I notice how incorrect my thoughts are. In a split second, our brain will tell us an awful story about how a terrible thing is going to happen, how we are terrible people for thinking this thought, or how we cannot handle this feeling. We must come to accept that much of what we think is incorrect. I want to introduce you to TWO words that could change your life and make you more present if you put it into practice enough. Before I share the words with you, I want to encourage you to first get used to observing what you are thinking, feeling, experiencing. It could be emotions such as sadness, anger, frustration, irritability etc. It could be thoughts, such as "I am so angry- I am so upset- I am not getting better- I cant do this- I cant handle this- I am feeling hopeless......" It could be sensations such as panic and anxiety-related sensations, increased heart rate, shaking, sweating, depersonalization etc It could be sensations related to Body-Focused Repetitive Behaviors (Trichotillomania and Compulsive Skin Picking) such as tingling fingers, itchiness or throbbing. Once you are able to notice and observe these experiences, I encourage you to click on the link and add these two little words to your narrative. Enjoy! I hope they bring you as much peace as they bring me. I have even added a short meditation to help you with this practice. :)

Mar 16, 2018

If you have ever experienced the discomfort of a panic attack, you will appreciate this episode. When it comes to managing Panic, there is a lot of bad advice out there. I often have clients come to me reporting that they have been trying to "Stop Panicking" for years, only to find that nothing was working. They report painfully fast heart rates, tight chests, and fear that they will die. If you have experienced this, you are definitely not alone. In today's podcast, I will share with you My 5 Favorite Tips for Managing Panic Attacks (or Anxiety Attacks). As I mention in the episode, these are not the ONLY tips you need, but they are super important ones and ones I share often with my clients. These mindfulness tools are SUPER helpful in managing your mindset and perspective on anxiety. I hope they help you on your journey to managing anxiety, panic, Obsessive-Compulsive Disorder and other struggles related to fear and worry. Forward we go, Kimberley

Mar 9, 2018

Hi, there folks! Once again, it is an honor to hang out with you. This week's podcast is a little bit silly. But, I am dead serious when I say that This. Tool. Works! If you are struggling with perfectionism, or anxiety that stops you from starting a project or participating in an event, this is the podcast for you. Sometimes we need a different perspective to pull us out of our constant need to make things perfect and perform in a way that doesn't make us vulnerable. Writing about it doesn't really do it justice, so give this episode a listen. I hope it gives you a little laugh and you can use this tool when you are up against fear and need a little push forward. Forward we go, Kimberley

Mar 2, 2018

Today, I am thrilled to interview Stuart Ralph, the host of the amazing OCD Stories Podcast . In his podcast, Stuart interviews some of the most influential and inspiring psychotherapists and researchers in the anxiety and Obsessive Compulsive Disorder field. During our interview together, I asked Stuart to tell us about some of the most inspiring and memorable interviews he has done and he gave us some SUPER important takeaways. In the podcast, we discussed: How Steven Hayes (author of Get out of Your Mind and Into Your Life ) told Stuart, "You are the Lucky Ones!" How Reid Wilson taught him that "The Content of your worries is trash". How Professor Paul Gilbert (Founder of Compassion Focused Treatment and author of the book, The Compassionate Mind ) discussed the application of Self Compassion and how important it is for mental health recovery (especially those who experience anxiety, OCD and mood disorders). Stuart left us with this big piece of wisdom; "We all need love and self-care, and if we give ourselves huge doses of that we can move towards recovery". I hope you enjoyed this interview as much as I did! Please don't forget to leave a review for this podcast! Your reviews help us reach more people, so then I can help more people! Virtual Hugs everyone!

Feb 23, 2018

Sometimes we are so overwhelmed with all of the pressure (from work, friends, family, school, society) that we forget that the pressure we feel isn't always mandatory. We CAN give ourselves permission to drop the pressure and just BE. I know! This might sound super impossible, but hear me out. What would happen if you responded to the anxiety and pressure and stress with, "I give myself permission to eat whatever I wanted" "I give myself permission to have scary thoughts" (such as intrusive violent, sexual or scrupulous thoughts) "I give myself permission to not only have these scary thoughts but also not solve what they mean about me" "I give myself permission to allow this anxiety to be here" "I give myself permission to be imperfect" "I give myself permission to rest!" "I give myself permission to just be ME" This is some powerful stuff! Giving yourself permission to listen to your body can be incredibly helpful when managing eating disorders (and disordered eating), Intrusive thoughts associated with Obsessive Compulsive (including harm, sexual, religious, contamination and symmetry obsessions to list a few), Social Anxiety, Perfectionism, low self-esteem and chronic anxiety and panic. Listen to hear why this is such an important tool for managing anxiety and reducing the pressure we feel daily.

Feb 15, 2018

Are you tired of feeling like anxiety always has the reins? This tool might be exactly what you are looking for and can be a powerful complement to the work you are already doing with anxiety. The tool is called "Shoulders Back!" and our AMAZING CBT ROCKSTAR guest is Shala Nicely! Shala explains how she came across this tool and how she uses it, both in her own life and with her clients with anxiety and Obsessive Compulsive Disorder (OCD). The reason I LOVE this tool so much is that it is easy, empowering and science-based. Here are the links we discussed! Don't forget to check out Shala and Jeff Bell's E-course to help you with motivation for ERP for OCD. Click here for Shala and Jeff's E-Course Beyond The Doubt. Amy Cuddy Ted Talk talks about using a Power Pose Everyday Mindfulness Book (Written with Jon Hershfield)

Feb 9, 2018

Yep, you read it correctly! Today we are talking about Checking Behaviors! Chances are, you have done these behaviors a million times They sound like this...."Just to make sure" "I would prefer to be certain" "I cant handle my anxiety if I don't...." "Terrible things will happen if I don't....." If you have Obsessive Compulsive Disorder, you might check doors, stove knobs, hair dryers, crock pots (new for those who watched the TV show, This IS us), For those with Health Anxiety, you might check your ailments, sores, blemishes, degree of pain etc For those with Perfectionism, you might check emails, texts, phone messages, assignments for school etc For those with social anxiety, you might check Evite lists on who is going to an event, check your clothing or teeth in the mirror repetitively. Checking is an attempt to control our surroundings in hopes to avoid possible bad things from happening. We might be avoiding the uncertainty of knowing if we will get sick or not. We might be trying to eliminate entirely the chances of the house burning down or being robbed. Or, we might be trying to eradicate any chance of being seen as anything less than perfect. We might be afraid of embarrassment. But let's be honest! The chances are, you are mostly just trying to eradicate THOUGHTS about these events. Or, maybe you are trying to eradicate the presence of anxiety around these topics. I understand this conundrum. It is not uncommon to want to make sure you aren't going to burn down the house or miss a deadline or leave the door of your house wide open. We all do checking behaviors from time to time. However, let's be really honest with ourselves. If you find you are doing these activities over and over, chances are that you are mostly in the fight against uncertainty….and let me let you in on a little secret. You won't will this one. Fighting uncertainty is like trying to get a toddler out the door on time for school. The more you rush it, the longer they take. True story! Some might say, but when I do it, after some time, I DO find relief. I get it. Some are lucky to find those moments when the anxiety is lifted and you can walk away with a sense of, "Ok. I can move on" Listen to the episode to learn about how to work on reducing compulsive checking behaviors! When it comes to anxiety, WE CANNOT CONTINUE WITH THIS. We must change the arm in which we are strongest. And lets be honest. Uncertainty is all around us. It is something we have to deal with even if few don't have anxiety. It comes in every stage of our lives. Let's work to strengthen our ability to make space for discomfort in our lives. As always, have a wonderful week!

Feb 2, 2018

Well, this week I tell you a story about the most influential moment I have experienced regarding boundary setting. It is one of my favorite stories to tell because it taught me SO MUCH about setting boundaries and helped me see that some of the beliefs I had around setting boundaries were ENTIRELY wrong! During this podcast, we discuss FOUR steps to Boundary Setting and discuss how this can help us manage anxiety, resentment, and anger. I hope you enjoy the story as much I as enjoy telling it! Forward we go, Kimberley

Jan 26, 2018

Wassup Yo! This podcast is seriously Badass, even if I do say so myself! I am honored to introduce to you, Tiffany Roe. Tiffany is a Licensed Professional Counselor in the state of Utah and has the most incredible Instagram account, which is where I "met" her. Tiffany is another one of those CBT Rockstars, who uses Mindfulness and CBT to help her clients manage Anxiety, Depression and Eating Disorders. I just adore her! In this podcast, we talk about how to talk back to depression like a Gangsta. Tiffany shares some incredibly inspirational, empowering and FUN ways to talk back to Depression, when it bullies us and makes us feel like there is no hope. BUT THERE IS MORE! Tiffany was so excited about our conversation, she kindly put together a Spotify Playlist of her favorite music that helps her lift out of depression and back into her own power and strength. See below or click HERE for the link. NB: Please note that some of the songs listed in the playlist include profanity. Thank you Tiffany for joining us at Your Anxiety Toolkit. It was so fun talking with you. https://open.spotify.com/user/122159189/playlist/0OuZaqSrqLQyVsHtx4yPbS?si=IgB475OAT4KlRs0R-atTqg

Jan 19, 2018

#32: How to Reduce Reassurance Seeking Behaviors Welcome back, everyone! Welcome back to the Series on Problematic Anxiety-Related Behaviors. Today, we are talking about Mindfulness-based tools to help with Reassurance Seeking. For those of you who don't think this topic applies to you, stick around a little. You might find that you are employing this behavior, even in slight and tricky ways. As mentioned in the last episode, there are behaviors that you can reduce, which will result in better outcomes when it comes to anxiety. Last Week we discussed Avoidance and how this compulsion only makes fear worse. This week, as we mentioned, we are discussing Reassurance Seeking Compulsions. So, What is Reassurance Seeking? Before I give a definition, let me give you some examples and you can see if you resonate with any of these. Am I doing this right? (Common in Perfectionism) Did you turn off the stove? Did I turn off the........ (Common in Obsessive Compulsive Disorder) Are you sure everything will be ok? Do I look ok? (Common in Body Dysmorphic Disorder, Eating Disorders) You still love me, right? Do you think I will fail this test? (Common in Perfectionism) Do you think I hurt their feelings? Do you think they are mad at me? Do you think I could get sick? (Common in Health Anxiety and Contamination OCD) Did I hurt someone? Could I hurt someone? (Common in Harm OCD) Don't get me wrong. These are questions that I would consider "appropriate" questions. However, the problem lies in their frequency and intention. If you find yourself asking questions repetitively, or you find yourself asking these questions when you know they don't have the solution/answer, it is probably Reassurance Seeking. Also, if you find yourself asking these questions when you could be finding the solution yourself, this could be Reassurance Seeking. And lastly, if you find yourself attempting to find certainty in a situation where there is little to NO certainty, this podcast is for you! Reassurance Seeking is an action of removing someone's doubts or fears. Reassurance seeking is very common (and problematic) behavior in Anxiety Disorders such as OCD, phobias, panic disorder, Generalize Anxiety Disorder. It is also common in Body Dysmorphic Disorder and Eating Disorders. That being said, it applies to us all, in our management of our own anxiety. The goal is to recognize that we must not reach outside ourselves to remove our doubts and fears. Drawing other into our anxiety usually only makes it messier and creates a dynamic where you feel reliant on them to manage your anxiety. Also, Reassurance Seeking complicates relationships and can backfire. People may not give you the response you were looking for and cause you to have even more anxiety. Often clients report that their partner sometimes is very supportive and answers their questions very well, but over time, then the partner gets annoyed and then it creates friction. Does this sound familiar? The goal is to acknowledge your own fears as they arise, either allow them to simply be there using your mindfulness skills or work through them on your own. Remember, treat your fears the way you want your brain to interpret them in the future. I hope that is helpful! Have a wonderful week.

