Your Anxiety Toolkit - Anxiety & OCD Strategies for Everyday
Your Anxiety Toolkit Podcast delivers effective, compassionate, & science-based tools for anyone with Anxiety, OCD, Panic, and Depression.
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An Anxiety Routine to Help You Get Through the Day | Ep. 383
05/03/2024
An Anxiety Routine to Help You Get Through the Day | Ep. 383
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 . 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 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 . 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 . 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 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 . 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 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 . 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. 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 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 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.
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Help Your Child Crush Their OCD (with Natasha Daniels) | Ep. 382
04/19/2024
Help Your Child Crush Their OCD (with Natasha Daniels) | Ep. 382
Helping children navigate the complexities of 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 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 ".” 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 , 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 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: 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....
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ADHD vs. Anxiety (with Dr. Ryan Sultan) | Ep. 381
04/12/2024
ADHD vs. Anxiety (with Dr. Ryan Sultan) | Ep. 381
Navigating the intricate landscape of mental health can often feel like deciphering a complex puzzle, especially when differentiating between conditions . 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 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 , how to tell the difference, kind of get you in the know of what is what. Today, we have . 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 , 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...
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Is Faith Helping Or Hindering Your Recovery (With Justin K Hughes) | Ep. 380
04/05/2024
Is Faith Helping Or Hindering Your Recovery (With Justin K Hughes) | Ep. 380
Exploring the relationship between faith and recovery, especially when it comes to managing , 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. , 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 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 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 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...
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Is Faith Helping Or Hindering Your Recovery (With Justin K Hughes) | Ep. 380
04/05/2024
Is Faith Helping Or Hindering Your Recovery (With Justin K Hughes) | Ep. 380
Exploring the relationship between faith and recovery, especially when it comes to managing , 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. , 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 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 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 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...
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Fix this Error in Thinking (if you want to be less anxious) | Ep. 379
03/29/2024
Fix this Error in Thinking (if you want to be less anxious) | Ep. 379
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 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 . 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, , 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 . 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 () 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 , 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 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 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.
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11 Things I Tell My Patients in Their First Session of OCD Treatment | Ep. 378
03/22/2024
11 Things I Tell My Patients in Their First Session of OCD Treatment | Ep. 378
(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 , 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 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 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 (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 . 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 . 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...
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Stop Doing These Things if You Have Panic Attacks | Ep. 377
03/15/2024
Stop Doing These Things if You Have Panic Attacks | Ep. 377
In the realm of managing anxiety and , 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 —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 . 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 . 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 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 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.
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20 Phrases to Use when you are Anxious | Ep. 376
03/08/2024
20 Phrases to Use when you are Anxious | Ep. 376
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 and get totally stuck in the tunnel vision of anxiety or feel completely overwhelmed by it. Today, I want to offer you 20 that you can use when you’re feeling anxious or experiencing . 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.
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Why teen depression is at an all-time high (with Chinwe Williams) | Ep. 375
03/01/2024
Why teen depression is at an all-time high (with Chinwe Williams) | Ep. 375
THE RISING TIDE OF TEEN DEPRESSION: UNDERSTANDING AND ADDRESSING A MODERN CRISIS In recent times, the specter of 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 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 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 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, . 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, . 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...
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What it is REALLY like to be an Anxiety Therapist | Ep. 374
02/16/2024
What it is REALLY like to be an Anxiety Therapist | Ep. 374
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 , shares insights from his latest book, ": 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...
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Living with Depression: Daily Routines for Mental Wellness | Ep. 373
02/09/2024
Living with Depression: Daily Routines for Mental Wellness | Ep. 373
In the realm of mental health, the significance of structured 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. , 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 , 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 , 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 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 , 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. 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 . 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. 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 , 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 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 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 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...
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Increasing Distress Tolerance (with Joanna Hardis) | Ep. 372
02/02/2024
Increasing Distress Tolerance (with Joanna Hardis) | Ep. 372
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, , 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, "," 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 "," 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. 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 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...
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Overcoming Visual Staring OCD (with Matt Bannister) | Ep. 371
01/26/2024
Overcoming Visual Staring OCD (with Matt Bannister) | Ep. 371
(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 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 , 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 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 (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 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 , 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 :[email protected] 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 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 , 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 . 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 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...
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5 Most Common Recovery Roadblocks (with Chris Tronsdon) | Ep. 370
01/19/2024
5 Most Common Recovery Roadblocks (with Chris Tronsdon) | Ep. 370
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 , 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 & 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 , 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 , 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 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 —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 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 . 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 . 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 , 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...