Jan 13, 2018

BIG announcement and Why You Have to Stop Avoiding First, let me share some EXCITING news with you! I am so excited to share with you some news about the work I am focusing on in 2018! But first, let me tell you the back story. Each year, I do my best to attend several conferences for OCD, Anxiety, Body Focused Repetitive Behaviors (BFRB's) and Depression. I have had the privilege of presenting at many of these conferences over the years and I often return home in a state of joy, empowerment and determination to help those who struggle with these debilitating disorders. I love learning all about the evidence-based treatment modalities for OCD, Anxiety Disorders and Body Focused Repetitive Behaviors such as Trichotillomania and Skin Picking and using the skills to increase recovery outcomes and improve self-esteem and self-care. However, last year, I left one of the conferences quite sad. I was sad for those sufferers who attended the conferences and then had to return home to their hometown, with very little support and no evidence-based services but licensed mental health professionals. So few therapist know how to treat OCD, BFRB's and Anxiety Disorders using the treatment modalities that are so successful and appropriate. From this frustration, I decided to create an online psycho-education platform where I can offer support and educational products to those who cannot access correct care. I am so proud to announce the creation of CBTschool.com . CBTschool.com is an online platform when you can access information and online courses on how to overcome your struggles with OCD, Body Focused Repetitive Behaviors (BFRB's), Anxiety Disorders, Panic and Depression. Each course will apply Cognitive Behavioral Therapy (hence the term CBT, in CBT School) and Mindfulness Tools. These are the exact tools I use with my clients every day in my office. I currently have one course ready to be purchased, called Mindfulness School for OCD. I will talk more about this in coming podcasts. Keep an eye out, as there will be more to purchase very soon. In addition to the online courses, I plan to meet at a designated time each month to join with you on Facebook Live and Instagram, to answer any questions you may have and help you along with your journey. More exciting news is the YOUR ANXIETY TOOLKIT podcast is now a production of CBTschool.com and we will continue to provide evidence based tools for Anxiety, Depression and Emotional Dysregulation. Lastly, if you check out CBTschool.com 's websites, you will see that there is also some awesome free PDF's available to help you with self care and mindfulness. I am so thrilled to share this news with you. Feel free to connect with me on FB or Instagram . Now, onto the important stuff! This episode is a part or an ongoing series where we discuss Problematic Anxiety Related Behaviors (also know as Compulsions). In this episode, we will discuss a very important and problematic compulsion, which is Avoidance. Avoidance is the withdrawal from an object, event, person or experience Avoidance is a common behavior we employ to manage anxiety, fear, panic, obsessions and intrusive thoughts. While our brain uses "flight" to activate us to run away from real danger and stressors, we sometime use avoidance and "flight" to avoid thoughts and fears of bad things happening. The problem is, the more you avoid events or experiences that you perceive to be dangerous (when really they are not currently a risk to your wellbeing) the more you tell your brain that that event or experience is dangerous and the more your brain responds with physical anxiety when you go to the event or engage in the experience. Example: What if I get sick if I touch that door handle or ATM teller? NOTE: Sentences that begin with "WHAT if" imply that they have not happened yet. If you were my client and this was a common fear for you, and you have been avoiding this, I would have you go and use the ATM bank teller!! By not avoiding, we unlock the fear response cycle our brain is looped into. This applies to fears that you are a bad person, that you will do something wrong, that awful horrible things will happen. Trick!!! When I say that….what is the immediate thought you have? But, Kimberley, my fear is serious!! Nope. Your fear is a thought But Kimberley, I could ruin peoples live if I stopped avoiding the thing I am afraid of. POSSIBLY!! Here is my questions for you. What kind of life do you want to live? Consult with your values. Do you want to live in fear? Do you want to let anxiety make your decisions? Or even more, a thought make your decisions? Or, do you want to strengthen courage and resilience? This is a question we have to ask ourselves every day. How Do I want to live my life? Take risks! Look at your life and ask yourself what you are avoiding. Try to not let anxiety win this one. Find a way to reduce the avoidance. Find a way to forgive yourself for avoiding it for so long. Don't beat yourself up. Have a wonderful week everyone! See you next week!

Jan 4, 2018

In this episode, we try a new meditation to help you stay present in THIS day. HAPPY NEW YEAR! It is a great guided meditation to help you stay centered on the present moment and let go of yesterdays events or tomorrows possible happenings. I recorded this meditation at the beach, as this is where I feel the most present and alive. I hope you find it helpful. It has become a daily part of my practice and I hope it brings you empowerment and peace. Forward we go! Kimberley

Dec 22, 2017

Happy Almost New Year!! Well, it's that time of year! You know, the time where you reflect on the year and set outrageous resolutions for the upcoming year. It is when you dwell on all the things you DIDN'T do last year that you said you would. During this podcast, I walk through a very successful way to set intentions for the upcoming Year, Month, Week, Day and even Hour! I walk you through why New Year's Resolutions rarely work and how I use Honesty and values to set goals that will improve self compassion, self-respect and effectiveness. I also give a few examples of how this applies to those with OCD, Eating Disorders, Social Anxiety and Panic Attacks. Last of all, I want to with you the HAPPIEST and SAFEST New Year! Forward we go! Kimberley

Dec 16, 2017

Hello there Everyone! Today, I am thrilled to have guest, Alison Dotson on the Your Anxiety Toolkit Podcast. During this podcast, Alison shares her journey from not even knowing what OCD was to what helped her with her recovery. Alison and I had a fun time also managing technological hiccups, which ended up being a wonderful practice of mindfulness. Alison Dotson is the author of Being Me with OCD: How I Learned to Obsess Less and Live My Life. In this book, Alison shares her personal journey with obsessive-compulsive disorder and includes some of the most heart-wrenching details. Her genuine goal is to spread awareness and helping teens and young adults with OCD. Resources Mentioned in this this Podcast: Alisondotson.com facebook.com/beingmewithocd Imp of the Mind IOCDF.org twitter- beingmewithocd OCD Twin Cities info@ocdtc.org

Dec 15, 2017

Today, we have an AMAZING guess on the podcast, Dave Trachtenberg. Dave is the Program Director at Minds Incorporated. Minds Inc. is a non-profit dedicated to empowering Washington DC-area schools by teaching mindfulness-based practices to students, educators, and parents. During the Podcast, Dave shares how Minds Inc. teaches students, starting in elementary school (and their educators, and parents) simple daily mindfulness practices. Dave speaks about how these teachings increase focus and attention, reduce stress and anxiety, create resilience and the capacity to handle difficult emotions, and build compassion. As discussed in the podcast, sometimes when I get down about the state of the world, I find myself doing late night Google searches on how I can make it better. In my searches, I found Minds Inc's website and came across Dave. Dave shared some beautiful stories about helping young children and teens and also shared his own struggles with OCD, Tic Disorder, Depression and Self-worth. Dave answered the following questions: Tell us about Minds Inc? What got you involved in teaching meditation to Teachers, Students and Parents? What is your personal experience with meditation and Mindfulness? What at some experiences/examples of situations you have had with youth at Minds Incorporated? (successes, struggles, changes made)? What type of meditation does Minds Inc. teach? What special tools/practices do you use for living mindfully? What advice do you give for those starting out with meditation? Tell us how you manage struggles with meditation? How can we teach our children? This was one of my favorite conversations and I am so thrilled to share it with you. I would love to hear your feedback. Have a wonderful day! Kimberley Resources: Mindsincorporated.org Brain Lock Angel Kyodo Williams http://transformativechange.org/founder/ Pema Chodron Link here Mindfulness For Dummies Mindfulness An * Week Plan How to Live in a Frantic World

Dec 11, 2017

Well, Lets be honest! Sometimes I get so excited about practicing and teaching the deep and helpful concepts of Mindfulness that I forget to remind y'all of how simple it can and should be! Often, when we experience anxiety (or other strong emotions), we often forget everything we have learned and are left standing helpful and afraid. In this podcast, we return to one of the most simplest and easiest Mindfulness tool available. Check it out! And, if you are noticing how basic and thinned out this blog is, that is no accident. This week, we are practicing simplicity!! See you next week!

Dec 2, 2017

Vulnerability: The Road to Courage, Self-Compassion and Self-Worth In today's podcast, I wanted to dissect the concept of Vulnerability. Brene Brown, reknowned researcher on Vulnerability defines Vulnerability as "Uncertainty, Risk and Emotional Exposure" I find this somewhat ironic, as Uncertainty, Risk and Emotional Exposure are the worst nightmare of someone who experiences anxiety, OCD, an eating disorder (such as Anorexia Nervosa or Bulimia Nervosa), trauma, grief or depression. I think many humans struggle with these concepts, but I feel that it is significantly difficult for those who struggle with these mental health disorders. In many cases, there is a complete rejection of vulnerability. I believe we think that if we avoid vulnerability, we can rid ourselves of shame, embarrassment, being judged, feeling sad or hurt. However, all we end up doing is numbing. When we have anxiety, we think that if we avoid vulnerability, we could rid ourselves of possible bad or catastrophic outcomes. However, all we end up doing is becoming compulsive. In this podcast, I detail the workings of those who are successful at being vulnerable and take a look at the outcomes that result. We will outlines ways that you can practice vulnerability in large or small steps. We look at the repurcussions of staying safe and avoiding vulernability and we detail the research's findings about self-worth and conectivity. I hope you enjoy it! This is one of my favorite subjects. Forward we go! Kimberley Photo by Nathan Anderson on Unsplash

Nov 24, 2017

Episode #24: Willingness-Leave It All Out On The Field! I LOVE the term, "leave it all out on the field!" There is something totally radical and badass about the idea of "leaving it all out on the field!" It means we are committed to the hard work. It demonstrates that we are ready to feel some discomfort. "Leaving it out on the field" describes giving it your everything. I LOVE it! How does this apply to Mindfulness? The degree that you "leave it out on the field" is a great way to describe Willingness. Willingness is radically accepting and giving consent to our present experience. We can conceptualize Willingness as scale, similar to a continuum. 0/10 Willingness implies we have absolutely NO willingness to be uncomfortable (or have anxiety, intrusive thoughts, panic, have uncertainty). We reject all feelings of discomfort Fear makes our decisions (causing us to do more compulsions) Disown any negative experience 10/10 Willingness is saying 100% "YES" to whatever experience of discomfort that arises Radically accepting the feared outcome Allowing yourself to have anxiety, fear and intrusive thoughts. You LEFT IT ALL OUT ON THE FIELD! Listen to hear ways to increase your WILLINGNESS, even if it is just a teeny, tiny bit. Enjoy! And Happy Thanksgiving!