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The Tools You Need (Part Two: 2024 Mental Health Recovery Plan) | Ep. 369
01/12/2024
The Tools You Need (Part Two: 2024 Mental Health Recovery Plan) | Ep. 369
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 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 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 . 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 . 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 . 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. 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 . 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, , 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 specifically and you want help with this, we have a full, comprehensive course called ERP School. If you go to , 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 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 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.” 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 . 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...
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Your Mental Health Plan for 2024 (Part One: Your Recovery Audit) | Ep. 368
01/05/2024
Your Mental Health Plan for 2024 (Part One: Your Recovery Audit) | Ep. 368
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 . 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 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 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, , panic, or , we have specific courses on 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 , 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 . 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 . 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 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...
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Could I Have PTSD or Trauma?
12/22/2023
Could I Have PTSD or Trauma?
Kimberley: Could I have PTSD or trauma? This is a question that came up a lot following a 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 , 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 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 ? 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 , 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 ? 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 . 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...
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Radical Acceptance (When Things Get HARD) | Ep. 366
12/15/2023
Radical Acceptance (When Things Get HARD) | Ep. 366
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 , 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 that yes, things are hard right now. WHY DOES RADICAL ACCEPTANCE SUCK? Often, we resist practicing 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 , 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 , 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.
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Is ERP Traumatizing? (with Dr. Amy Mariaskin) | Ep. 365
12/08/2023
Is ERP Traumatizing? (with Dr. Amy Mariaskin) | Ep. 365
Kimberley: Is ERP traumatizing? This is a question I have been seeing on social media or coming up in different groups in the and field. Today, I have , 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 . 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 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 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 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 . 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 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 “ ” 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...
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Compassionate OCD recovery (with Ethan Smith) | Ep. 364
12/01/2023
Compassionate OCD recovery (with Ethan Smith) | Ep. 364
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 , and I’m a national advocate for the International OCD Foundation and just an all-around warrior for , 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...
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What Do To When Feeling Hopeless | Ep. 363
11/24/2023
What Do To When Feeling Hopeless | Ep. 363
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 , 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 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 . 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 called , 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 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 , 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 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...
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When OCD and PTSD Collide (with Shala Nicely & Caitlin Pinciotti) | Ep. 362
11/17/2023
When OCD and PTSD Collide (with Shala Nicely & Caitlin Pinciotti) | Ep. 362
Kimberley: Welcome, everybody. This is a very exciting episode. I know I’m going to learn so much. Today, we have and , 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 , which is my story, and then co-author with Jon Hershfield of . I also produce the . 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 . 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 . 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 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 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 . 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 , 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...
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What Keeps Us Going (With Shaun Flores) | Ep. 361
11/10/2023
What Keeps Us Going (With Shaun Flores) | Ep. 361
When things get hard, it’s really quite difficult to find a reason to keep going. Today, we have an incredible guest, , 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 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, 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 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 . 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 . 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. 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 , my friend sent me your podcast about . 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...
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How to be Uncomfortable (without Making it Worse) | Ep. 360
11/03/2023
How to be Uncomfortable (without Making it Worse) | Ep. 360
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 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 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 , 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 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 specifically. The other one is Episode 113, which is where we talk about specifically . 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 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. , 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....
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How To Meditate To Reduce Anxiety | Ep. 359
10/27/2023
How To Meditate To Reduce Anxiety | Ep. 359
In today’s episode of Your Anxiety Toolkit podcast, you will learn how to meditate to reduce anxiety. You’ll also learn 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 . 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 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 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 , health anxiety, social anxiety, panic, generalized anxiety, and depression. There are meditations on sleep, , 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 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...
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I Am Scared to Take Medication (Managing Medication Anxiety) | Ep. 358
10/20/2023
I Am Scared to Take Medication (Managing Medication Anxiety) | Ep. 358
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 , 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 , 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 . 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 . 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 , 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 . 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, 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, , 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 , 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 () 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...
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GAD vs OCD (and How to Tell the Difference) | Ep. 357
10/13/2023
GAD vs OCD (and How to Tell the Difference) | Ep. 357
If you are wondering if you have (Generalized Anxiety Disorder) vs. (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 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 . If you’re interested to learn more about that, you can go to . 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 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 or an . 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 and the 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 , 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 , 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.
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How to Live According to Your Values, Not Fear | Ep. 356
10/06/2023
How to Live According to Your Values, Not Fear | Ep. 356
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 . 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 . What they do is they talk about 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 , 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 ‘.’ 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 . 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, , 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 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 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 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 , 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...
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Perfectionism Anxiety (and the Dreaded Perfectionist Trap) | Ep. 355
09/29/2023
Perfectionism Anxiety (and the Dreaded Perfectionist Trap) | Ep. 355
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...
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