Nov 15, 2017

The Mindful Use of Technology Hi everyone! I hope this finds you well. This podcast is about a topic that is so important and so interesting to me. In this episode, we speak with screen time expert, Dr Dustin Weissman about how to use technology (smart phones, tablets, internet etc) in a mindful and healthy way. We specifically discuss how to manage Obsessive Compulsive Disorder (OCD), OCD Spectrum Disorders such as Body Dysmorphic Disorder (BDD), and Eating Disorders. In this episode, we discussed: Does technology improve or harm our Self-Esteem? How can we create a Balanced lifestyle when using technology? How can Parents monitor and moderate their children's use? How can Parents practice sound and mindful discipline using technology as the reward or consequence? How can we, as adults, monitor and manage our use of technology in this era of information? How can we manage the compulsive use of internet/mobile devices for those with OCD and BDD? How can we manage reassurance seeking behaviors related to technology use? Special tips for those with Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD) and Eating Disorders. Earlier this year, Dr Weissman published his dissertation titled, Impacts of Playing Massively Multiplayer Online Role-Playing Games (MMORPGs) on Individuals' Subjective Sense of Feeling Connected with Others. Some links we discussed in the Podcast: Quality Time APP: http://www.qualitytimeapp.com/faq/ MindSpace Meditation APP: https://itunes.apple.com/us/app/mindspace/id967886308?mt=8 About Dr. Weissman: Dr. Dustin Weissman holds a Psychology Doctorate and works in private practice in Westlake Village, CA. He works with clients who are struggling with any form of internet addiction or problematic internet use, which include: online gaming, gambling, pornography, or smartphone addiction. Earlier this year, he published his dissertation, Impacts of Playing Massively Multiplayer Online Role-Playing Games (MMORPGs) on Individuals' Subjective Sense of Feeling Connected with Others. A link can be found from his personal website, DustinWeissman.com . He was recently featured as an expert on screen time in an online article and has given numerous workshops. I hope you found this episode helpful. I know I did! Warmly, Kimberley

Nov 5, 2017

Got something you really want to achieve? I am guessing that you most certainly do. What is holding you back from taking on this thing you want achieve? Why can't you reach this goal? This is the big question that I am toying with right now. Why can't I? Why not Me? Why not you? It is a really tough subject, because we have to face ourselves and our possibilities, and this can be SUPER scary. Sometimes, at least for me, when we look at our big goals, we are forces to tackle our deepest limiting beliefs. "I am not enough." "I am not strong enough." "No one cares about me anyway." "What's the point. I will only ruin everything anyway." These are all limiting beliefs that stop us from reaching realistic goals. Think about it. I am guessing at least one person (or maybe millions of people) have achieved your goal, or a goal like it, already. WHY NOT YOU? "It's not special if someone else has already done it." LIMITING BELIEF!!! "I don't have what it takes!" How do you know? Thomas Edison failed 1000's of times to make the light bulb. That is one piece of proof that you probably can! Persistence people! Let's really get to know our limiting beliefs and then be SUPER mindful about them. Listen to hear more about how. :)

Oct 23, 2017

Happy Halloween everyone! It's one of my favorite months and I LOVE that everyone is so willing to be afraid on this special day. Let's all commit to being willing to be scared/afraid/anxious every day, shall we? This episode is a little different to the normal format. Today, I answer questions from Your Anxiety Toolkit listeners about anxiety, OCD, Mindfulness and appropriate treatment for certain disorders. Questions include: How to manage Postpartum OCD (including thoughts of hurting our children) How to help someone with Scrupulocity or Moral Obsessions (including fear of offending God or sinning) How to help a son with OCD and Tic Disorder How to manage thoughts about Death GREAT, GREAT QUESTIONS! I hope my answers were helpful Have a wonderful day everyone!

Oct 3, 2017

Hi there guys! I couldn't finish the day without checking in with you and sending you my support after such a difficult day. This podcast was not planned and I kind of threw it together at the last minute. I hope it is helpful. For anyone in Las Vegas or Puerto Rico or any other place where there is destruction and pain, please know that I am praying for you and I hold you in my heart. These scary events can trigger our already high anxiety, so please listen for some tips and tools to manage your anxiety about the current events and affairs in the news. A couple of important points: Anger Sadness and Anxiety/Fear are all very human responses to these horrific events. Obsessions to look out for: "Will this happen to me, or a loved one?" Intrusive Imagery (Mental images of people suffering from traumatic events, shootings, hurricanes, earthquakes etc) Intrusive sounds (Gun shots, people crying, sobbing, screaming, sirens etc) For those with Harm OCD: "Am I capable of doing such an act?" Compulsions to look out for Mental Review or Mental Compulsions about the event or possibility of this happening to you or a loved one Reassurance Seeking (checking news, checking phones, asking a loved one if they will be ok etc) Avoidance (future vacations, work, school, thought blocking, etc) Increase in physical behaviors/compulsions.

Sep 28, 2017

If you are anything like me, the days go by too fast and you find yourself running through the day without stopping to take in the beauty of nature. Is it just me? Today, I was lucky enough to interview Zoe Gillis, who I consider to be the MASTER of combining mindfulness with a wilderness practice. She combines hiking, backpacking and camping with Mindfulness and Meditation as a way to get a deeper understanding of our self and each other. It is BRILLIANT stuff and it makes me want to pack my bags and go camp in the dessert right now! Zoe is a Licensed Marriage and Family Therapist and a wilderness guide who is the founder of Z Adventures. Z Adventures thrives on the belief that we need to disconnect before we can connect and step out into the wilderness more often. During this podcast, Zoe and I discuss: Ways to introduce nature into your mindfulness practice. How being in nature can help us identify how we see ourselves How being in nature can help us identify our strengths and weaknesses. The benefits of doing short vs. longer wilderness activities This is possibly one of my favorite episodes so far, so check it out! Click HERE to watch the interview on YouTube You can learn more about Zoe Gillis or Z Adventures at the below links: Zadventures.life http://www.zoegillis.com/ https://www.facebook.com/zadventuresla/ https://www.instagram.com/z_adventures/?hl=en

Sep 21, 2017

How to Heal Self-Blame with Self-Forgiveness using Ho'oponopono Meditation If you are anything like me, you are quick to blame yourself for any of the below reasons: You have not achieved some level or expectation. You tried to better yourself and you "failed." You made a mistake (unintentional) or had an accident (I call this, "You Did a human" AKA Making a human mistake) Especially for you, if you have OCD; You have "bad" thoughts, intrusive thoughts, thoughts you deem "unacceptable." You feel like you are a BAD person who doesn't EVER deserve to be forgiven. You are attempting to work through your mental health issues. You struggle to do exposures or follow some treatment goal. You experience self-disgust (for having pimples, cellulite, intrusive thoughts etc. My main message in this podcast is this: HUMANS ARE NOT SUPPOSED TO BE PERFECT! HUMANS ARE ALWAYS AND FOREVER GOING TO MAKE MISTAKES! This podcast details a practice called Ho'oponopono. Ho-oponopon is a spiritual practice of harmony between people, nature and spirit that has been used in Hawaiian and other Polynesian cultures for centuries. Ho'oponopono Key Concept: We can heal our own wounds and then we can then go out and heal our world. Ho'oponopono Meditation Foundation: I'm sorry. Please forgive me. I love you. Thank you. Here are some ridiculous reason to not practice Self-Forgiveness: You only deserve Self-Forgiveness after you make the world better (giving service to others). If you forgive myself, you will stop caring and let yourself go and become and even worse person. Once you are perfect, then you can forgive yourself. If you blame myself first, it will hurt less if someone else blames you or notices your imperfections. Please do not let these reason stop you from freeing yourself from Self-Blame. Give it a try and see if it works for you! I found it to be a very powerful practice. Have a great week!

Aug 19, 2017

What You Say To Yourself Matters. More importantly, what you say to yourself about anxiety matters! In this podcast, I delve into the importance of accurate and mindful language, specifically related to how to experience and manage anxiety. Believe it or not, the story you tell yourself can greatly change the way you see yourself and the world around you. The way we talk to ourselves about our experience of anxiety can greatly affect the management of our anxiety, and can create a platform for whether we thrive or merely survive our anxiety. To help us conceptualize this subject, I use a fictional example, Mary. My hope is that Mary can help us understand the complexity of our negative thinking and help us to find new ways to talk to ourselves about our anxiety. Example: Mary has anxiety and wakes up and feeling anxious. She immediately thinks, "I am so anxious", "Something bad is going to happen", "It isn't fair that this is happening", and "Why me?" She goes off to work, repeating in her head, "I can't do this, I can't do this, I can't do this…" What she is telling herself: Things are bad Things aren't going to get better She is the victim. That she has no choices here She doesn't have coping skills/ She will not survive this event What you can do differently: During this podcast, I discuss four key steps you can take to improve your personal narrative about your anxiety. They steps will lead you towards more mindful and helpful approach to talking about your anxiety. I have outlined a step-by-step plan to help you better manage your narrative related to anxiety. We go into greater detail in the podcast, so enjoy listening! _______________________ 4-point plan to creating a more Mindful Narrative Be objective, not subjective See Episode #1: The Skill or Non-Judgment for more info Be in the present moment See Episode #8: Skill of Awareness for more info Take responsibility for your experience Practice Uncertainty See Episode #6: The Beginners Mind for more info _____________________ To help you along with practicing these steps, I have also created a fun PDF that you can download/print and use at your leisure. Sign up below to get access to all the Podcast Add-ons! [embed_popupally_pro popup_id="3"] I challenge you to try this as much as you can and see the difference it makes. Small changes lead to large changes, so don't be afraid to try it a little at a time. Even trying it once a day can get the ball rolling. Enjoy! This podcast should not replace professional mental health care. This podcast is for education purposes only. If you feel you would benefit by seeing a clinical professional, please contact a professional mental health care provider in your area.

Jul 20, 2017

GUILT, SHAME and being "SO OCD" with Shala Nicely I am honored to share with you a recent interview I did with OCD ROCKSTAR and dear friend, Shala Nicely. Shala is a Licensed Professional Counselor in Atlanta and treats OCD and OCD Spectrum Disorders using Cognitive Behavioral Therapy. I briefly outlined the conversation and left all the links discussed during the podcast. Enjoy! Shala recently wrote an awesome blog post article about a top women's magazine that posted an article encouraging readers to "be a little OCD!" Shala declared enough was enough and got writing. Shala and her ROCKSTAR mom are doing so much to advocate for the OCD community. See the below link to check it out. http://www.shalanicely.com/misc/aha-moments-magazine-encouraging-us-little-ocd/ How do you respond when people say, "I am SO OCD?" Shala reports that she always aims to never shame anyone. For this reason, she talked about polite and non-shaming ways to educate others on what OCD and how painful and debilitating it can be. How does it feel when you hear someone say "I am so OCD"? "First, frustration", but then desire to educate others about the severity of OCD and other mental health disorders. Are people with OCD, "SO OCD?" In today's society, being "SO OCD" is generalized to describe someone who is meticulous and likes symmetry and neatness. This is not typical for someone with OCD. Someone who has severe OCD might be entirely ok with a dirty bedroom and not need symmetry or cleanliness at all. It is important that we educate people about the specific sub-types of OCD so that people better understand the complexities and variety of OCD symptoms. Go to Iocdf.org for more information How can we manage the shame and guilt that comes with having OCD or another mental health disorder? Brene Brown has written some AWESOME literature and has done amazing research about shame and guilt. Because Shame and Guilt are so common amongst those with OCD, Anxiety, Eating Disorders and Body- Focused Repetitive Disorders, we both strongly encourage listeners to read any of her books. Kimberley also discussed Brene's explanation of how to identify if you can trust someone. Check out the link below to watch. https://www.youtube.com/watch?v=ewngFnXcqao Shala's FAVORITE mindfulness tool: Dan Harris' 10% Happier book and App. https://www.amazon.com/10-Happier-Self-Help-Actually-Works/dp/0062265431/ref=sr_1_1?ie=UTF8&qid=1500508777&sr=8-1&keywords=10%25+happier How to find out more about Shala Nicely Shalanicely.com Beyondthedoubt.com/keywords You can also watch the unedited version of this podcast below https://www.youtube.com/watch?v=_4zPJTCORqg&t=8s

Jul 3, 2017

Hello everyone! I am excited to share this months podcast, as we are joined by what I call a CBT SUPERSTAR, Sara Vicendese . Sara is a Licensed Marriage and Family Therapist who specializes in Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in addition to traditional PsychoDynamic therapy. This podcast is based on the phrase, " It takes a village to raise a child ". This phrase is used often to explain the importance of community when raising a thriving and successful child. We believe that you can create your own "micro-village" to help you along with your recovery. Today we talk about ways to create YOUR "Village" (in whatever form you think is helpful) to help you with your on personal recovery. We discuss how to find the correct treatment, access the most helpful resources and how to include your family members, friends or partners in your recovery, in a healthy and helpful way. Below is a basic layout of our conversation. Enjoy!!! Today we talk about ways to create YOUR "Village". What is the most effective form of treatment for OCD, and how do I find a therapist who provides it? Sara talks about the difference between Cognitive-Behavioral Therapy (CBT) including Exposure and Response Prevention (ERP) and psychodynamic "talk" therapy, specifically focusing on: How to interview your therapist: what questions to ask, how to ask them, and the importance of interviewing therapists without assuming that everyone with a degree is going to be the right fit. How to know what kind of therapy you're in. How do you find a good ERP Therapist Check out IOCDF.org for a list of therapists who are trained in CBT and Exposure and Response Prevention (ERP). Once in contact with a therapist, ask if they know what ERP is? Ask what books they rely on when treating OCD? (This might allow you to screen them for their knowledge) Ask if they have they worked with OCD before and for how long? Where did they get their training How do you know your current therapy is or isn't working? Sara writes, "A lot of dynamic therapists will stress that things can "get worse before they get better," encouraging clients to wait months – or even years – to see the benefits of their work. It's true that in any therapy, including ERP, you will likely feel worse before you start to feel better…but if months go by and you aren't experiencing any reduction in symptoms OR if you notice – at any time – that you are getting significantly worse, it is likely time to move on." What advice do you have for those who cannot find an ERP therapist in their area? Or, for those who can only afford a therapist in-network who does not know about ERP? There are some awesome workbooks out there for OCD. ( Mindfulness Workbook for OCD , The OCD Workbook , Trichotillomania: An ACT-enhanced Behavior Therapy Approach Workbook ) Ask your non-ERP therapist to read these workbooks (depending on your symptoms) ahead of time and go through them together in session. There are also so awesome online forums (Yahoo groups are GREAT) or online resources such as IOCDF.org , OCD stories etc (See my resources page for more info) Also consider the potential for Skype or teletherapy (always ask the therapist if they are legally allowed to see you from the state they are licensed in, depending on where you life) What advice do you have for those who want to start ERP treatment, but currently have a non-ERP therapist? Sara writes: "There are really two options here; you can leave your current therapist and start with an ERP therapist, OR you can explore the potential of seeing both at the same time." Sara discusses the importance of collaboration and making sure that both therapists are in regular touch with each other – to prevent each therapist from working against each other. Sara encouraged therapists to coordinate care and maintain the effectiveness of both. What advice do YOU give to the family members of those who are struggling with mental health issues such as Obsessive Compulsive Disorder (OCD) and Body Focused Repetitive Behaviors (BFRB's) or Eating disorders? Living with, and loving, someone with these disorders can be extremely challenging and it's critical that all members of the family are as healthy as possible for everyone to thrive. Jon Hershfield's book is great in this situation, as psycho-education is so important. Sara discusses the importance of involving family in treatment as appropriate (assuming family is supportive and including them wouldn't be detrimental to treatment). Sara also discussed how she often recommends that family members seek out their own support – either through support groups or personal therapy. Kimberley discusses to use of the Family Accommodation Scale (FAC) to identify ways the family are accommodating the OCD compulsions. Click here for a link to the Family Accommodation Scale. Is there a kind of therapy can benefit the spouse or parent or family member of someone with OCD or other anxiety disorder, or a BFRB? Individual therapy (and/or support groups) for the family member can be very successful. In addition, there is great benefits from continuing to be educated about the loved ones disorder and get consultation on the best ways to support them though their recovery process. What can a sufferer do when their family member or friend is not supportive of their recovery? This is a tough, but important, question. Being unsupportive can take many different forms, from simply not understanding / participating in treatment to (on the other extreme end) working against treatment or purposely interfering with it. Someone who is not supportive of treatment is someone who is, in some way, colluding with the illness. Maybe recovery would mean that their life will be more difficult for them, or perhaps the treatment itself is hard to tolerate. Sara discusses how she often see families where more than one member is suffering from the disorder – however, only one is diagnosed and in treatment. If one partner is going through ERP, that can stress the relationship if the other partner has similar undiagnosed issues. Sometimes people aren't supportive of recovery because it is hard at first and requires more energy/work than they are willing to put in. I can think of an example where a parent consistently disrupted treatment for their child because they didn't want to see them in distress and the increased anxiety in the household during exposures made them uncomfortable. A highly anxious parent may have as much trouble with their child's exposures as the child – for their own reasons. In most cases, most people get on board given enough time and education. That said, we are faced with tough decisions if our loved ones / friends interfere with treatment. Again, it is important that loved ones be brought into treatment, encouraging them to get their own support, and even the option of moving on from the relationship if it is keeping the sufferer stuck. Sara Vicendese has a private practice in Westwood, CA. Learn more about Sara on her website at http://saravicendese.com/ You may also see the unedited video interview here

May 13, 2017

The Skill of Being Patient There is an urgency that is ruining us in today's culture. We must have everything right away and we get upset when we don't get our way. When I catch myself in these behaviors, and I am mindful enough, I ask, "Why am I behaving this way?" The answer is always FEAR! We are afraid of being late. We are afraid someone will judge us or be upset at us for being late. We are afraid of not checking off everything on our list of things to do, which will make us feel unsatisfactory. We are afraid if we don't do it fast enough, we won't get home early enough to have a moment to ourselves, where we can breathe and find some peace. So, we clench our teeth, take the corners too fast and we fail to take in any of the joy of that moment. We keep forgetting is that peace lies in this moment. The problem here is that rushing and insisting things go to our expected timeline is setting us up to have discomfort. Patience requires us to accept and tolerate difficulties and delays, without getting angry or upset. So, how do we practice patience when we are being followed by anxiety all day, every day, particularly for those who have an anxiety disorder such as Obsessive Compulsive Disorder (OCD), Panic Disorder, Generalized Anxiety (GAD) or a specific phobia? This questions also applies to those who have other disorders such as and Eating Disorder (Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder), or Body Focused Repetitive Behavior (hair pulling or skin picking)? Lets take a look at a few examples of how anxiety requires patience. "I want anxiety to go away now" Patience involves the practice willingness to feel anxiety. Patience is going about your day while experiencing the anxiety you have. This is the golden rule for managing anxiety. If you are running from anxiety or pushing too fast through it, you are creating an anxiety monster. Patience is willingness and compassion all rolled into one. Patience will involve not getting angry or condemning yourself for having this fear. We tend to play the blame game when we are struggling, thinking that an appropriate amount of blame and shame will teach us to no longer feeling this way or prevent feeling it in the future. This also applies to not blaming others. Our anxiety is ours. We cannot blame others for it. Even if someone does something that makes us anxious, we must work to heal our own hearts and learn how to manage it. I want to solve the problem RIGHT NOW! I need to know the answer RIGHT NOW! This is where patience is needed most; when you want something you have not got. This is where you have to loosen your grip and make a lot of space for uncertainty. We have to develop a deep respect for the natural unfolding of time. Just because it is unknown, does not mean it must be known. Your job is to be patient with the feeling of "un-knowing" and trust that things will happen at their pace. Again, loosen your grip, or loosen your reins and take a look around. Consider, that the answer is right in front of you. If you have Obsessive Compulsive Disorder (OCD) or anxiety, and you are on a mad rush to find the answer to an obsession you are having, it might be that patients IS the answer. It might be that madly finding the answer IS the problem. We must slow down. You take a breath and you take note of all the other things that are going on. You notice that the clouds in the sky remind you of a warm winters day when you were a kid. You actually taste the food you are eating. You really look your partner in the eye. You slowly take the corner in your car. Maybe you are overwhelmed with the societal pressure or self-imposed pressure to be better, faster, smarter, better looking, healthier, free from anxiety. Sometimes the faster you try to achieve something, the longer it takes. If you choose the fast, wont-stop-for-anyone pace, I can almost guarantee you that you wont make lasting relationships. Its really hard to get to know someone and connect with them when you are living a rushed life, unless they are running at the same pace and enjoy the direction you are heading. The trick here is patience and compassion. We must slow down and acknowledge that we are growing at a pace that is just right for us. You are exactly where you need to be and the pace will find you. This might be hard to take, but that's where compassion comes in. With compassion, you acknowledge how hard this is for you, right now. You accept that many others (basically any human with a heart beat) must accept that we don't get everything we want right away, nor should we want to. There is no shame is slowing down. General life With patience, we get to slow down and see that a lot of what we own in our house and in our life is filler to make us feel like we are going places faster. When we are patient and mindful, we can observe ourselves better and begin to see a lot of our pure and natural beauty. We get to notice all that we are. It was there all along. We were just speeding, too fast to see it. Patience is willingness to be uncomfortable and compassion for self and others, all rolled into one ball. It is a skill that will reward you greatly, if you learn to make friends with it.

Apr 13, 2017

This is a message to you, for those times when you feel like you are failing. This is a little bit of a verbal manifesto for you, if you feel like you are not winning the fight against anxiety and you are lost on where to go next. Maybe you feel like you can't seem to get relief from your anxiety. Or you are unable to do something that is super scary for you. Possibly you have mastered one struggle and then you have found that a new anxiety or struggle has risen. In this moment, you may feel like you cannot seem to get "control" over whatever it is that you are dealing with. Because of this, your emotions might be raging, despite your attempts to calm them. Below are my favorite FIVE points to remember when you think that you are failing, or not winning. I hope they find you some peace and give you some ideas to help you keep moving forward. FIVE things for you to remeber when you think you are "failing" Thing #1 You cannot "fail" if you are trying. If you are trying, you are being willing Failing is if you stop trying. There will be times when you have to slow down and stop your work for a moment. You may need some time to reflect (see Thing # 3 for more information on this). That being said, try to remember that slowing down is not failing either. Thing #2 This struggle is real and IMPORTANT. You are not making this struggle up. If it is hard for you, it IS hard. Just because it isn't hard for others, does NOT discount that it IS hard for you. Be gentle with yourself. You are not dumb, or stupid, or messed up because this struggle is so hard for you. There is no rhyme or reason why this struggle chose you. All I can say is that it is yours and you are correct. IT IS HARD. Thing # 3 Make the "fail" or the struggle count. There is knowledge in each struggle. I can be helpful to ask yourself, "What message is there that we could learn from?" Possible obstacles that might be getting in the way could include concepts such as- I cannot let go of control. I am struggling with concept of uncertainty I am struggling with accepting my physical discomfort Once you have identified the obstacle, you might review (by yourself or with your therapist) if it would be helpful to go back to identifying and correcting your irrational thoughts about your fear. You might also want to revisit your willingness tools. An important tool that we often forget is to apply TONS of compassion. Or maybe just a little bit, if compassion is a hard tool for you to access. You could use this "fail" to dispel the misconception that you should be ashamed of having this struggle. Can you share it with someone your trust? We all, even those who seem happy and lucky, have struggles. You are not alone. Don't hide it all to yourself. Reach out and ask for a hug. Allow yourself to be comforted. Brene Brown's research on trust has shown that others trust us more when we share our own struggles with others. Thing #4 Beating yourself solves NOTHING. Do you look back on past events and say, "I am so glad I beat myself up over that!" I am sure you do not. J Could you allow this struggle to be hard just for the present moment? Sometime when we allow things to be hard, miraculously, they become jus a little easier, or the heaviness of them becomes less. Some Yoga Instructors say that there are some advanced moves that require you to fall 1000 times before you can master a pose. If you didn't know that it took 1000 falls to master the pose, you would probably give up pretty fast. I like to use this as a metaphor for dealing with anxiety. Remind yourself that you will have to fall a few times at least (more likely 1000) when dealing with anxiety. If you find that infuriating, try not to judge the process. Allow yourself to fall, knowing that the falls are accruing towards a great outcome. Thing #5 "Failing" is a point of view. Remember, you cannot fail if you are trying. If someone tells you your trying is not enough, that's ok. They can have that opinion. However, no one knows your struggle. No one gets to tell you how your recovery should look. Just keep looking at the steps you are taking. Be SUPER careful of looking too far ahead. If you are climbing a mountain (which I am sure this is how it feels to you right now if you are listening this far into the podcast), just focus on the steps you are taking. If you look too far up the mountain, you WILL trip and then you will feel like you are "failing". Sound familiar. Try to just stay here , on this one step. Master this one step and give yourself time and compassion for how hard this step is. Consider "failing" as proof of bravery. If you are listening to this, in my mind, YOU are a winner. You are brave, just for trying to conquer something hard. It takes courage to admit to having struggles. It would be so easy to go and hide and let whatever it is that you are dealing with just keep happening. It takes a lot of courage to fight through something instead of run away or fight it with anger or self-criticism. Open yourself to allowing the struggle to be a part of your story, instead of fighting it all the way. Every good story or movie needs a struggle. I see your strength. I see your possibilities. Keep your fire alive. I believe you can do this. I have seen some pretty amazing stuff in my career. I've seen people tell me they "will never beat this" and they did. Keep trying!

Mar 11, 2017

Let's talk about your Brain and Anxiety When your physical symptoms of anxiety are high, you may feel like nothing works. You may have moments when you feel like you can't come back to your rational brain. When we are all wound up on anxiety, fear can run the show. You know what I am talking about, right? Despite there being some great tools out there, but one of the most difficult parts of having severe anxiety or panic is the comprehending what IS real danger and what IS NOT. Last month we talked about R.A.I.N, which is an acronym that helps us use some of the most important mindfulness tools. There is also non-judgment, acceptance, willingness, bringing our attention to the present moment. These are all wonderful tools. For me personally, if I can understand the mechanism behind what is happening, I can handle it better. That is why understanding what was happening in my brain was SO helpful. Today we are going to delve deeper into understanding our brain and what happens when we experience high anxiety. The problem with the anxious brain is that it often sets of an alarm, making us feel like our lives are at risk, danger is ahead, when really there is no danger at all. This is a mistake our brain makes, particularly when we have an anxiety disorder like Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Panic Disorder, Social Anxiety or Specific Phobias. Sometimes just understanding a little bit about what our brain is doing can help us with awareness and then allow us to implement the tools better. A Simple way to Understand YOUR Brain and Anxiety I want you to think of the brain like a house. This house is a two-story house, with a stairway that leads us to from upstairs to downstairs, or vice versa. Dan Siegel and Tina Payne wrote a wonderful book called, The Whole Brain Child that coined this concept, but I have shifted them a little to specifically address the management of anxiety. **Please note that scientifically, this is not perfect. It would take hours for me to explain the intricacies of the brain and all the areas that provide different functions. For the purpose of getting a basic understanding, we will use this simple metaphor. The Upstairs of the brain is where we do most of our Executive Functioning. What this means is, in the upstairs brain lives the "Thinkers". Functions of the upstairs brain allows us to Regulate our body (speed up or slow down) Tune in to someone else or something else. Balance our Emotions and use Empathy and compassion Have response flexibility (slows down the time between impulses or urges and an action). Basically, this means that we don't respond based on pure emotion. Calm our fear: There are inhibitory peptides called gabba that tame our fear and help us interpret the stimuli in a rational, appropriate way. This occurs in the Prefrontal Cortex at the front of the brain. For kids, I love Hazel Harrison's idea of giving each of these functions a character name. Hazel Harrison is a blogger for Mindful.org , if you are interested. You can be super creative with this process and make it silly and fun. In our upstairs brain lives: Creative Cassidy Problem Solving Pete Patty the Planner Reasonable Renee Calming Catarina Kind Kelly Flexible Felix The downstairs area of the house lives the Basic functions. While these might not seem as sophisticated as the upstairs of the brain, the downstairs helps us to stay alive. Downstairs brain controls Bodily mechanisms that are automatic (Breathing, Digestions and Blinking). It is really quite incredible that our whole body can function without us needing to do anything at all. Fight, flight and freeze mechanisms. This is the most important, for today's discussion. The downstairs is the Emotional hub of the brain. We need to be thankful for this part of our brain, as it keeps us safe from real danger. This downstairs area of the brain is what keeps us from touching the hot plate on the stove or not walking out onto a busy highway. For the kids (and for use Adult Kids!), our downstairs brain is the home of: Fearful Frannie Panicky Pete (Fight flight or freeze) Sad Sandra Furious Frank Bossy Benjamin In the downstairs brain lives the Amygdala, which interprets the current stimuli, past memories about such stimuli and the general environment to determine if there is danger or not. If there is danger, the Amygdala sends out a message to the body to prepare for flight, fight or freeze. This message may cause a bunch of bodily sensations that will prepare you for survival. Your heart rate might go up, which is your body preparing to be able to run a long distance in a short amount of time. This message may cause you to have stomach issues such as diarrhea or vomiting, which is your body's way of emptying its contents, again, so you can be lighter and get away from such danger. Using the metaphor of the house representing the brain, the stairway of the house helps the upstairs and the downstairs communicate together. The upstairs and the downstairs work together to think and feel in a way that is regulated and reasonable. If there is a real danger, let's say there is an earthquake, the downstairs brain (specifically Fearful Frannie and Panicky Pete) take over to make sure they can send all the messages necessary to keep the body safe. An example of this is, if there was in fact an huge earthquake, the upstairs "Problem Solving Pete" would not stop to pick up the stray shoes that have been left in the middle of the lounge room in case someone trips. Or, "Reasonable Renee" would not signal for us to stop to say goodbye to the people we are standing with before we ran for safety. Our downstairs brain works very hard so it can get us to the safest place in the fastest possible time. Once the danger has gone, we go back to using a more balanced distribution of the upper and lower brain. What happens when we have an Anxiety Disorder? In some cases, as mentioned above, our brains interpret that there is danger and sends out these messages when there is, in fact, little or no danger at all. This is VERY common in anxiety disorders. We could say that our downstairs made a mistake and set off the alarms, signaling to the whole body that is must prepare for fight or flight. When I am using the metaphor of the two-story house, I often call this "lockdown". Sometimes, just as our brains do where there is a REAL danger, when our brains mistakenly set off the alarm bells, it "locks down" the downstairs brain and won't allow us to access our upstairs brain in a reasonable way. Problem Solving Pete and Rational Renee have no way of communicating with Panicky Patty and this keeps us from questioning if this danger is, in fact, a danger. There is great benefit from knowing this information and being able to notice and observe when your brain is sending you into "lockdown". Just understanding and observing this can allow us to reset. In fact, identifying that we are in lockdown and that our downstairs brain is being activated instantaneously opens up the stairway a little and allows reasonable Renee to begin doing her work. It is Reasonable Renee who allows us to say "OK, I am in lockdown right now". Isn't that SO cool?! Dan Siegel uses the quote, "you have to name it to tame it" and I cannot agree more when it comes to anxiety. When you (or your little ones) can name what is happening in their brain, it helps them to feel in control and then are able to tame their heightened sense of danger. Now, don't get me wrong, knowing this information will not make anxiety go away completely. But, the more we can identify when our downstairs is in lockdown mode, the more likely we are to use our mindfulness and Cognitive Behavioral Therapy tools. Another tool is to practice using you upstairs brain when you aren't in automatic lockdown. By exposing yourself to the very things that set off the downstairs brain in to lockdown (when there is, in fact, no danger at all), you can re-train your brain to reassess the danger appropriately. You will use your upstairs brain to regulate your downstairs brain when it wants to send you into lockdown. It is important to know that the upstairs part of the brain isn't fully built until sometime in a child 20's. This doesn't mean that this tool isn't helpful to those who are children or adolescents. In fact, it is even more important for those who are younger. Understanding your brain can help develop the use of the upstairs brain and can benefit then in many, many ways. The goal is to have an upstairs and downstairs brain that communicate and work together. Discussing Anxiety and the Brain with your Kids If you are working with young children, try to make it fun. If your child is in lock down, have Bossy Benjamin tell Panicky Pete to "scram!!!!". You could say, "You don't belong here Panicky Pete!" You might also ask the lovely Calming Catarina to help with breathing and doing a fun activity that engages your child. For little kids (and us big Adult kids), you might ask Reasonable Renee to keep and eye on Worried Wanda. Worried Wanda often spends too much time worrying about the future and all the bad things that might happen. Reasonable Renee can help remind Worried Wanda that her imagination has gone a little wild. Reasonable Renee might also sit down and come up with some activities that your child can do when Worried Wanda talks too loud and starts to become a bother. Ideas might include arts and crafts, take a walk, build a lego castle, do a jigsaw puzzle. The trick is to get hat upstairs AND downstairs brain engaged and communicating together! Play around with some of these ideas and please let me know if you have any great ideas or questions.

Jan 31, 2017

RAIN: A four step Mindfulness tool Welcome back and Happy New Year everyone! Today we are discussing a very valuable mindfulness tool called RAIN. It can be a super helpful way to manage strong emotions and sensations. RAIN can help manage anger, shame, guilt, sadness, depression and pain. I have found this tool to be a particularly helpful tool for those experiencing anxiety or panic, but is also a very helpful tool for strong hair pulling or skin picking urges. RAIN is an acronym. Each letter represents one step and is a part of a 4-step mindfulness tool. R is for RECOGNIZE: The first step is to recognize what is going on in this present moment. Recognizing gets us to slow down, or stop. Often, we are so reactive that we don't stop to notice if there might be another solution or another was to respond. An example of this might be "Oh, I am feeling hurt right now" or "Oh, I am having a thought about the possibility of me panicking very soon" We stop to recognize things for how they really are. A is for ALLOW or ACCEPT: First, start by saying "YES" Do not fight that this is what is happening. By allowing, you are not denying it. You are making room for it in your day By allowing, you are also not invested in its removal or exit. You are staying present. An example of allowing and accepting is, "I am going to allow the sensations of anxiety in my body right now. They will not hurt me" or, "This urge to pull my hair is very strong, but I am going to just allow it to come and go. I wont last forever" I is for Investigate: When we investigate, we take note of what is going on We become aware of the real details. It is IMPORTANT to know that this does NOT mean that you should be thinking about the perceived problem. This does not mean that you should be trying to figure out the perceived problem. Let me explain using a few examples E.g. #1. Lets say you have OCD and you have had the thought "What if I go crazy and go on a shooting rampage" (a typical harm OCD thought). Before using this tool, you might immediately feel anxious, and then go into a long process of trying to get rid of that thought and find proof that you would NEVER EVER, EVER do such a thing. You might spend hours going over and over in your head if that would appeal to you or if others would think you are capable of such an act. Using the I of RAIN, which is investigate, you would investigate what it feels like to have that thought. You would NOT investigate the validity of that thought. The goal is to investigate by saying something like, "Oh, I notice that thought makes my anxiety increase. Isn't it interesting that my brain and body is responding to this thought this way?" Example #2: Lets say you have an Eating Disorder such as Anorexia Nervosa, Bulimia Nervosa or Binge-Eating. It is common for someone with an eating disorder to "feel fat". When someone "feels fat", they immediately feel fear, guilt and shame about this experience. Using RAIN, the goal would be to Recognize, "Oh, this experience is here again". Then, one would work on allowing that experience to be present. Using I for investigate, one who experiences the feeling of "being fat" would then investigate what sensations come along with this experience? Do I feel a sense of my body that is different to normal?" or "Do I notice that this feeling immediately makes my heart begin to race?" The goal of investigate is NOT to investigate if that feeling has any validity by checking in the mirror or body fat checking. Investigate is about asking yourself, "what's going on for me right now? "How does this feel in my body in this moment?" N: Non-identify: Non-identify is the act of not taking the experience personally. When we are uncomfortable, we often identify with the emotion If you felt anxiety, you might say, "I am an anxious person" Instead, say, "I am anxious in this moment" or even better is. "There is a lot of anxiety here" If you feel sad and depressed, you might non-identify by stating, "I notice sensations of sadness" instead of, "I am depressed" A trick here is to notice if you ever label yourself as one thing. We are never one emotion or one identity. Our work is to not put ourselves in an identity One last time, RAIN is a super helpful mindfulness tool. RAIN R is for recognize A is for Allow or accept I is for investigate N is for Non-identify

Jan 5, 2017

YOUR MINDSET MATTERS: How being in "Yes Mind" can be a game changer for you! My main goal for this podcast is to create a new approach for handling Anxiety and other difficult emotions and sensations. During today's podcast I am talking about being in YES mind, NO mind and MAYBE mind and what that all means in relation to how we approach anxiety and other emotions. We will conclude with a short mindfulness meditation to help you take on some of the mindfulness skills discussed today. Some may have heard me speak about this idea of YES NO and MAYBE, but during this podcast I am going into greater detail and discuss why this concept is so important when you live with anxiety, depression or other similar struggles such as eating disorders and BFRB's. In order to make this easy to understand, lets pretend you have been asked to present at the annual conference for the industry you work in and you are terrified of public speaking. You can insert your own story into this story (Contamination OCD and you have to go to the hospital for a family member, for example) You have 3 OPTIONS: You could say YES: PRO to saying YES: You might meet new people or make new connections in your industry, it looks excellent on your resume, and MOST importantly, you are not letting anxiety make your decisions. CON: You have to prepare, and have to manage and tolerate your anticipatory anxiety until the event occurs and the emotions related to worrying how it will go You could say NO: PRO: You get the relief of not adding this challenge to your plate. While that is a pretty sizable PRO, given that anticipatory anxiety can be hard to manage, try to stay open minded about the fact that saying no gives your short term comfort, but leads to longer term discomforts. CON: You miss out on a huge opportunity to build your public speaking skills and your reputation in your industry. Colleagues might stop asking you to these events and not give you these opportunities in the future. Biggest CON is that Anxiety wins. Anxiety makes your decisions. You could say Maybe: We end up spending the entire time mentally ruminating You go back and forth, with no real relief from your emotions and feelings and no real success. Its Repetitious and exhausting. For those of you who have heard this concept before, or for those of you who are guessing, I am hoping that we can agree that of all the choices, MAYBE is the most dangerous. For those who thought Maybe was a good choice, lets take a closer look at each option. When dealing with emotions such as fear, anger, sadness or physical discomfort, even pain, when we choose NO or to be in "No Mind", we push away our feelings as if this will allow us to move away from the "problem". The problem isn't the conference. The problem is that we are saying NO to the conference There is little mental rumination or review about the decision and if this was the correct decision. While saying no to going to the conference might seem harmless (no one needs to know), it is an avoidant behavior (one that is quite problematic when you have disorders like OCD, or Panic Disorder, Social Anxiety, Anorexia or other eating disorders), it saves you from having to face your fears or other emotions or sensations. The biggest problem is that your emotions make your decisions and before you know it, the emotion has won. Fear or sadness or anger or even guilt and shame decides where you go, who you meet and prevents you from having many wonderful experiences. Saying MAYBE is SUPER problematic because it gives you ample opportunity to go BACK AND FORTH and back and forth on the pros and cons of the decision. While some may argue that this is a good thing, it is not for those with anxiety. I like to call this back and forth, "MAYBE mind". Maybe mind is exhausting, time consuming and doesn't encourage the skill of positive self-assurance (E.g. "I can do this"). leaves us spending the entire week going over the pros and cons of saying YES to going to the party and the pros and Cons of saying NO to going to the party. The truth is, when it comes to anxiety, the pros and cons are often the same, no matter what the feared event or situation is. As mentioned above, the pros of saying "yes" are that you get to live your life, experience more and not let fear make your decisions. The cons are that you having to be willing to experience anxiety. The pros of saying no is that you DON'T have to feel anxiety for the short term, but the con is that you sided with fear and let fear make your decisions (log term consequence). If you are wondering how this applies to you, lets take a closer look at Yes mind and see how it can help you manage fear, pain, or other uncomfortable sensations. To use the example, saying Yes to speaking at the conference allows you to commit to a life where anxiety doesn't make your decisions. Being in "yes mind" doesn't mean you just say yes to all events that scare you. It is you saying YES to anxiety in general. It is an offering to let anxiety come with you on your journey. It is the commitment to welcoming fear, which is a human experience, into our days and lots getting side tracked with its presence. Being in "Yes Mind" is a mindset. It moves us closer to acceptance of our discomfort and improves our ability to just be in our experience, without fighting it, resenting it or pushing it onto other people. Why is acceptance and willingness important? Studies suggest that accepting your discomfort will actually reduce your perceived discomfort. Some studies have even concluded that when studying patients with severe pain, the acceptance of pain resulted in reports of lower pain than those who were medicated for pain. While these studies are very complex with many complex components, the point is, acceptance works! When we accepted fear, we use our energy appropriately and productively, instead of wasting energy going over and over how terrible things are (or might be). PS: Remember, this is "maybe mind". So, lets try to catch ourselves in NO mind and MAYBE mind. Lets try to stay in YES mind as much as we can, OK?

Jan 5, 2017

Hi there everyone! This months podcast is a guided relaxation meditation. I ADORE this meditation and is one that I have adapted from several meditations that I love. It is super easy and doesn't require a lot of effort, except just staying with me. It is particularly easy to use before, during or after doing exposure for OCD or other anxiety disorders. I also encourage this when practicing mindful eating or intuitive eating. It is a great way to direct your attention back to your body and into the moment. Try it and let me know what you think. And Happy Belated Thanksgiving! Warmly, Kimberley

Oct 27, 2016

The Skill of Awareness Halloween is just around the corner and we are moving into the holiday season. You may notice that you can go the whole day without noticing. You are in what I call Autopilot. Much of the time we are so in our head, we forget to be aware When we experience stress, we assume that something fundamentally is wrong or that a disaster will happen. We become disconnected. We avoid situations. We stop taking care of ourselves. We get irritated. We mentally ruminate. We judge ourselves negatively. For those who have OCD, you have more obsessions and do more compulsions For those with an Eating Disorder, you might restrict more, or binge more, or purge more. If you have a Body Focused Repetitive Behavior (BFRB), you will spend more time in a "trance" state. Awareness can be a VERY helpful tool to protect us against these behaviors. What is Awareness? Definition knowledge or perception of a situation or fact. concern about and well-informed interest in a particular situation or development. I particularly love the second definition. "concern about and well-informed interest in a particular situation or development" Concern: Sometime means anxiety or worry (but this is not the way I like to look at it) Also means interest The goal is to take more interest in your surroundings or notice the atmosphere of your brain. "well-informed interest in a particular situation or development" Well informed: Rational, reasonable, objective If I think it, it must be true Eg: "I can't do this" (test, get up, stop a behavior that is problematic, get a new job, go to a party etc). Thoughts without anxiety= no big deal Thoughts with fear/anxiety: Must be a sign of trouble to come Being well informed allows us to identify what is a thought and what is a fact, despite what emotion or feeling it is coupled with. Often, we have thoughts about events of developments that have not even occurred yet. We try to use our thinking as a way to confirm certainty or find the solution. Let me ask you… How successful and productive is your thinking about this not-yet-occurring situation? Could there be peace in not going over every last detail of the possible disaster? Are we using up THIS present moment to find solutions, without recognizing that RIGHT NOW is still and quiet and safe? One of the main reasons we mentally ruminate is FEAR. It's everywhere. If you have fear, it may not feel safe, but your job is to watch how caught up you get with it. Become more aware of the unrealistic and irrational places it takes you. You can practice awareness simply by bringing your attention to your surroundings. The 5 Senses Meditation is an easy way to practice this tool. One of my most favorite ways to managing this is with the following meditation. The more you practice it formally, the better you become at it. The better you become at this awareness practice, the more you are able to use it during your busy day, or when distressed, or even panicking. It is an amazing tool. I hope you enjoy it. Meditation: Find a position that is comfortable Put your feet flat on the ground Slowly close your eyes, Soften your eyebrows, your jaw, your shoulders, your stomach, your hands, your feet. Breathe in Breathe out Bring your attention to your breath Notice the rise and fall of your chest Imagine that your breath is like a swinging door. Each time you breathe in, the door swings to the left. Each time you breathe out, the door swings to the right. Continue to follow this pattern, just keeping your minds eye on the swinging door. You may find that your thoughts wonder off. That is ok. Just gently bring yourself back to the image of the swinging door as you breathe in and out. Continue to breathe, allowing your breath to decide its own rhythm, and while watching the swinging door swing back and forth gently and evenly. It is important to remember that it is natural for your thoughts to go off towards something completely unrelated. You may notice that your thoughts often go to very scary or disturbing subjects. You may start to go over all the things you have to achieve later today, or in your life. When you become aware of this, just come on back. Come back to your breathe, as your anchor. Gently come back to the swinging door. You may find that you have to do this "coming back" quite a lot. Again, this is totally normal and healthy, showing us that your brain is alive and well. Try not to be hard on yourself for this. The goal is to learn the great discipline of coming back to our present moment and not get caught up in thoughts that are not helpful. Continue to practice this, noticing your breath and the swinging door. Slowly, bring your attention back to your body Slowly open your eyes Congratulate yourself for trying as hard as you did. May this practice bring you strength and compassion with the thoughts that you have. ~~~~~~~~~~~~~~~~~~~~~~ I hope you have enjoyed this episode of My Anxiety Toolkit. My name is Kimberley Quinlan. This podcast is not intended to replace correct professional mental health care. Please speak to a trained mental health professional if you feel you need it. Have a wonderful day

Sep 30, 2016

Self-Compassion is a helpful tool for managing shame and blame and negative self-talk. It is particularly, in my experience, helpful for those struggling with OCD, Panic Disorder, Phobias, Health Anxiety, Body Focused Repetitive Behaviors, Eating Disorders and Depression. The Center for Mindful Self Compassion (centerformsc.org) describes self-compassion in the following way- "Self-compassion involves responding in the same supportive and understanding way you would with a good friend when you have a difficult time, fail, or notice something you don't like about yourself." Self-compassion is Kindness, Warmth, Gentleness and Care. When I talk about the practice of self-compassion, I use the metaphor that self-compassion washes away shame and blame like the rain washes away the dirt on our cars. As the rain gently falls, the dirt slowly falls away. Once the rain has come and gone, there is less heaviness and dirt on the car. It is easier to see out the windows and now you can see the beautiful fields and trees that you pass on your way to work or school. A part of this metaphor includes this final sentiment. Even though the rain has come and gone and the car is mostly cleansed of its dirt, there is still slight streaks of the dirt left behind. As much as I would love to say that self compassion will wash away all of the dirt and dust on the car, this is not realistic. The tiny little streaks left behind is a reminder that compassion is a job that is never over. It must be practiced over and over, for the years to come. This podcast offers a meditation that uses the basics of Kristin Neff's self compassion research, including the three elements of self compassion. For more info go to selfcompassion.org

Sep 1, 2016

This podcast discusses Uncertainty and how it exists on a spectrum, The Beginners Mind, Tools to manage anxiety and uncertainty, and the joys that curiosity provide. A short meditation is offered at the end to help the listener practice these skills.

Jul 26, 2016

Key Points from todays podcast! What IS the difference between Fear and Bravery? Is someone who has social anxiety, who goes to the party, but is visibly anxious, fearful or brave? Is someone who has perfectionism, who finishes a text without going over and over the answers before turning it in? Is someone who is ashamed of his or her body and afraid of peoples rude comments, but goes to the party anyway in the dress or outfit they love fearful or brave? My thoughts are….they are both. Begin fearful is not a weakness. Allowing there to be both allows for compassion and strength Brene Brown "Courage starts with showing up and letting ourselves be seen" My definition of Bravery is the examples above. Having fear AND showing up. Vulnerability is not a weakness. It is a measure of courage Perfectionism is an attempt to avoid vulnerability with ourselves and others. Go and be brave, while being afraid. Go and make friends with vulnerability "Owning our story and loving ourselves through that process is the BRAVEST thing that we will do" Brene Brown The gifts of Imperfection "Owning our story can be hard, but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky, but not nearly as dangerous as giving up on love and belonging and joy-the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light." Brene Brown

Jun 30, 2016

It's time for a parade!!! Hello and welcome back!!! My name is Kimberley Quinlan and this is Your Anxiety Toolkit Podcast, speaking about anything and everything related to anxiety and mindfulness. Today, in the spirit of the upcoming 4th of July, I wanted to talk about parades!! You know???? Floats and crowds and cheers and lollipops and picnic chairs. For some, these are some of our greatest memories. I often use a parade as a metaphor for our thoughts. In fact, I have heard several different clinicians or teachers of eastern philosophy use a parade metaphor to discuss the experience of anxiety, pain, sadness or life, in general. As I said, for the purpose of this podcast, I am going to use the metaphor in relation to our thoughts. Lets get straight to it, shall we???? First, I would like you to slowly take a deep breath. If you would like, you can close your eyes, but it is not entirely necessary for this activity. Again, I would like you to take a breath and imagine yourself at the sidewalk of a street, waiting for a parade to begin. You are sitting or standing behind the yellow ribbon and you have your family and friends with you. You also have your favorite flavored lollipop in your hand. The morning sun is gently shining of you and the crowd is excited. This is a great day! You hear the music start and slowly, you to see the first float approach the crowd lined street. It slowly approaches you and your friends are waiting patiently to see what it is about and who is on it. As it gets closer and closer, you experience a sensation of satisfaction. This float it is very appealing and has all of your favorites colors and favorite flowers. It is simply beautiful! You wave at the children and adults on the float and they smile back at you as they wave. Up next is a float made out of a trailer bed, with a racecar on it. This float is all about shine and muscle. The surface of the car is so shiny, you could almost see your reflection in it. Even the trailer bed is sparkling and has sponsorship stickers all over it. The drivers wave as they rev the car. It is invigorating, but a little loud. Still, you are having a great time. You wave to the two men and one woman on the float who are dressed in their racing outfits and then you slowly turn your head to see what is next. Coming up next is a very scary looking float. On it, is lots of people and they are yelling at all the spectators. Some a yelling very scary things and others are yelling very mean things. The float is covered in grey and black streamers and there is a cloud of smoke coming from the front of the float. You are surprised to see this float in the parade and wonder, "what is going on?" This float was significantly unpleasant and you angrily consider writing a letter to the parade committee to inquire about the purpose of this float at such a celebratory event. The float comes and then moves down the street, scaring the people as it passes. You have a hard time directing your attention away from the scary, grey and morbid float, but you bring your attention to the approaching city's marching band that is playing the most festive music as they slowly follow the scary float. OK guys, let's stop there! What a parade so far, right? There has been beauty, and music, and loud revving car and a float that was quite scary. It is very similar to our thoughts, am I right? I am sure we can agree that we are sometimes passed by thoughts that bring us much joy. And, in a similar fashion, sometimes our thoughts are down right demoralizing and scary. This imaginary parade is very similar to the way our brain operates. Happy thoughts, scary thoughts, interesting thoughts, maybe thoughts we don't even notice. When we experience thoughts that we enjoy, we often bask in the beauty and festivity of them. The use the metaphor, when looking at the pleasant float, we don't question why they chose those particular beautiful flowers or what was the purpose of that float. We watch and enjoy and then we excitedly search for the next float to arrive. However, when we observe a grey and scary float, we are completely alarmed, we become angry and try to discover who would create such a float. We might even respond my yelling back, thinking that might stop them from shouting OR prevent them from showing up to next years 4th of July parade. We might also close our eyes and try to pretend the float is not there, or try to think of a previous float that we enjoyed. Simply put, we are being highly reactionary to thoughts that scare us. This is a particularly troublesome practice. If we were to experience each of our thoughts as if we were watching floats in a parade, we could see that our experience of the parade is levied on our emotional reaction to each float. We are completely at the mercy of which float is next. This can create quite a predicament. Because we cannot control which float comes out next OR the theme of the float, we are left feeling out of control and anxious about our experience. This is true of our thoughts also. We are constantly spectators to a whole range of thoughts that come and go, like floats in a parade. Going back to the parade metaphor, when being passed by the scary float, you might find yourself trying to get it to pass you quickly. You might even find yourself whispering (or yelling) "Get outta here! You have NO place here, in this parade!" This type of behavior does not make the float pass the crowds faster. It just makes us more frustrated and ruins our 4th of July parade experience. Now, going back to our thoughts, we are going to have a very difficult time if we are fighting what thoughts come and go. The trick is to create a non-judgmental and accepting attitude towards each and every float. If a float (or a thought) arises that makes us uncomfortable, just notice your experience, similarly to how you did when a pleasant float passed. For the pleasant float, you noticed satisfaction and the people on the float and how the flowers and colors brought up sensations in your body. When scary or more difficult thoughts arise, your job is to observe and wave, knowing that that float (or thought) will pass in time also. Sometime we have to acknowledge that just because the float looks scary, doesn't mean there is actually real danger. For example, Lots of people LOVE scary movies and will even PAY to go an get scared in a movie theatre, but they can separate their experience of fear and become observers instead of reacting to their fear. I invite you to move into your day, allowing your mind to be like a parade with many types of floats, meaning, allow all of your thoughts. I don't expect you to be fantastic at this. It is like a muscle that must be strengthened. Just practice noticing the temporary fashion of each thought and do not fight them when they are passing you by. It is the fight that will create your dismay. Last of all, don't be afraid to bring your camera to this metaphorical parade!!! Use your zoom to zoom on and out while capturing the ENTIRE scene. Don't get too focused on just the floats. The floats alone do not make up the entirety of a parade. The parade also consists of the crowds and their cheers and the streets and most importantly, the lollipops!! I hope you have enjoyed this episode of My Anxiety Toolkit. My name is Kimberley Quinlan. If you have any thoughts or comments, please feel free to comment in the comment section of my blog. This podcast is not intended to replace correct professional mental health care. Please speak to a trained mental health professional if you feel you need it. Have a wonderful day

May 30, 2016

5 SENSES PODCAST Hello and welcome to Your Anxiety Toolkit. My name is Kimberley Quinlan. A big part of my work as a therapist is to help clients tolerate fear and anxiety (or other forms of discomfort such as urges and sometimes pain), instead of doing compulsive behaviors. In effort to keep this podcast short, I wont go into detail about compulsions. But, if you are wanting more information on compulsive behaviors related to specific anxiety disorders, eating disorders, or Body Focused Repetitive Behaviors, please go to my website under "Areas of specialty" The reason I decided on this specific topic today is because of the common question asked by clients "If I choose NOT to do these compulsive behaviors, what should I do instead?". Well, I like to think of our experience in this life like looking through the lens of a camera. When we are anxious, we often ZOOM in on what is making us anxious or we zoom in to our sensations of anxiety. We FOCUS on the problem. We stay zoomed in, thinking this will solve it. That makes sense, right? If we could just figure out how to solve the problem, we would then fix the problem, right? But what if zooming in was not the solution. What if zooming OUT was the solution?? Hmmm, interesting right?? One of my favorite activities for clients (or for myself) when anxious or dealing with discomfort involves just becoming an observer. The following meditation is an exercise of this. It is a meditation of noticing. I like to call it "the 5 senses Mediation. I hope you enjoy it. And feel free to leave a comment in the comment section of the blog that accompanies this podcast. OK, I want you to find a place where you can rest, preferably in sitting position, and take a deep breath. And then another. You are here because you probably are uncomfortable. Something just happened that created a lot of anxiety or distress for you, - or maybe you just finished up doing an exposure. I can imagine that you are experiencing some pretty uncomfortable feelings. Maybe your stomach is in knots. Maybe you have a really tight chest or maybe a racing heart rate. Maybe your head is spinning, telling you to "make this anxiety or this feeling go away!" You know from experience that doing a compulsive behavior keeps you in the cycle of anxiety. So instead, you are here, sitting with your discomfort. Again, take a deep breath and congratulate yourself for how brave you are. After another breath in…and then out, I want you to shift your gaze to your noticing mind. As you breathe in and out. I want you to close your eyes and just notice what it is like for your chest to rise and fall. Continue to breathe at a pace and depth that feels good for you as you observe. Now, I want you to shift your attention to what you hear. What sounds do you hear? Are they pleasant or unpleasant? Try not to get too caught up in your emotions about the noises. Just notice them You may find that your thoughts drift off, try not to be alarmed or frustrated. This is just your brain doing what it does. Just bring your attention gently back to what you were noticing. If you find your mind keeps going other directions, that is ok and very normal. Don't give it too much attention. Just notice and return back to the meditation. Again, return to your breath. And now, I want you to notice what you smell? Continue to breathe and observe the scents around you. Did you notice them before? Or are you just now noticing them? Take another deep breath, and this time notice if there is a particular taste in your mouth. Do you taste the flavors of your most recent meal? Or do you have the freshness of your toothpaste on your tongue as you observe the sensation of taste. What textures do you notice? So, we have already explored sound, smell and taste. Now I encourage you to gently open your eyes and notice what your see. What shapes do you see? What colors do you see? Are there any particular colors that you enjoy? Or do you notice an aversion to certain colors or textures. Try not to get too caught up in what is the "right" way to observe. Just notice that you are noticing. That is all this is about. Lastly, I want to you gently close your eyes again and notice your breath again. As you breathe in an out, turn your noticing mind towards the sensation of being pulled down onto the chair by gravity. Where do you notice the strongest pull of gravity? Is it under your thighs and buttocks as you sit? Or is it under the soles of your feet, if you are standing? Or do you feel a strong pull of gravity under your back, as you recline in your chair? Isn't it interesting to notice this??? You might also notice what it feels like to touch whatever it is that is close to your hands. What texture do you feel? Is it soft or hard? Maybe crinkly? Maybe spongy. If you like, you might also notice what it feels like for the air to touch your skin, maybe on your arms or on your face. If you find that this creates discomfort for you, gently return to one of the other sensations that you enjoyed. Remember, there is no pressure with this meditation. It is just about noticing. Again, return to your breath. Before we wrap up with this meditation, I invite you to slowly open your eyes. Give yourself one last breath, this one a gift for with you just did! Fantastic job!! As you continue to breath, go into your day using your noticing mind as much as you can. You might work to just observe what flowers you see as you walk to your class? Or you might notice and observe what it feels like for your hands to grip your fork as you eat? OR maybe you just notice your breath, going in and out of your chest. Enjoy your day! Please note that this podcast should not be a substitute for professional mental health care. Please speak with a professional mental health care provider for information on what tools would best suit you.

Apr 27, 2016

Lovingkindness is a great way to create more compassion and self care in your life. I was recently lucky enough to attend and present at the Trichotillomania Learning Center Annual Conference in Dallas for those who suffer Body Focused Repetitive Behaviors. The conference was filled with a beautiful group people who struggle with hair pulling and skin picking, two disorders that are grossly misunderstood and stigmatized in our culture. What struck me over the long weekend was the incredible love between the attendees. There were tears and laughter and hugs and love shared between so many people from all over the world. On the last day, I could see that most of the tears were coming from the fact that they most would leave their conference family, where they were accepted, and return back to their lives, where they feel so alone and were no longer fully understood. I share this meditation in hope to create or continue an experience of love that that I felt so strongly during such a beautiful gathering. It is a loving kindness meditation that has helped me greatly when I feel alone or misunderstood and I hope it helps you also.

Mar 31, 2016

The First and Second Arrow During this podcast, I hope to give you some tools to manage judgment, or what is sometimes called “the second arrow”. My hope is that this podcast can help you have a more non-judgmental relationship with your body and your body’s experience of anxiety and discomfort. Intended for those suffering OCD, Anxiety, Panic, Eating Disorders, Depression, Stress and worry. NOTICING with Non Judgment: MEDITATION Take a long, deep breathe in. And slowly exhale. Take another. As you breathe in and out, congratulate yourself for taking the time to do this. Just stopping and breathing can be difficult and uncomfortable when you are managing life, anxiety and stress. Good job! Again, take a nice deep breathe in and slowly exhale. If you find that taking a deep breathe is too uncomfortable, just breathe at a depth and pace that feels good for you. There is no “right” way to do this. Now, I want you to continue to breathe in this fashion, but as you breathe, notice where in your body you feel discomfort. Is it in your chest? Your stomach? Your forehead? Your shoulders? Just do a quick inventory and just notice where your discomfort lies. Once you have identified the areas in which you are uncomfortable, I want you to practice just breathing while you notice these discomforts. Take some time to experience the discomfort. Try to just be with it, without running away from it. Again, good job. This is not easy. Now, as you notice where your discomfort lies, I now want you to notice if there are any judgments about your experience. These judgments come in the form of thoughts, such as “I cant do this” or “I shouldn’t be this anxious”. Maybe you are having the thought.. “this feeling is awful!” or “I hate that I feel this way and I shouldn’t have to feel this way” . You might start to compare yourself to others, having thoughts like “Most people don’t feel this way, something must be wrong with me”. These thoughts are all judgments. Judgments are not facts. They are usually a person’s personal reflection on an event, often subjective to their beliefs and views. They are often not true at all. When it comes to judgments, I love the Buddhist parable about the first and second arrow. This parable uses the metaphor that when we experience an event that causes discomfort in us, it is similar to being hit by an arrow. In this case, we will call that first experience of discomfort “The first arrow”. The first arrow is something that we cannot control and is challenging, even painful. If we were to look back at our experience at the beginning of this meditation, the “first arrow” would be the physical discomfort you noticed when you first did an inventory of your body. The second arrow is the judgment that we have about the discomfort we experienced. These judgments are often what reinforces the pain and discomfort. The second arrow is a personal narrative that pulls us into a pattern of faulty thinking about our experience and our ability to tolerate anxiety and the discomfort that is present. The sensations and judgments you experienced just a few minutes ago is a great example of this. I invited you to notice your discomfort, and it is common to immediately follow this noticing with a judgment about our experience. It is the judgments such as “I cant handle this” or “This feeling should not be here” that makes the first event even harder. In fact, we could argue that the judgment is what can keeps the discomfort around….it keeps us feeling fearful, discouraged and sometimes hopeless. So, lets go back to noticing. Notice again where you are uncomfortable, or remember back to an event that caused you discomfort. When you observe this event or feeling, the first arrow, you might start to notice feel those second arrows coming up again. If you were to remove that second arrow, the judgment, you would begin to see that this event or this feeling, is, in fact, just an event or feeling. And also, it is temporary. If we strip ourselves of judgment, we can allow this moment to be just what it is; a moment. It is neither good, nor bad. And now, in THIS very moment, it might be slightly different to the moment you experienced just a few moments ago. So, to conclude this mediation, I encourage you to go into the day, noticing first and second arrows. You might be surprised how often you are spearing yourself with an arrow that is not necessary. I will be offering other podcasts that I hope will be helpful for you, so keep checking in. Please feel free to comment below on the blog page I hope you have a wonderful day!